Necrotizing Enterocolitis (NEC) is one of the leading causes of infant mortality in premature or low-birth-weight infants (AlFaleh et al., 2014; Chang et al., 2017; Bernardo et al., 2013; Meyer et al., 2017; Patole et al., 2016; AlFaleh & Anabrees, 2014; Thomas et al., 2017; Uberos et al., 2017; Fernandez-Carrocera et al., 2013; Samuels et al., 2016; Repa et al., 2015; Oncel et al., 2014). It is considered a medical emergency and is the most common form of gastrointestinal condition found in neonates. Necrotizing Enterocolitis is a serious disease of preterm infants that can result in feeding intolerance, the need for bowel resection, impaired physiological and neurological development, and increased mortality rates. NEC is a multifactorial disease that results from the interaction between the loss of integrity of the intestinal mucosa and the host response to this damage (Bernardo, Aires, Carneiro, Sá, Rullo, & Burns, 2013). Associated with bowel wall necrosis that can lead to bowel perforation. It has been reported to affect up to 10% of very low birth weight infants (Alfaleh & Anabrees, 2014). Evidence suggests that the use of probiotics may reduce the incidence of developing necrotizing enterocolitis in infants born less than 32 weeks gestation and/or less than 1500 grams. This review aims to answer the question of whether probiotics reduce the incidence of necrotizing enterocolitis in premature or low birth weight infants.
Methods:
The review was conducted modifying Whittemore’s methodology of Integrated Research Reviews (2005). A search of articles was completed using three of the major literature databases: Cochran Library, CINAHL, and Medline. Key words used in this search included: “probiotic” and “necrotizing enterocolitis” and “reduction”. Search criteria was limited to “full text articles” between the years of 2013-2018 for all databases. A total of 32 articles were located, all articles were critically analyzed using evaluative checklists; PRISMA using published appraisal guides (Brown, 2018). Of the 32 articles found, seven were duplicates and twelve met specifications to be included in this review. Of the twelve articles, five were Level 1, two were Level 2, and five were Level 4 using a Nursing Levels of Evidence Pyramid (Long & Gannaway, 2014).
Results:
The overall literature review has resulted in reduction of necrotizing enterocolitis when probiotics are administered to infants less than 32 weeks. Ten articles found significant reduction in necrotizing enterocolitis with the use of probiotics. Evidence from two studies lead to results that were statistically insignificant; both trials used the same strain of probiotic. Four of the articles specifically reported the need for more research in strain and dosage to be used.
Conclusion:
There is a significant amount of evidence supporting the use of probiotics in the reduction of necrotizing enterocolitis. The evidence demonstrates a need for further research on the specific strains of probiotics and dosage that is needed to be most beneficial to the reduction of necrotizing enterocolitis. There is concern that if an infant is given formula instead of expressed mothers milk that it could alter the effectiveness of the probiotics. These barriers are preventing implementation in Neonatal Intensive Care Units nationwide.