BACKGROUND: Among critically ill pediatric patients, a common complication experienced is nosocomial pneumonia. One field that garnered special interests as an alternative and promising way of preventing infection is the utilization of Probiotics. But whether it can prevent occurrence of ventilatorassociated pneumonia (VAP) among critically ill pediatric patients remains unclear. OBJECTIVES: To determine whether probiotic supplementation will prevent the incidence of ventilatorassociated pneumonia among critically ill pediatric patients. METHODS: Literature search was conducted in PubMed, MEDLINE, EMBASE, CINAHL, SciHub, Herdin, Google Scholar, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews to identify all relevant randomized controlled trials (RCTs) published between 1980 and 2016. The reviewers extracted data and reviewed the quality of the studies independently. RESULTS: Three randomized controlled studies with a total of 327 pediatric patients admitted at the PICU were analyzed. Pooled analysis showed a statistically significant reduction in nosocomial pneumonia rates (odd ratio [OR] = 0.31, 95% CI 0.18 to 0.55, P< 0.0001, I 2 = 53%) and statistically significant difference was found regarding overall mortality (OR =0.51 , 95% CI 0.30 to 0.88, P = 0.01, I 2 = 0%) due to probiotics. However, no statistically significant difference was found between groups regarding duration of stay in the PICU (Mean Difference [MD] in days = 2.93, 95% CI 1.84 to 4.01, P < 0.00001, I2 = 97% ), and duration of stay in the hospital (MD = 4.33 days, 95% CI 2.85 to 5.81, P < .00001, I 2 = 97%). CONCLUSIONS AND RECOMMENDATIONS The use of probiotics was associated with statistically significant reduction in the incidence of VAP in critically ill children. However, larger and well-designed, multi-center, RCTs are needed to further establish the effects of probiotic in the pediatric population of critically ill children who are at risk of developing nosocomial infection.
Probiotics