A multimodal analysis of patients with multiple myeloma who developed enterocolitis following BCMA CAR-T cell treatment shows that CAR-T cell-associated enterocolitis is not defined exclusively by pla...

Italian Journal of Pediatrics - Necrotizing enterocolitis (NEC) is a severe intestinal disease primarily affecting premature newborns, with high morbidity and mortality. Although typically linked...

The pathogenesis of neonatal necrotizing enterocolitis (NEC) remains to be fully elucidated. Zhang et al. demonstrate that dysbiosis induces ferroptosis of intestinal epithelial cells via bile acid re...

A multimodal analysis of patients with multiple myeloma who developed enterocolitis following BCMA CAR-T cell treatment shows that CAR-T cell-associated enterocolitis is not defined exclusively by pla...

Necrotizing enterocolitis strikes premature babies with almost no warning. A new approach aims to detect it early with a quick, low-risk scan.

Rates of necrotizing enterocolitis, late-onset sepsis no different with and without probiotics

Importance  Probiotics are reported to benefit preterm infants, but population-based clinical evidence is limited. In 2020, the Swedish Neonatal Society issued a national recommendation to supplement very preterm infants (28 weeks 0 days’ to 31 weeks 6 days’ gestation) with probiotics.Objective  To investigate whether probiotic supplementation was associated with risk of death, necrotizing enterocolitis (NEC), and/or culture-proven sepsis in infants born very preterm.Design, Setting, and Participants  This population-based cohort study examined data from the Swedish Neonatal Quality Register from January 1, 2017, through December 31, 2024. Live-born, very preterm infants, excluding those who died within the first 3 days of life or due to congenital or chromosomal abnormalities, were included.Exposure  Daily probiotic supplementation of 1 billion colony-forming units of freeze-dried Bifidobacterium infantis, Bifidobacterium lactis, and Streptococcus thermophilus initiated following birth and discontinued at postmenstrual week 34.Main Outcomes and Measures  Composites of death and/or NEC (Bell stage 2-3), death and/or surgical NEC (Bell stage 3), and death and/or culture-proven sepsis were assessed. Modified Poisson regression, propensity score–matched, and inverse probability of treatment weighting analyses were used for replication analyses. A multivariate bayesian modeling analysis accounting for the association between NEC and mortality was performed to estimate the association between probiotic exposure and mortality.Results  Among 4695 infants (mean [SD] gestational age, 30.2 [1.1] weeks; 2550 male [54.3%]), probiotic exposure increased from 0% before the national recommendation in 2020 to 16.9% in 2020 and a mean (SD) of 64.8% (4.7%) in 2021 to 2024. Probiotic supplementation vs no supplementation was associated with lower risk of death and/or NEC (rate, 0.8% vs 3.4%; adjusted relative risk [ARR], 0.28 [95% CI, 0.14-0.56]). When assessed separately, risks of death (rate, 0.3% vs 1.4%; ARR, 0.16 [95% CI, 0.06-0.45]) and NEC (rate, 0.6% vs 2.5%; ARR, 0.25 [95% CI, 0.10-0.61]) were both lower in the probiotic group. Multivariate bayesian modeling suggested that a substantial proportion of the observed mortality reduction was mediated via reduced NEC incidence (42.3% [credible interval, 16.1%-100%]). Probiotic supplementation was not associated with death and/or culture-proven sepsis (rate, 3.4% vs 4.4%; ARR, 0.86 [95% CI, 0.58-1.26]).Conclusions and Relevance  This cohort study of very preterm infants found that implementation of a multistrain probiotic was associated with a significant reduction in death and/or NEC, which may help inform shared decision-making between clinicians and families. These results should not be generalized to extremely preterm infants (<28 weeks’ gestation).

Bacteriófagos y genes de resistencia a antibióticos aparecen como nuevos biomarcadores capaces de distinguir a los prematuros con mayor riesgo antes de que aparezca la enfermedad   ...