Prophylactic use of the probiotic strain Lactobacillus casei rhamnosus as part of a triple anti-infective regimen in very preterm infants during neonatal intensive care

Abstract

Background. Probiotics are increasingly used in neonatal intensive care and prove to reduce rates of necrotizing enterocolitis (NEC), sepsis and all-cause mortality by meta-analyses. Objective. Aim of the study was to analyze the prophylactic use of the probiotic Lactobacillus casei rhamnosus (LCR) as part of a triple anti-infective treatment regimen in very preterm neonates in respect to complications and possible side effects. Setting. This was a study on 1169 very preterm infants of 32 weeks of gestational age and less born between 2005 and 2015 who were admitted within the first 24 hours of life to the neonatal intensive care unit (NICU) and hospitalized for at least 7 days. Design. Retrospective observational STROBE compliant single-center cohort study Intervention. All infants received a standardized prophylactic anti-infective treatment regimen with enteral probiotics (LCR), antifungal agents, and oral gentamycin over the study time starting at the first day of life. Outcome measures. Perinatal and neonatal data were collected for descriptive analysis. Complications possibly avoided by the anti-infective regimen included NEC, lateonset sepsis (LOS), late-onset multiple organ dysfunction syndrome (MODS), and ventilator associated pneumonia (VAP). Main results. Eleven of 1169 infants 11 (0.9%) had diagnosis of NEC ≥ IIa, 141 (12.1%) exhibited at least one episode of LOS, 31 (2.7%) a VAP, and 44 (3.8%) a MODS. Those infants with complications were of younger gestational age (p<0.001), had lower birth weight (p<0.001), lower Apgar scores at 1/5/10 minutes (p<0.001), were more common SGA (p=0.007), had longer courses of mechanical ventilation and longer hospital stays and for longer time parenteral antibiotics (all p<0.001). Mortality rate was increased in infants having experienced complications (6.9 vs. 1.7%, p<0.001). Conclusions. Over an 11-year period, the use of the probiotic LCR as part of an antiinfective regimen was safe and resulted in low rates of NEC, LOS, VAP, and MODS compared to the literature. Those infants with complications had higher mortality rates.