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The future of probiotics in the preterm infant

Lookup NU author(s): Professor Janet Berrington, Dr Stefan Zalewski

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Abstract

© 2019Probiotic administration to preterm infants is not universal despite randomised trial data from >10,000 infants, significant observational data and multiple meta-analyses. Advocates point to reductions in necrotising enterocolitis and sepsis, ‘sceptics’ hold concerns over data quality/interpretation or risks. Issues revolve around different products, primary outcomes, uncertain dosing strategies and individual large ‘negative’ trials alongside probiotic associated sepsis and quality control concerns. We review concerns and how to move probiotic use forward. Surprisingly little is known about parental perspectives, vital to inform next steps. How to share information and decisions around probiotic use now, and how this impacts on future available strategies is discussed. We address placebo controlled trials and propose alternate designs, including head to head studies, using ‘routine’ data collection systems, opt out consents and ‘learning technologies’ embedded in health care systems. We also raise the importance of underpinning mechanistic work to inform future trials.

Publication metadata

Author(s): Berrington JE, Zalewski S

Publication type: Article

Publication status: Published

Journal: Early Human Development

Year: 2019

Volume: 135

Pages: 75-81

Print publication date: 01/08/2019

Online publication date: 24/05/2019

Acceptance date: 02/04/2019

ISSN (print): 0378-3782

ISSN (electronic): 1872-6232

Publisher: Elsevier Ireland Ltd

URL: https://doi.org/10.1016/j.earlhumdev.2019.05.008

DOI: 10.1016/j.earlhumdev.2019.05.008

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