OBJECTIVETo assess the role of probiotics in the prevention of neonatal necrotizing enterocolitis (NEC) and to investigate the risk factors for NEC.

METHODSA total of 2528 hospitalized neonates between January 2002 and May 2005 were assigned into either receiving prophylactic use of probiotics bifoco (Prevention group, n=1182) or without probiotics supplementation (Control group, n = 1346). The incidence of NEC was compared between the two groups. The risk factors for NEC were investigated by conditional logistic regression multifactorial analysis.

RESULTSThere were 19 cases of NEC in the Control group (1.41%), but only 6 cases in the Prevention group (0.51%) (P < 0.05). Gestational age (OR = 5.521), hypoxicdouble ended arrowischemic encephalopathy (OR = 3.887), specticemia (OR = 4.854) and critical illness scores (OR = 5.989) were the risk factors for NEC, while the prophylactic use of probiotics was an independent protective factor for NEC (OR = 0.255).

CONCLUSIONSThe prophylactic use of probiotics may reduce the incidence of NEC in neonates.

Case-Control Studies ; Enterocolitis, Necrotizing ; prevention & control ; Female ; Humans ; Infant, Newborn ; Male ; Probiotics ; therapeutic use

OBJECTIVES: To investigate the risk factors for necrotizing enterocolitis (NEC) in preterm infants, and to establish a scoring model that can predict the development and guide the prevention of NEC. METHODS: A retrospective analysis was performed on the medical data of preterm infants who were admitted to the Department of Neonatology,Bethune First Hospital of Jilin University, from January 2011 to December 2020. These infants were divided into two groups: NEC (298 infants with Bell II stage or above) and non-NEC (300 infants). Univariate and multivariate analyses were performed to identify the factors influencing the development of NEC. A nomogram for predicting the risk of NEC was established based on the factors. The receiver operator characteristic (ROC) curve and the index of concordance (C-index) were used to evaluate the predictive performance of the nomogram. RESULTS: The multivariate logistic regression analysis showed that grade ≥2 intracranial hemorrhage, peripherally inserted central catheterization, breast milk fortifier, transfusion of red cell suspension, hematocrit >49.65%, mean corpuscular volume >114.35 fL, and mean platelet volume >10.95 fL were independent risk factors for NEC (P<0.05), while the use of pulmonary surfactant, the use of probiotics, and the platelet distribution width >11.8 fL were protective factors against NEC (P<0.05). The nomogram showed good accuracy in predicting the risk of NEC, with a bootstrap-corrected C-index of 0.844. The nomogram had an optimal cutoff value of 171.02 in predicting the presence or absence of NEC, with a sensitivity of 74.7% and a specificity of 80.5%. CONCLUSIONS The prediction nomogram for the risk of NEC has a certain clinical value in early prediction, targeted prevention, and early intervention of NEC.
Enterocolitis, Necrotizing/prevention & control* ; Female ; Humans ; Infant, Newborn ; Infant, Newborn, Diseases ; Infant, Premature ; Retrospective Studies ; Risk Factors

OBJECTIVETo systematically evaluate the efficacy and safety of probiotic supplementation for preventing necrotizing enterocolitis (NEC) and reducing mortality in preterm very low birth weight (VLBW) infants.

METHODSThe randomized controlled trials (RCTs) about probiotics for preventing NEC in preterm neonates were searched in PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), the ISI Web of Knowledge databases, China Biology Medicine disc (CBM), China National Knowledge Infrastructure (CNKI), Weipu and Wanfang Data from their establishment to March 2014. The Cochrane Collaboration's RevMan 5.1 Software was used for a Meta analysis.

RESULTSA total of 21 RCTs involving 4 607 preterm VLBW infants were eligible for inclusion in the Meta analysis. The Meta analysis showed that probiotic supplement was associated with a significantly decreased risk of NEC in preterm VLBW infants (RR=0.47; 95%CI: 0.35-0.62; P<0.001). Risk of mortality was also significantly reduced in the probiotic group (RR=0.63; 95%CI: 0.51-0.78; P<0.01). Probiotic supplement did not decrease the risk for sepsis (RR=0.87; 95%CI: 0.72-1.06; P=0.17) and NEC related mortality (RR=0.68; 95%CI: 0.31-1.48, P=0.33).

CONCLUSIONSThe results confirm that probiotic supplement can reduce risk of NEC and mortality in preterm VLBW infants. However, the long-term effects and safety of probiotics need to be assessed in large trials.

Enterocolitis, Necrotizing ; mortality ; prevention & control ; Humans ; Infant, Newborn ; Infant, Very Low Birth Weight ; Probiotics ; adverse effects ; therapeutic use ; Sepsis ; prevention & control

OBJECTIVES: To systematically evaluate the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical development in preterm infants. METHODS: A computerized search was performed in the databases including China National Knowledge Infrastructure, Wanfang Data, Weipu, PubMed, Embase, and the Cochrane Library to identify randomized controlled trials of the effect of prophylactic use of hydrolyzed protein formula on gastrointestinal diseases and physical growth in preterm infants. RevMan 5.3 software was used to perform a Meta analysis for the included studies. RESULTS: A total of 7 randomized controlled studies were included. The results of Meta analysis showed that compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula could reduce the risk of neonatal necrotizing enterocolitis (RR=0.40, P=0.04) and feeding intolerance (RR=0.40, P=0.005), and had no significant effect on the growth of weight, length and head circumference (P>0.05). CONCLUSIONS Compared with the whole protein formula, the prophylactic use of hydrolyzed protein formula in preterm infants may reduce the occurrence of necrotizing enterocolitis and feeding intolerance, and can meet the nutrient requirement of physical development. However, the evidence is limited, and the results of this study cannot support the routine prophylactic use of hydrolyzed protein formula in preterm infants.
Enterocolitis, Necrotizing/prevention & control* ; Gastrointestinal Diseases/prevention & control* ; Humans ; Infant ; Infant Formula/chemistry* ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Randomized Controlled Trials as Topic

Animals ; Anti-Bacterial Agents ; administration & dosage ; Enterocolitis, Necrotizing ; diagnosis ; etiology ; prevention & control ; Humans ; Immunoglobulins ; therapeutic use ; Infant, Newborn ; Prebiotics ; Probiotics ; therapeutic use

OBJECTIVETo investigate the effect and safety of extensively hydrolyzed formula (EHF) in preterm infants.

