In studies included in this meta- analysis , probiotic administration was associated with a reduction in NEC-related mortality
Aim of the study Probiotic administration to preterm infants has the potential to prevent necrotising enterocolitis ( NEC ) .
Data from r and omised controlled trials ( RCT ) are conflicting but meta-analyses seem to support this intervention .
To date , these analyses have not focused on surgical NEC .
We aim ed to determine the effect of probiotic administration  to preterm infants on prevention of surgical NEC .
Gut bacteria dysbiosis and necrotising enterocolitis in very low birthweight infants: a prospective case-control study
BACKGROUND Gut bacteria might predispose to or protect from necrotising enterocolitis , a severe illness linked to prematurity . In this observational prospect i ve study we aim ed to assess whether one or more bacterial taxa in the gut differ between infants who subsequently develop necrotising enterocolitis ( cases ) and those who do not ( controls ) . METHODS We enrolled very low birthweight ( 1500 g and lower ) infants in the primary cohort ( St Louis Children 's Hospital ) between July 7 , 2009 , and Sept 16 , 2013 , and in the secondary cohorts ( Kosair Children 's Hospital and Children 's Hospital at Oklahoma University ) between Sept 12 , 2011 and May 25 , 2013 . We prospect ively collected and then froze stool sample s for all infants . Cases were defined as infants whose clinical courses were consistent with necrotising enterocolitis and whose radiographs fulfilled criteria for Bell 's stage 2 or 3 necrotising enterocolitis . Control infants ( one to four per case ; not fixed ratios ) with similar gestational ages , birthweight , and birth date s were selected from the population after cases were identified . Using primers specific for bacterial 16S rRNA genes , we amplified and then pyrosequenced faecal DNA from stool sample s. With use of Dirichlet multinomial analysis and mixed models to account for repeated measures , we identified host factors , including development of necrotising enterocolitis , associated with gut bacterial population s. FINDINGS We studied 2492 stool sample s from 122 infants in the primary cohort , of whom 28 developed necrotising enterocolitis ; 94 infants were used as controls . The microbial community structure in case stools differed significantly from those in control stools . These differences emerged only after the first month of age . In mixed models , the time-by-necrotising-enterocolitis interaction was positively associated with Gammaproteobacteria ( p=0·0010 ) and negatively associated with strictly anaerobic bacteria , especially Negativicutes ( p=0·0019 ) . We studied 1094 stool sample s from 44 infants in the secondary cohorts . 18 infants developed necrotising enterocolitis ( cases ) and 26 were controls . After combining data from all cohorts ( 166 infants , 3586 stools , 46 cases of necrotising enterocolitis ) , there were increased proportions of Gammaproteobacteria ( p=0·0011 ) and lower proportions of both Negativicutes ( p=0·0013 ) and the combined Clostridia-Negativicutes class ( p=0·0051 ) in infants who went on to develop necrotising enterocolitis compared with controls . These associations were strongest in both the primary cohort and the overall cohort for infants born at less than 27 weeks ' gestation . INTERPRETATION A relative abundance of Gammaproteobacteria ( ie , Gram-negative facultative bacilli ) and relative paucity of strict anaerobic bacteria ( especially Negativicutes ) precede necrotising enterocolitis in very low birthweight infants . These data offer c and i date targets for interventions to prevent necrotising enterocolitis , at least among infants born at less than 27 weeks ' gestation . FUNDING National Institutes of Health ( NIH ) , Foundation for the NIH , the Children 's Discovery Institute
In studies included in this meta- analysis , probiotic administration was associated with a reduction in NEC-related mortality
Aim of the study Probiotic administration to preterm infants has the potential to prevent necrotising enterocolitis ( NEC ) .
Data from r and omised controlled trials ( RCT ) are conflicting but meta-analyses seem to support this intervention .
To date , these analyses have not focused on surgical NEC .
We aim ed to determine the effect of probiotic administration  to preterm infants on prevention of surgical NEC .