The use of the probiotic Lactobacillus plantarum plus fructooligosaccharide in neonates born in developing countries is effective in preventing the onset of sepsis, according to a study published in Nature.
“The disease burden of sepsis, at 6.9 million cases per year in moderate-to-late preterm neonates in sub-Saharan Africa, south Asia and Latin America, accounts for a loss of disability-adjusted life years similar to that of HIV or AIDS,” Pinaki Panigrahi, MD, PhD, FIDSA, from the Center for Global Health and Development at the University of Nebraska Medical Center, and colleagues wrote.
The researchers note that although the use of probiotics to prevent sepsis has been suggested, limited data are available on their use in neonates. This population, according to Panigrahi and colleagues, are an ideal cohort to in which to assess the use of probiotics because they have a “largely naive immune system and less complex intestinal microbiome [that] should make colonization with probiotic strains more feasible.”
To assess the efficacy of the probiotic in infants born in rural India, the researchers conducted a community-based, double-blind, placebo-controlled randomized trial that included 149 randomly selected villages within Odisha state. The 4,556 infants included in the trial were at least 2,000 g at birth, at least 35 weeks’ gestational age, and had no other signs of sepsis or disease. The infants were monitored for 60 days once the trial began.
Death and neonatal sepsis decreased 40%, with a prevalence of 9% in the control group and 5.4% in the probiotic group. Of those included in the study, 10 infants died: six within the treatment group and four within the control group. Culture-positive sepsis, culture-negative sepsis and lower respiratory tract infections were also reduced within those that received treatment.
Only six of those in the probiotic group had positive microbial cultures compared with 27 in the placebo group (RR = 0.22, 95% CI = 0.09-0.53). Gram-positive infections had a risk reduction of 82%, and gram-negative infections had a risk reduction of 75%. The prevalence of culture-negative sepsis reduced by 47% (RR = 0.53, 95% CI = 0.30-0.92), and the incidence of lower respiratory tract infections reduced by 34% in the probiotic group (number needed to treat = 48).
“Early life events lead us to believe that the timing of the intervention is probably crucial,” Panigrahi and colleagues wrote. “There is likely to be a critical perinatal window during which the interaction of the host with the microbiome must occur for optimal immune development, and during which exposure to specific probiotics may enhance immune-mediated homeostasis.” – by Katherine Bortz
Disclosure: Infectious Diseases in Children was unable to determine researchers’ relevant financial disclosures prior to publication.