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Dose-interval study of a dual probiotic in preterm infants
  1. Claire Watkins1,2,3,
  2. Kiera Murphy1,
  3. Eugene M Dempsey4,5,
  4. Carol Anne O’Shea5,
  5. Brendan Paul Murphy4,5,
  6. Paul W O’Toole2,3,
  7. R Paul Ross1,3,6,
  8. Catherine Stanton1,3,
  9. C Anthony Ryan4,5
  1. 1 Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
  2. 2 Department of Microbiology, University College Cork, Cork, Ireland
  3. 3 APC Microbiome Ireland, University College Cork, Cork, Ireland
  4. 4 Infant Centre and Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
  5. 5 Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
  6. 6 College of Science Engineering and Food Science, University College Cork, Cork, Ireland
  1. Correspondence to C Anthony Ryan, Paediatrics & Child Health, Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland; tony.ryan{at}ucc.ie

Abstract

Objective The objective of this study was to investigate the appropriate dosing interval of a probiotic (Infloran) given daily, biweekly and weekly in preterm infants <32 weeks’ gestation.

Methods There were 8 infants in the daily group, 8 infants in the biweekly group and 10 infants in the weekly group, all born between 25 and 32 weeks’ gestation. The control group consisted of 12 preterm infants who did not receive the probiotic. Infloran (250 mg/capsule), containing Bifidobacterium bifidum (1×109 colony-forming unit (CFU)) and Lactobacillus acidophilus (1×109 CFU), was administered in 2.5 mL of breast milk per kilogram weight of the infant (2×109 CFU of bacteria in total), until 34 weeks postmenstrual age (PMA). Stool samples were collected at 31, 34, 41 and 44 weeks PMA and frozen at −20°C.

Results After administration of the probiotic at 31 weeks PMA, Bifidobacterium were significantly higher in the daily group (45%) in comparison with the biweekly (17%) and weekly (9%) groups. At 34 weeks PMA, Bifidobacterium were significantly higher again in the daily (60%) group in comparison with the biweekly (21%), weekly (23%) and control (15%) groups. At 41 weeks PMA a decrease in the relative abundances of Streptococcaceae and Enterococcaceae was found in all three probiotic groups, and by 44 weeks PMA significantly higher levels of Lactobacillus were found in the biweekly group (16.5%) in comparison with the weekly group (2.1%).

Conclusion Our results indicate that a daily dose of Infloran is a suitable dosage for preterm infants in the neonatal intensive care unit, with significantly higher levels of Bifidobacterium found in the daily probiotic group up to 44 weeks PMA.

  • probiotic
  • preterm
  • dosage
  • bifidobacteria
  • breast milk
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Footnotes

  • Contributors The authors’ responsibilities were as follows: CW: contributed to the processing of the faecal samples in the laboratory, acquired the data, analysed the data, drafted the initial manuscript and revised the manuscript for submission. KM: carried out the bioinformatic analysis, acquired and interpreted the data, and critically reviewed and revised the manuscript. EMD: contributed to the design of the study, interpretation of the data, and critically reviewed and revised the manuscript. CAO’S: contributed to the concept and design of the study, was involved in probiotic administration in the NICU, interpretation of clinical data, and reviewed and revised the manuscript. RPR: contributed to the interpretation of data, critically reviewed and revised the manuscript, and approved the manuscript for submission. PWO’T: contributed to the interpretation of the data, contributed to the study design, and critically reviewed and revised the manuscript. CS: contributed to the design of the study, interpretation of the data, critically reviewed and revised the manuscript, and approved the final manuscript for submission. CAR: conceptualised and designed the study, critically reviewed and revised the manuscript, and approved the final manuscript for submission. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors are supported, in part, by the Science Foundation Ireland, through APC Microbiome Ireland (APC), and INFANTMET, funded by the Food Institutional Research Measure (FIRM) of the Department of Agriculture, Food and the Marine (10/RDT/MFRC/705).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the Cork University Hospital’s Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Full data set, including 16S sequencing FASTQ files, is available from the first author at Claire.Watkins@teagasc.ie. Consent was obtained and presented data are anonymised, with risk of identification low.

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