The Use of Probiotics for Prevention of Late Onset Sepsis in Very Preterm or Very Low Birth Weight Infants: A Scoping Review

Abstract

Background: Neonatal late-onset sepsis (LOS) is a major cause of morbidity and mortality in very preterm and/or very low birth weight (VLBW) infants. Immaturity of the gut and immune system, together with microbial dysbiosis, increases susceptibility to bacterial translocation. Probiotics have been proposed as a preventive strategy, but evidence for their efficacy remains uncertain.

Objective: This scoping review aimed to collect and analyse existing information regarding the prophylactic effect of probiotics on the incidence of LOS in very preterm (gestational age (GA) <32 weeks) and/or VLBW infants (birth weight <1500 grams).

Design: A search was conducted on 06/08/2023 in the PubMed (Medline) database, yielding 1073 articles after deduplication. Randomised, double-blinded, and placebo-controlled, with a population consisting of very preterm and/or VLBW infants, and with incidence of LOS as primary or secondary outcome, were included. In total, twelve articles met the criteria.

Results: Three studies reported a significant reduction in LOS with probiotic supplementation. In one of these studies, this difference was observed only in the subgroup with GA ≥ 28 weeks. However, eight studies, including the one with the largest study population (N=1310), did not yield significant results, and one study did not provide results from statistical analysis.

Conclusion: Due to clinical and statistical heterogeneity, it is difficult to draw a conclusion about the efficacy of probiotics in preventing LOS in very preterm and/or VLBW infants. Additionally, no clear answer could be provided regarding the optimal probiotic strain, dosage, and duration of treatment. Further, more homogeneous research is needed.