Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight 1000 grams a sequential analysis.docVIP

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Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight 1000 grams a sequential analysis.doc

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Effect of routine probiotic, Lactobacillus reuteri DSM 17938, use on rates of necrotizing enterocolitis in neonates with birthweight 1000 grams a sequential analysis

Hunteretal.BMCPediatrics2012,12:142 /1471-2431/12/142 RESEARCH ARTICLE OpenAccess Effectofroutineprobiotic,Lactobacillusreuteri DSM17938,useonratesofnecrotizing enterocolitisinneonateswithbirthweight1000 grams:asequentialanalysis ChelseaHunter1,MaryAnnVTDimaguila1,2,PeterGal1,3,4*,JohnEWimmerJr1,2,JamesLaurenceRansom1,2, RitaQCarlos1,2,McCraeSmith1,2andChristieCDavanzo1,2 Abstract Background:Necrotizingenterocolitis(NEC)isadiseaseinneonates,oftenresultingindeathorseriousmedicalor neurodevelopmentalcomplications.TherateofNECishighestinthesmallestbabiesandmanyeffortshavebeen triedtoreducetherateofNEC.Inneonatesbornbelow1500grams,therateofNEChasbeensignificantlyreduced withtheuseofvariousprobiotics.Thisstudyexaminestheimpactofroutineuseofaprobiotic,Lactobacillusreuteri DSM17938(BioGaiaW),ontherateofNECinneonatesathighestriskfordevelopingNEC,thosewithbirthweight ≤1000grams. Methods:ThisisaretrospectivecohortstudycomparingtheratesofNECinneonateswithbirthweight≤1000 grams.ThegroupsareseparatedintothoseneonatesbornfromJanuary2004toJune30,2009,beforeintroduction ofL.reuteri,andneonatesbornJuly2009throughApril2011whoreceivedroutineL.reuteriprophylaxis.Thechart reviewstudywasapprovedbyourinstitutionalreviewboardandexemptedfrominformedconsent. Neonateswereexcludediftheydiedorweretransferredwithinthefirstweekoflife.Theremainderwere categorizedashavingnoNEC,medicalNEC,surgicalNEC,orNECassociateddeath.Sincenomajorchanges occurredinourNICUpracticeinrecentyears,andtheintroductionofL.reuteriasroutineprophylaxiswasabrupt, weattributedthepost-probioticchangestotheintroductionofthisnewtherapy.RatesofNECwerecompared usingChisquareanalysiswithFisherexactt-test. Results:Medicalrecordsfor311neonateswerereviewed,232before-and79after-introductionofL.reuteri prophylaxis.TheincidenceofNECwassignificantlylowerintheneonateswhoreceivedL.reuteri(2of79neonates [2.5%]versus35of232untreatedneonates[15.1%]).Ratesoflate-onsetgram-negativeorfungalinfections(22.8 versus31%)werenotstatisticallydifferentb