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Bifidobacterium and Lactobacillus for preventing necrotizing enterocolitis in very-low-birth-weight preterm infants: a systematic review and meta-analysis

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Abstract

Background

The therapeutic effect of Bifidobacterium and Lactobacillus on necrotizing enterocolitis (NEC) in very-low-birth-weight preterm infants was controversial, and we aimed to explore the exact impact of the two probiotics.

Methods

The PubMed, EMBASE, Web of Science and Cochrane Library were systematically searched for studies published from January 1, 2010 to February 28, 2019. Results were combined with fixed-effect model or random-effect model with specific conditions. Sensitivity analysis was conducted by the trim-and-fill method, and the Begger’s and Egger's test were used to measure publication bias.

Results

The meta-analysis included 16 original articles with 4632 very-low-birth-weight preterm infants. With respect to the intervention of Bifidobacterium, we estimated non-significant decrease in the morbidity of NEC with a risk ratio (RR) of 0.75 [95% confidence internal (CI) 0.56–1.01, P = 0.06]. Regarding the effect of Lactobacillus, there was no evidence of significant lower risk in the incidence of NEC (RR = 0.67, 95% CI 0.39–1.17, P = 0.16). The use of mixture of probiotics (Bifidobacterium and Lactobacillus) reduced the risk of NEC in the probiotics group (RR = 0.45, 95% CI 0.25–0.80, P = 0.007).

Conclusion

The mixture of Bifidobacterium and Lactobacillus could prevent the morbidity of NEC in very-low-birth-weight preterm infants. But Bifidobacterium or Lactobacillus alone did not show this effect.

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Acknowledgements

We would like to express sincere thanks to Qi Li, Xin-Yuan Guo, Chun-Jie Jiang and Hong-Ying Jia who conducted clinical guidance, reviewed the manuscript and offered information on time.

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    Authors and Affiliations

    1. School of Medicine, Shandong University, Jinan, China

      Xue Jiao & Meng-Di Fu

    2. Department of Neonatology, Second Hospital of Shandong University, 247# Beiyuan Road, Jinan, China

      Ya-Yun Wang & Jiang Xue

    3. Center of Evidence-Based Medicine, Institute of Medical Sciences, Second Hospital of Shandong University, 247# Beiyuan Road, Jinan, China

      Yuan Zhang

    4. School of Public Health, Shandong University, Jinan, China

      Yuan Zhang

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    1. Xue Jiao
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    Contributions

    XJ designed the study, collected data and drafted the manuscript. MF collected data and revised the manuscript. YZ supervised data collection, and critically reviewed the manuscript for important intellectual content. JX and YW reviewed the manuscript. All authors approved the final manuscript. XJ and MF contributed equally to this manuscript.

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    Correspondence to Yuan Zhang.

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    Jiao, X., Fu, MD., Wang, YY. et al. Bifidobacterium and Lactobacillus for preventing necrotizing enterocolitis in very-low-birth-weight preterm infants: a systematic review and meta-analysis. World J Pediatr 16, 135–142 (2020). https://doi.org/10.1007/s12519-019-00297-5

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