Role of probiotics in the prevention of the enteric colonization by Candida in preterm newborns
This open, prospective and randomised study investigated whether two different probiotics could decrease the risk of gastrointestinal colonisation of Candida species, of late-onset sepsis and neurological outcome in preterm neonates in an intensive care unit.
249 infants, of which 56 had a birth weight <1500 g, were consecutively assigned to either supplementation with Lactobacillus reuteri ATCC 55730 (10^8 CFU/day, group I), supplementation with Lactobacillus rhamnosus ATCC 53103 (=LGG, 6×10^9 CFU/day, group II) or no supplementation (group III). The supplementation started within 72 hours of admittance and continued for six weeks or until discharge.
Compared to the control group, both probiotics significantly reduced the incidence of high Candida faecal counts (>10^4 CFU/g of faeces), p<0.01, and there were also fewer fungal and bacterial infections, although the differences were not statistically significant. The number of infants with gastrointestinal symptoms was significantly reduced in the Lactobacillus reuteri group (3/83) vs. group II (29/83) and III (36/83), p<0.05. Consequently, the infants given Lactobacillus reuteri were weaned from parental nutrition more quickly and the time to reach full energy intake was also significantly shorter. Days on antibiotic treatment were reduced by Lactobacillus reuteri: 3.4 days vs. 5.8 days and 6.9 days in group II and III, respectively (p<0.05). Hospital stays were also significantly shorter in the Lactobacillus reuteri group: 18 days vs. 27 and 31 in group II and III, respectively (p<0.0001). At the follow-up of neurological outcomes at 12 months there were significantly fewer children with suboptimal scores in both probiotic groups compared to the control group, p<0.05.
Both probiotics reduced the incidence of high faecal counts of Candida in these preterm infants and demonstrated no safety problems. Fewer infants given Lactobacillus reuteri needed antibiotic treatment, fewer of them had any gastrointestinal problems and the hospital stay was reduced; these outcomes were significantly different to the results for the infants in the LGG and the control group. Infants supplemented with probiotics had a significantly reduced incidence of suboptimal neurological outcome at one year of age compared to the control group.