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
- PubMed: 26059900
- DOI: 10.1177/0148607115588113
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
| Supplement | Health Outcome | Effect Type | Effect Size |
|---|---|---|---|
| Lactobacillus reuteri | Reduced Colitis-Related Mortality | Neutral | Moderate |
| Lactobacillus reuteri | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri | Reduced Incidence of Stage II or Greater Necrotizing Enterocolitis (NEC) | Beneficial | Moderate |
| Lactobacillus reuteri | Reduced Time to Full Feeding | Beneficial | Moderate |
| Lactobacillus reuteri DSM 17938 | Reduced Colitis-Related Mortality | Neutral | Moderate |
| Lactobacillus reuteri DSM 17938 | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri DSM 17938 | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri DSM 17938 | Reduced Incidence of Necrotizing Enterocolitis | Beneficial | Moderate |
| Lactobacillus reuteri DSM 17938 | Reduced Risk of Necrotizing Enterocolitis | Neutral | Small |
| Lactobacillus reuteri DSM 17938 | Reduced Time to Full Feeding | Beneficial | Moderate |
| Lactobacillus reuteri HA-188 | Improved Feed Tolerance | Beneficial | Moderate |
| Lactobacillus reuteri HA-188 | No Adverse Events from Supplementation | Neutral | Large |
| Lactobacillus reuteri HA-188 | Reduced Colitis-Related Mortality | Neutral | Moderate |
| Lactobacillus reuteri HA-188 | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri HA-188 | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri HA-188 | Reduced Stage II or Higher Necrotizing Enterocolitis | Neutral | Small |
| Lactobacillus reuteri LRE02 | Improved Feed Tolerance | Beneficial | Moderate |
| Lactobacillus reuteri LRE02 | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri LRE02 | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri LRE02 | Reduced Necrotizing Enterocolitis | Beneficial | Moderate |
| Lactobacillus reuteri MAK02L14R | Reduced Colitis-Related Mortality | Neutral | Moderate |
| Lactobacillus reuteri MAK02L14R | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri MAK02L14R | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri MAK02L14R | Reduced Necrotizing Enterocolitis (NEC) Incidence, Stage II or Greater | Neutral | Moderate |
| Lactobacillus reuteri MAK02L14R | Reduced Occurrence of Necrotizing Enterocolitis | Beneficial | Moderate |
| Lactobacillus reuteri MAK02L14R | Reduced Time to Full Feeding | Beneficial | Moderate |
| Lactobacillus reuteri Osfortis | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri Osfortis | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri Osfortis | Reduced Mortality Rate | Beneficial | Small |
| Lactobacillus reuteri Osfortis | Reduced Risk of Advanced NEC | Beneficial | Small |
| Lactobacillus reuteri Osfortis | Reduced Time to Full Feeding | Beneficial | Moderate |
| Lactobacillus reuteri RC-14 | No Adverse Health Effects | Neutral | Large |
| Lactobacillus reuteri RC-14 | Reduced Colitis-Related Mortality | Neutral | Moderate |
| Lactobacillus reuteri RC-14 | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri RC-14 | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri RC-14 | Reduced Incidence of NEC Stage II or Greater | Neutral | Moderate |
| Lactobacillus reuteri RC-14 | Reduced Occurrence of Necrotizing Enterocolitis | Beneficial | Moderate |
| Lactobacillus reuteri RC-14 | Reduced Time to Full Feeding | Beneficial | Moderate |
| Lactobacillus reuteri UALre-16 | NEC Stage II or Higher | Neutral | Moderate |
| Lactobacillus reuteri UALre-16 | Reduced Colitis-Related Mortality | Neutral | Moderate |
| Lactobacillus reuteri UALre-16 | Reduced Hospitalization Duration | Beneficial | Large |
| Lactobacillus reuteri UALre-16 | Reduced Incidence of Late-Onset Sepsis | Beneficial | Moderate |
| Lactobacillus reuteri UALre-16 | Reduced Occurrence of Necrotizing Enterocolitis | Beneficial | Moderate |
| Lactobacillus reuteri UALre-16 | Reduced Time to Full Feeding | Beneficial | Moderate |