To assess the impact of probiotic use on necrotizing enterocolitis (NEC), mortality, and sepsis in very preterm infants following national recommendations in Sweden.
Approach:
Study Design: Utilized the Swedish National Quality Register (SNQ) to analyze changes in probiotic use and associated outcomes across 38 NICUs from 2021 to 2024.
Probiotic Administration: Probiotic use increased from 0% to 65% among very preterm infants following national recommendations.
Statistical Analysis: Adjusted relative risk (ARR) calculations were employed to assess the association between probiotic use and outcomes, controlling for confounding factors.
Key Findings:
Probiotic supplementation was associated with a significantly lower risk of death and/or NEC (ARR, 0.28; 95% CI, 0.14-0.56).
Overall NEC risk was reduced (ARR, 0.25; 95% CI, 0.10-0.61), with severe NEC (Bell stage 3) occurring in only 0.1% of probiotic recipients.
Mortality risk was reduced by 84% (ARR, 0.16; 95% CI, 0.06-0.45) among probiotic recipients.
No significant change in sepsis risk was observed (ARR, 1.22; 95% CI, 0.78-1.90).
Limitations:
Potential biases in treatment effect estimates due to immortal time bias and differential ascertainment of NEC.
Nutritional approaches were not detailed or analyzed in the cohort.
The study did not assess probiotic-associated infections, which are a concern in preterm infants.
