65 - An Observational Cohort Study on the Usage of Probiotics in the Neonatal Intensive Care Unit (NICU)

Probiotics are used as a dietary supplement to aid in colonizing the gastrointestinal system with potentially beneficial strains of bacteria. Recently, much attention has been given to its use in preterm infants who are at higher risk for illnesses such as late-onset sepsis and necrotizing enterocolitis (NEC).

Objective:

To evaluate the effects of a probiotic dietary supplement (Similac Probiotic Tri-Blend) on certain neonatal intensive care unit (NICU) outcomes in premature infants.

Design/Methods:

A retrospective observational cohort study was conducted at a level III NICU over a period of two years. Infants born ≤ 1500 g or < 32 weeks from 08/24/2019 to 08/24/2021 were enrolled and compared those who received probiotics to those who did not. Demographics, nutrition practices, and additional NICU outcomes were collected. Growth during hospitalization was measured by observing the difference in weight, length, and occipitofrontal circumference (OFC) at birth and 36 weeks postmenstrual age (PMA). Continuous variables were compared using Mann-Whitney U tests, while categorical variables were evaluated using Fisher exact tests. Linear regression was used to determine independent predictors of continuous outcomes.

Results:

A total of 150 infants were enrolled with 75 in each cohort. The groups were similar in race and ethnicity, yet those who received probiotics were born earlier as seen by their smaller gestational age (GA) and their significantly lower birth weight despite randomization. Although younger, those that received probiotics had improved weight gain from birth to 36 weeks PMA (1045 vs 1255, p = 0.067), which trended towards significance (Table 1). Infants who received probiotics had increased days of total of total parenteral nutrition (TPN) administration, longer duration of ventilator usage and length of hospital stay. On multivariate analysis, after adjusting for birth weight, birth length, GA, sepsis, NEC, ventilator days, and any breast milk use; probiotic use was not an independent predictor of TPN days (Table 2). Of note, there was a 50% decrease in cases of NEC in those given probiotics (2 vs 4, p = 0.341) (Table 3).

Conclusion(s):

Probiotics may have a positive impact on growth as seen by the group of infants in our study that were smaller and younger at birth but had surpassed their peers in weight gained by 36 weeks PMA. We did not find the use of probiotics in preterm infants to pose any obvious risks and larger, multicenter trials are warranted to detect safety and additional benefits in this population.