132 Probiotic supplementation and feeding tolerance in preterm infantsg
Bibliographic record
Abstract
Probiotic bacteria are defined as live nonpathogenic bacteria species that normally reside in the GI tract of healthy infants. In VLBW preterm infants probiotics have played a defined role in the prevention of NEC. The use of probiotics has now increased across Canada including neonates and infants who are not at high risk for NEC, and is thought to improve ‘feeding tolerance’. Probiotics are now also increasingly being given to former NICU patients by parents. The role of probiotics in more mature preterm infants has been poorly studied however and its use in these infants extends to beyond the NICU period. To determine whether the administration of probiotics: Florababy (FB), Biogaia (BG) compared with no supplementation is beneficial to the preterm infant born between 30–33+ weeks gestation. Institutional Research Ethics Board (REB) approval was obtained. A comparative prospective chart review of neonatal patients from 30–33 weeks completed gestation (GA) were analyzed from the Neonatal Intensive Care unit at St. Michael’s hospital prospectively, from 2015–2018. A convenience sample of neonates (inborn and retro-transferred) who were treated as per routine clinical orders (FB, BG or no treatment) were then included for analysis. Exclusion criteria included congenital gastrointestinal/surgical abnormalities, families unable to communicate in English and infants that were apprehended by children’s services. The primary outcome was feeding tolerance, estimated through the following variables: time to full feeds, number of aspirates/emesis, spells with feeds and other symptoms of gastroesophageal reflux disease. Secondary outcomes included: incidence of Necrotizing enterocolitis (NEC), bloody stools and length of stay. A total of 110 infants were analyzed (60% male). 40 infants received FB, 30 received BG treatment and 40 infants received no probiotic treatment during their neonatal stay. The mean gestational age of the cohort was 31.4 weeks (+/- standard deviation (SD) 1.9 weeks). Mean birth weight was 1659 grams (+/- 223 grams). Breast milk was used exclusively 67.2% of all infants, including donor milk. 18 of the 110 (16.3%) infants demonstrated symptoms of feeding intolerance however there was no statistical difference amongst the three groups (FB n=7, BG n=3, control =8). There was no difference noted in the days to full feeds (mean 8.8 +/ 2.2 days). 11 out of the 110 (10%) infants presented with blood in their stool at some point during their hospitalization, with no differences between groups (n=2 BG, FB n=5, BG n=2, control n=4). No NEC was observed. Groups were not statistically different with respect to LOS (mean 36.6 +/10.7 days). Those infants with feeding intolerance did have a lower gestational age, lower birth weight, longer length of stay and lower gestational age did correspond with more days on TPN and longer times to reach full feeds. Symptoms of feeding intolerance were not higher in thoses who received formula (Kruskal-Wallis test p =0.5708). Our study was limited by design and numbers of charts analyzed. In our comparative cohort study of preterm infants with a gestational age of 30–33 weeks, we found no advantage to routine use of probiotics. Although our study is limited by design and patient numbers we feel that the use of probiotics (and/or discontinuation of probiotics) needs to be thoughtful since there are cost implications to these medications, and parents often give them to their babies following NICU discharge.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".