Cohort Study of Probiotics in a North American Neonatal Intensive Care Unit
Notice bibliographique
Résumé
Studies have confirmed a major reduction in necrotizing enterocolitis (NEC) and death with routine use of probiotics in high-risk preterm infants. Although no major differences were reported in the preparations containing lactobacilli, just bifidobacteria, and a mixture, mixtures of different organisms may be more effective than a single species. This prospective cohort study was performed to determine the clinical outcomes after starting probiotics use in a neonatal intensive care unit (NICU). After the first 17 months of using probiotics, incidences of NEC and death were compared with those during the prior 17 months before introducing probiotics. All infants at less than 32 weeks’ gestation at birth were eligible to receive probiotics unless they had a gastrointestinal malformation. They received FloraBABY probiotic mixture, containing Bifidobacterium breve, Bifidobacterium bifidum, Bifidobacterium infantis, Bifidobacterium longum, and Lactobacillus rhamnosus GG (2 × 109 colony-forming units/0.5 g) mixed with 1 mL water just before milk feeding once daily. Probiotics were started at the time of the first feed and continued until the infant reached 34 weeks’ postmenstrual age. Mortality was defined as death before discharge home. Health care–associated infection (HCAI) was defined by a positive culture of a normally sterile body fluid, occurring after 3 days of age. As a proxy for feeding tolerance, the day that intravenous (IV) nutrition was first stopped and the final day of receiving IV nutrition were recorded. The preprobiotic and probiotic cohorts included 317 and 294 infants, respectively. Compared with the preprobiotic cohort, the probiotic cohort had a significant reduction in the incidence of NEC (10% vs 5%; P < 0.05), a nonsignificant reduction in death (10% vs 7%), and a significant reduction in the proportion of infants who died or developed NEC (17% vs 11%; P < 0.05). No significant effect on HCAI (18% vs 17%) was noted. The average duration of therapy was 24 ± 16 days, and the average time of starting probiotics was day 4.3 ± 5.1. When only the infants with a birth weight of less than 1001 g were analyzed, similar percentage reductions in NEC and the combined outcome of death and NEC were found. The 2 cohorts did not differ significantly in average gestational age or in proportions who were small for gestational age, female, or less than 26 weeks’ gestation. The odds ratios for NEC, death, NEC or death, and HCAI were 0.51 (95% confidence interval [CI], 0.26–0.0.98), 0.71 (95% CI, 0.38–1.34), 0.56 (95% CI, 0.33–0.93), and 0.98 (95% CI, 0.81–1.98), respectively, with receipt of probiotics. The mean difference in the time to first stopping IV nutrition was 4.6 days (95% CI, 1.8–7.3 days), and the mean difference in time to finally stopping IV nutrition was 5.3 days (95% CI, 0.8–9.9 days). Administration of probiotic organisms to prevent NEC is feasible, supported by clinical evidence, and has a beneficial balance. Studies comparing strains and examining additional NICU populations and length of therapy are needed.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».