Janet Sharpe1, Mandy Way2, Pieter J Koorts1, Mark W Davies3,4. 1. Grantley Stable Neonatal Unit, Department of Neonatology, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, 4029, Australia. 2. Queensland Institute of Medical Research and Royal Brisbane and Women's Hospital Statistical Unit, Brisbane, QLD, Australia. 3. Grantley Stable Neonatal Unit, Department of Neonatology, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, 4029, Australia. mark.davies@health.qld.gov.au. 4. Department of Pediatrics and Child Health, The University of Queensland, Brisbane, QLD, Australia. mark.davies@health.qld.gov.au.
Abstract
BACKGROUND: To determine whether the introduction of pasteurized donor human milk and probiotics for infants born < 32 weeks gestational age or < 1500 g birthweight is associated with a reduction in mortality and the incidence of necrotising enterocolitis (NEC) and sepsis. METHODS: We performed a retrospective analysis of two cohorts: before and after the introduction of probiotics and pasteurised donor human milk. Univariate analysis of primary and secondary outcomes was performed; variables impacting outcomes were assessed using multivariate logistic regression. RESULTS: There were 1791 infants: 1334 in the pre-donor milk/probiotic cohort and 457 in the post-donor milk/probiotic cohort. On univariate analysis, mortality (7.6 vs. 2.4%, P < 0.001) and incidence of sepsis (6.2 vs. 3.5%, P = 0.028) were statistically significantly lower in the post-donor milk/probiotic group. NEC (2.8 vs. 1.5%, P = 0.14) and non-NEC associated gastrointestinal perforation (1.6 vs. 0.4%, P = 0.052) were lower in the post-donor milk/probiotics cohort, but these were not statistically significant. The difference in mortality remained statistically significant on multivariate analysis in the post-donor milk/probiotic cohort compared to those in the pre-donor milk/probiotic cohort (odds ratio 0.31, 95% confidence interval 0.16-0.61). The decrease in the incidence of NEC was consistent with previous observational studies but the difference was not statistically significant. CONCLUSION: The availability of probiotics and pasteurised donor human milk is associated with a reduction in mortality in very preterm infants.
BACKGROUND: To determine whether the introduction of pasteurized donorhuman milk and probiotics for infants born < 32 weeks gestational age or < 1500 g birthweight is associated with a reduction in mortality and the incidence of necrotising enterocolitis (NEC) and sepsis. METHODS: We performed a retrospective analysis of two cohorts: before and after the introduction of probiotics and pasteurised donorhuman milk. Univariate analysis of primary and secondary outcomes was performed; variables impacting outcomes were assessed using multivariate logistic regression. RESULTS: There were 1791 infants: 1334 in the pre-donor milk/probiotic cohort and 457 in the post-donor milk/probiotic cohort. On univariate analysis, mortality (7.6 vs. 2.4%, P < 0.001) and incidence of sepsis (6.2 vs. 3.5%, P = 0.028) were statistically significantly lower in the post-donor milk/probiotic group. NEC (2.8 vs. 1.5%, P = 0.14) and non-NEC associated gastrointestinal perforation (1.6 vs. 0.4%, P = 0.052) were lower in the post-donor milk/probiotics cohort, but these were not statistically significant. The difference in mortality remained statistically significant on multivariate analysis in the post-donor milk/probiotic cohort compared to those in the pre-donor milk/probiotic cohort (odds ratio 0.31, 95% confidence interval 0.16-0.61). The decrease in the incidence of NEC was consistent with previous observational studies but the difference was not statistically significant. CONCLUSION: The availability of probiotics and pasteurised donorhuman milk is associated with a reduction in mortality in very preterm infants.
Authors: Susan E Jacobs; Jacinta M Tobin; Gillian F Opie; Susan Donath; Sepehr N Tabrizi; Marie Pirotta; Colin J Morley; Suzanne M Garland Journal: Pediatrics Date: 2013-11-18 Impact factor: 7.124