Daily Probiotics Linked to Lower Risk of Severe Gut Disease and Mortality in Preterm Infants
A comprehensive nationwide study conducted in Sweden has revealed that daily supplementation with specific probiotic strains is associated with significantly lower rates of necrotizing enterocolitis (NEC) and mortality in very preterm babies. However, the research, which was published in the journal JAMA Network Open, found that the risk of sepsis remained unaffected by the intervention.
Necrotizing enterocolitis is a severe, life-threatening gastrointestinal condition that predominantly impacts premature infants who possess immature gut structures and functions. The disorder is characterized by acute inflammation and the death of intestinal tissue. Because gut microbiota dysbiosis plays a central role in the development of the condition, researchers have increasingly investigated whether administering live, beneficial microorganisms can help protect the fragile digestive systems of vulnerable infants.
To explore these real-world effects, investigators utilized health data from the Swedish Neonatal Quality Register. The population-based cohort study analyzed 4,695 very preterm infants with a mean gestational age of approximately 30.2 weeks. Among the observed cohort, about 33.5% received a multi-strain probiotic formulation containing three distinct bacterial strains: Bifidobacterium infantis, Bifidobacterium lactis, and Streptococcus thermophilus. The remaining 66.5% of the infants did not receive probiotic supplementation.
The study followed the implementation of a 2020 national recommendation by the Swedish Neonatal Society, which endorsed probiotic use for very preterm infants following guidance from the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. Following this policy shift, overall probiotic uptake across Swedish neonatal units rose sharply from 16.9% in 2020 to an average of 64.8% between 2021 and 2024.
When comparing health outcomes, the data showed a marked improvement among infants who received the daily supplements. Between 2021 and 2024, the combined rate of death and necrotizing enterocolitis was just 0.8% among infants exposed to probiotics, compared to 2.9% in the unsupplemented group. Across the entire 2017 to 2024 study cohort, probiotic supplementation was associated with a 72% lower adjusted relative risk of death and/or necrotizing enterocolitis.
Further exploratory analysis indicated that a substantial portion—specifically 42.3%—of the observed reduction in mortality among supplemented infants was directly mediated through a lower incidence of necrotizing enterocolitis. When researchers examined surgical cases of the gut disease specifically, the relative risk reduction associated with probiotics was even larger.
Despite these positive gastrointestinal findings, the study reported no significant association between probiotic exposure and a reduction in sepsis risk. This result mirrors findings from a previous randomized clinical trial conducted in Australia and New Zealand that utilized the exact same bacterial strains. The authors noted that inconsistencies across international studies regarding sepsis reduction could stem from varying disease definitions, distinct study populations, or differences in the probiotic strains administered.
The research team emphasized several important clinical limitations. Most notably, the findings cannot be generalized to extremely preterm infants born before 28 weeks of gestation, as these babies face significantly higher baseline risks and were excluded from the initial national guidelines due to insufficient evidence. Additionally, because the study relied on national registry data, potential misclassification of necrotizing enterocolitis cases could exist.
The authors also disclosed a potential conflict of interest: study author Stefan Johansson serves as a co-founder and chief medical officer of Neobiomics AB, the commercial supplier of the probiotic preparation used in the investigation. Nevertheless, the research funders, including the Swedish Research Council and the Gastroenterological Research Fund, played no role in the design, execution, analysis, or publication of the study.
Source: News-Medical.net
