77 - A Survey Update of Probiotic Use in NICUs in the United States

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 77
Publication Number: 77.235

Mecklin V. Ragan, Nationwide Children's Hospital, Columbus, OH, United States; Samantha Wala, Nationwide Children's Hospital, Columbus, OH, United States; Erin Pryor, NEC Society, Dayton, OH, United States; Jennifer M. Canvasser, NEC Society, Davis, CA, United States; Karen A.. Diefenbach, The Ohio State University College of Medicine, Columbus, OH, United States; Gail Besner, Nationwide Children's Hospital, Columbus, OH, United States

Presenting Author(s)

Mecklin V. Ragan, MD (she/her/hers)

Pediatric Surgery Research Fellow
Nationwide Children's Hospital
Columbus, Ohio, United States

Background: Necrotizing enterocolitis (NEC) is the most common gastrointestinal surgical emergency in premature infants. Probiotics are routinely administered to premature neonates in many countries to help prevent NEC; however, their use in the U.S. remains relatively low. The number of U.S. neonatal intensive care units (NICUs) administering probiotics to very low birth weight (VLBW) premature infants rose from 5.2% in 2013 to 14% in 2015. Low usage may be due to variable reported efficacy, and the lack of FDA-approved probiotic preparations.

Objective: To characterize the current use of prophylactic probiotic administration in NICUs in the U.S.

Design/Methods: A REDCap survey was distributed by email to members of the American Academy of Pediatrics (AAP) Section on Neonatal Perinatal Medicine (SONPM) between August and November 2022 to assess current probiotic administration in Level II, III, and IV NICUs. Data were collected regarding specific protocols, probiotics administered, and their preparation; timing, duration, and dose of probiotic use; adverse events; and individual provider opinions regarding the influence of the recent AAP statement on probiotic use, and whether an FDA-approved probiotic option would affect provider use.

Results:

During the survey period, 30.1% (62/206) of responding NICUs were administering prophylactic probiotics to premature infants, with all indicating a standardized administration protocol in place. Common indications for administration were to help reduce NEC (98.4%), reduce the risk of sepsis (41.9%), and decrease feeding intolerance (41.9%). The most common probiotics used were Similac Triblend (Bifidobacterium lactis, B. infantis, Streptococcus thermophilus) (35.6%, 21/59) and Envivo (B. infantis) (18.6%, 11/59). When used, the gestational age at which probiotics were administered were: < 24 weeks, 8.1%; 24-28 weeks, 40.3%; 28-32 weeks, 43.5%; 32-37 weeks, 4.8%; >37 weeks, 3.2%. 56.5% (161/285) of providers indicated that the AAP statement on probiotics affected their NICUs’ stance on probiotic use. 70.5 % of providers not using probiotics indicated that FDA approval of a probiotic preparation would influence their willingness to routinely administer probiotics to premature infants.

Conclusion(s): Probiotic administration in U.S NICUs has more than doubled since 2015 but remains limited. While further investigation is required to establish a consensus on the safety and efficacy of probiotics in premature infants, it is likely that an FDA-approved probiotic formulation would further increase prophylactic probiotic use in U.S. NICUs.