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Lactobacillus reuteri DSM 17938 as a Probiotic for Preterm Neonates: A Strain-Specific Systematic Review.

  • 2015-06-09
  • Journal of Parenteral and Enteral Nutrition 40(6)
    • G. Athalye-Jape
    • Shripada C Rao
    • S. Patole

Abstract

Introduction: Prevention of necrotizing enterocolitis (NEC) while optimizing enteral nutrition (EN) is a priority in preterm neonates. Lactobacillus reuteri DSM 17938 (L reuteri) is known to improve gut motility. Previous systematic reviews have not adequately assessed the effects of L reuteri in improving feed tolerance in preterm neonates.

Objective: To assess the effects of L reuteri in preterm neonates.

Design: A systematic review of randomized controlled trials (RCTs) and non-RCTs of L reuteri was conducted. We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL databases and proceedings of Pediatric Academic Society meetings in December 2014.

Results: Six RCTs (n = 1778) and 2 non-RCTs (n = 665) were included. Meta-analysis of RCTs estimated that the time to full feeds (mean difference [MD], -1.34 days; 95% confidence interval [CI], -1.81 to -0.86; 2 RCTs), duration of hospitalization (-10.77 days; 95% CI, -13.67 to -7.86; 3 RCTs), and late-onset sepsis (LOS) (relative risk [RR], 0.66; 95% CI, 0.52 to 0.83; 4 RCTs) were reduced in the L reuteri group. Mortality (RR, 0.79; 95% CI, 0.57-1.09; 3 RCTs) and ≥ stage II NEC (RR, 0.69; 95% CI, 0.47-1.01; 3 RCTs) were reduced but statistically not significant. There were no adverse effects of supplementation. Both non-RCT studies showed significant improvement in the incidence of NEC with L reuteri supplementation.

Conclusions: Evidence from a limited number of studies suggests that L reuteri supplementation has the potential to reduce the risk of NEC and LOS while facilitating EN in preterm infants. Larger definitive RCTs are needed to confirm these findings.

Keywords: enteral nutrition; life cycle; neonates; nutrition, probiotics; research and diseases.

Research Insights

SupplementHealth OutcomeEffect TypeEffect Size
Lactobacillus reuteriReduced Colitis-Related MortalityNeutral
Moderate
Lactobacillus reuteriReduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteriReduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteriReduced Incidence of Stage II or Greater Necrotizing Enterocolitis (NEC)Beneficial
Moderate
Lactobacillus reuteriReduced Time to Full FeedingBeneficial
Moderate
Lactobacillus reuteri DSM 17938Reduced Colitis-Related MortalityNeutral
Moderate
Lactobacillus reuteri DSM 17938Reduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri DSM 17938Reduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri DSM 17938Reduced Incidence of Necrotizing EnterocolitisBeneficial
Moderate
Lactobacillus reuteri DSM 17938Reduced Risk of Necrotizing EnterocolitisNeutral
Small
Lactobacillus reuteri DSM 17938Reduced Time to Full FeedingBeneficial
Moderate
Lactobacillus reuteri HA-188Improved Feed ToleranceBeneficial
Moderate
Lactobacillus reuteri HA-188No Adverse Events from SupplementationNeutral
Large
Lactobacillus reuteri HA-188Reduced Colitis-Related MortalityNeutral
Moderate
Lactobacillus reuteri HA-188Reduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri HA-188Reduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri HA-188Reduced Stage II or Higher Necrotizing EnterocolitisNeutral
Small
Lactobacillus reuteri LRE02Improved Feed ToleranceBeneficial
Moderate
Lactobacillus reuteri LRE02Reduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri LRE02Reduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri LRE02Reduced Necrotizing EnterocolitisBeneficial
Moderate
Lactobacillus reuteri MAK02L14RReduced Colitis-Related MortalityNeutral
Moderate
Lactobacillus reuteri MAK02L14RReduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri MAK02L14RReduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri MAK02L14RReduced Necrotizing Enterocolitis (NEC) Incidence, Stage II or GreaterNeutral
Moderate
Lactobacillus reuteri MAK02L14RReduced Occurrence of Necrotizing EnterocolitisBeneficial
Moderate
Lactobacillus reuteri MAK02L14RReduced Time to Full FeedingBeneficial
Moderate
Lactobacillus reuteri OsfortisReduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri OsfortisReduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri OsfortisReduced Mortality RateBeneficial
Small
Lactobacillus reuteri OsfortisReduced Risk of Advanced NECBeneficial
Small
Lactobacillus reuteri OsfortisReduced Time to Full FeedingBeneficial
Moderate
Lactobacillus reuteri RC-14No Adverse Health EffectsNeutral
Large
Lactobacillus reuteri RC-14Reduced Colitis-Related MortalityNeutral
Moderate
Lactobacillus reuteri RC-14Reduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri RC-14Reduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri RC-14Reduced Incidence of NEC Stage II or GreaterNeutral
Moderate
Lactobacillus reuteri RC-14Reduced Occurrence of Necrotizing EnterocolitisBeneficial
Moderate
Lactobacillus reuteri RC-14Reduced Time to Full FeedingBeneficial
Moderate
Lactobacillus reuteri UALre-16NEC Stage II or HigherNeutral
Moderate
Lactobacillus reuteri UALre-16Reduced Colitis-Related MortalityNeutral
Moderate
Lactobacillus reuteri UALre-16Reduced Hospitalization DurationBeneficial
Large
Lactobacillus reuteri UALre-16Reduced Incidence of Late-Onset SepsisBeneficial
Moderate
Lactobacillus reuteri UALre-16Reduced Occurrence of Necrotizing EnterocolitisBeneficial
Moderate
Lactobacillus reuteri UALre-16Reduced Time to Full FeedingBeneficial
Moderate
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