The efficacy of an oral probiotic combination on late onset infections, bacterial sepsis and growth of very low birth weight preterm infants (less than 1500 g).

摘要

Nosocomial infections, especially hospital-acquired sepsis in infants with very low birth weight, present an important share of morbidity as well as mortality.;The purpose of the study was to establish from a randomly chosen group of children whether supplementing infants milk feedings with probiotics Lactobacillus acidophylus, Enterococcus faecium and Bifidobacterium infantum with the ratio of 1.5:1:1.5 at a dosage of 0.6 x 10 7 CFU twice a day decreases the number of nosocomial infections and hospital-acquired sepsis as well as affects infants' growth.;Half of the randomly chosen infants with birth weight under 1500g had their milk feedings supplemented with probiotics Lactobacillus acidophylus, Enterococcus faecium and Bifidobacterium infantum with the ratio of 1.5:1:1.5 at a dosage of 0.6 x 107 CFU whereas the other half did not. The primary objective was to observe the number of late onset sepsis and other infections, infants' growth and pomenstrual age at discharge. Cases of late onset sepsis were defined by considering the combination of anamnestic and clinical factors, clinical criteria for systemic inflammatory response typical for sepsis and positive two blood cultures. We created the criteria for categorizing sepsis into different groups (sepsis with positive blood cultures and clinical symptoms of systemic inflammatory response, clinical sepsis and suspected sepsis/infection). The growth of bodyweight in infants was followed by observing the dynamics at 1st, 2 nd, 4th, 8th and 12th week after admission and at discharge. The growth of head circumference and body length was measured once a month and at discharge. By comparing groups of children who received probiotics and those who did not, we established a lower statistically significant number of children with late onset sepsis (sepsis with positive blood cultures and clinical symptoms of systemic inflammatory response as well as clinical sepsis). In the group receiving probiotics, 16 children (40%) became ill and in the group without probiotics 29 children (72.5%); p= 0.006. The number VII of all late onset sepsis in the group with probiotics was 30, which was statistically less significant than in the group without probiotics, where 69 cases were recorded; p = 0.003.;Statistically significant less children were treated for at least one nosocomial infection. In the group with probiotics 20 children (50%) had a nosocomial infection and 32 children (80%) in the group without probiotics; p= 0.009. In the group with probiotics we recorded a statistically significant lower number of episodes of all nosocomial infections (35 episodes) than in the group without probiotics (79 episodes); p = 0.002.;A comparison of weight, length and head circumference at discharge between groups did not show any statistically significant difference in growth. Children who received probiotics were discharged with a smaller statistically significant postmenstrual age. None of the added probiotics was isolated in any of the blood or other cultures.;Children receiving prophylactic probiotics Lactobacillus acidophylus, Enterococcus faecium and Bifidobacterium infantum with a ratio 1.5:1:1.5 at a dosage of 1.2x 107 CFU with their first milk feeding until discharge had less nosocomial and other infections. Probiotics did not show any effect on the growth and children with probiotics were discharged with smaller pomenstrual age. Adverse effects of using probiotics were not recorded.