METHODSA total of 692 preterm infants between January 2007 and December 2016 were enrolled as subjects. According to the feeding pattern, they were divided into EHF group (327 infants) and standard preterm formula (SPF) group (365 infants). A retrospective analysis was performed for their clinical data during hospitalization, including the incidence of feeding intolerance, time to establish full enteral feeding, time to first excretion of meconium, time to complete excretion of meconium, presence or absence of intestinal infection or neonatal necrotizing enterocolitis (NEC), serum albumin level within 3 weeks after admission, and time to the appearance of skin jaundice and its duration.

RESULTSThere were no significant differences between the two groups in the starting time of breastfeeding, time to first excretion of meconium, time to the appearance of skin jaundice, serum albumin level at weeks 1 and 2 after admission, and time to recovery of birth weight (P>0.05). Compared with the SPF group, the EHF group had significantly lower incidence rates of feeding intolerance, intestinal infection, and NEC and a significantly lower positive rate of stool occult blood test (P<0.05), as well as significantly shorter time to complete excretion of meconium, duration to establish full enteral feeding, duration of jaundice, and length of hospital stay (P<0.05). At week 3 after admission, the EHF group had a significantly higher serum albumin level than the SPF group (P<0.05).

CONCLUSIONSEHF can reduce the incidence rates of feeding intolerance and NEC in preterm infants, shorten the duration of jaundice, promote defecation, and help them to achieve full enteral feeding early. It has significant advantages over SPF.

Breast Feeding ; Enteral Nutrition ; Enterocolitis, Necrotizing ; prevention & control ; Female ; Humans ; Infant Formula ; Infant, Newborn ; Infant, Premature ; Male ; Retrospective Studies ; Serum Albumin ; analysis

OBJECTIVES: To investigate whether evidence-based standardized nutrition protocol can facilitate the establishment of full enteral nutrition and its effect on short-term clinical outcomes in very preterm/very low birth weight infants. METHODS: A retrospective analysis was performed on the medical data of 312 preterm infants with a gestational age of ≤32 weeks or a birth weight of <1 500 g. The standardized nutrition protocol for preterm infants was implemented in May 2020; 160 infants who were treated from May 1, 2019 to April 30, 2020 were enrolled as the control group, and 152 infants who were treated from June 1, 2020 to May 31, 2021 were enrolled as the test group. The two groups were compared in terms of the time to full enteral feeding, the time to the start of enteral feeding, duration of parenteral nutrition, the time to recovery to birth weight, the duration of central venous catheterization, and the incidence rates of common complications in preterm infants. RESULTS: Compared with the control group, the test group had significantly shorter time to full enteral feeding, time to the start of enteral feeding, duration of parenteral nutrition, and duration of central venous catheterization and a significantly lower incidence rate of catheter-related bloodstream infection (P<0.05). There were no significant differences between the two groups in the mortality rate and the incidence rate of common complications in preterm infants including grade II-III necrotizing enterocolitis (P>0.05). CONCLUSIONS Implementation of the standardized nutrition protocol can facilitate the establishment of full enteral feeding, shorten the duration of parenteral nutrition, and reduce catheter-related bloodstream infection in very preterm/very low birth weight infants, without increasing the risk of necrotizing enterocolitis.
Birth Weight ; Enteral Nutrition/methods* ; Enterocolitis, Necrotizing/prevention & control* ; Humans ; Infant ; Infant, Extremely Premature ; Infant, Newborn ; Infant, Very Low Birth Weight ; Retrospective Studies ; Sepsis/epidemiology*

The gastrointestinal structure, function and immunity of preterm infants are immature. Furthermore the gastrointestinal microbe colonization is abnormal. Therefore the preterm infants are prone to a variety of gastrointestinal diseases. Probiotics can regulate gastrointestinal microbe constitute, improve gastrointestinal barrier function, reduce gastrointestinal inflammation response and regulate the immunity. At present, it is used for the prevention of necrotizing enterocolitis, late-onset sepsis, and feeding intolerance. The safety and efficacy of probiotics for preterm infants are still controversial.
Apoptosis ; Enterocolitis, Necrotizing ; prevention & control ; Gastrointestinal Tract ; immunology ; microbiology ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; prevention & control ; Invasive Fungal Infections ; prevention & control ; Neonatal Sepsis ; prevention & control ; Probiotics ; adverse effects ; therapeutic use

Enteral Nutrition ; methods ; Enterocolitis, Necrotizing ; mortality ; prevention & control ; Gastrointestinal Tract ; microbiology ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; mortality ; prevention & control ; Pharmaceutical Preparations ; Probiotics ; administration & dosage ; therapeutic use ; Sepsis ; mortality ; prevention & control

Anti-Bacterial Agents ; therapeutic use ; Emergencies ; Enterocolitis, Necrotizing ; diagnosis ; epidemiology ; etiology ; prevention & control ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases ; diagnosis ; epidemiology ; etiology ; prevention & control ; Infant, Very Low Birth Weight ; Infection Control ; Intensive Care Units, Neonatal ; Premature Birth ; prevention & control ; Risk Factors