PURPOSE: Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. METHODS: This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28–34 weeks and birth weight of 1,000–1,800 g. RESULTS: Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12–0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99–1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). CONCLUSION: The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.
Birth Weight ; Diarrhea ; Enterocolitis, Necrotizing ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Lactobacillus reuteri ; Lactobacillus ; Length of Stay ; Mortality ; Parenteral Nutrition ; Prevalence ; Probiotics ; Sepsis

Introduction: Preterm infants are vulnerable to nutritional deficiencies, thus optimal nutrition is crucial in promoting growth among these infants. However, socio-cultural complexities and limited resources in the Asia-Pacific demands a judicious approach in implementing nutritional care that is pragmatic to align with current evidence-based recommendations. Methods: A roundtable meeting was held in Jakarta in 2017 for key opinion leaders in neonatology from the Asia- Pacific to discuss issues when delivering nutritional care in this region and the unique circumstances encountered. Results: Priority areas discussed include: (i) breast milk feeding, (ii) donor milk bank/sharing, (iii) human milk fortification, and (iv) nutrient-enriched breast milk substitutes. Socio-cultural practices impeding breastfeeding, insufficient maternity leave, the religious issue of milk kinship, and limited availability of specialty nutritional care products were among the most challenging factors. Conclusion: The group proposed recommendations to enhance breastfeeding uptake, accessibility to a complete portfolio of specialty nutritional care products, and encouraging more active collaborations to engage policy makers in addressing these contemporary issues.