350 - Current Patterns of Probiotic Use in Neonatal Intensive Care Units: A Multi-Institution Survey

Probiotic use in premature infants has been shown to significantly reduce the risk of severe necrotizing enterocolitis and all-cause mortality. However, the heterogeneity in the composition, dosage, and absence of FDA regulation are major deterrents to using probiotics. The 2021 American Academy of Pediatrics (AAP) statement on probiotics advised caution and restraint against their routine use in preterm infants.

Objective:

To assess the current institution-wide patterns of probiotic use in newborns admitted to the neonatal intensive care unit (NICU) and to evaluate the impact of the AAP statement on probiotic use in a large multicenter cohort of NICUs across the United States.

 

Design/Methods:

An IRB-approved web-based survey of 33 adaptive questions using REDcap was emailed to hospitals in the Children’s Hospitals Neonatal Consortium (CHNC) and the Pediatrix Medical Group, a national network of NICU centers comprising both tertiary referral centers and community birthing hospitals. Data gathered included details on the use of probiotic supplementation, criteria for their initiation and discontinuation, reasons for stopping, intent to resume the use of probiotics, and the impact of the AAP statement on their use of probiotics.    

Results: 91 hospitals completed the survey, including 38/46 (83%) CHNC centers and 53/380 (14%) Pediatrix-affiliated NICUs. 36/91 (40%) of NICUs report current use of probiotics comprising of 10/38 (26%) of CHNC and 26/53 (49%) of Pediatrix NICUs. 7 out of 91 centers (8%) reported prior use of probiotics that was discontinued following the AAP statement. Of the centers currently not using probiotics, 18/48 (38%) centers are considering using probiotics in their NICU. 14 different brands of probiotics were used across the centers. 70% of centers did not use either consent or assent in their process. Birth weight (< 1500g) and gestational age (< 32 weeks) were used by a majority of the centers as criteria for starting probiotics. However, a significant variability was noted regarding the requirements for initiation, cessation, the formulations used, area of preparation, and guidelines in the use of probiotics.

Conclusion(s):

There is significant inter-hospital variability regarding probiotic use in NICUs across the USA. The 2021 AAP statement significantly affected the use of probiotics across the country. These results highlight a need for national consensus guidelines to facilitate the widespread intent to use probiotics in preterm infants among the US NICUs while incorporating the current evidence and safe practice.