Probiotics give new hope to premature babies

Spring 2016

One in eight babies born in Canada is born preterm. Many of these babies are at risk of developing a serious bowel condition called necrotizing enterocolitis, or NEC. This potentially fatal condition occurs because the baby’s bowel is immature and is colonized by bad, instead of good, bacteria. These fragile patients can require surgery, multiple hospital visits and have serious long-term outcomes – a very stressful start to a new life for the child and parents alike. 

To help babies avoid contracting this devastating bowel condition, caregivers in the Neonatal Intensive Care Unit (NICU) at Children’s Hospital, London Health Sciences Centre are implementing a preventative measure which is low cost and simple – providing a probiotic supplement. Probiotics are live bacteria and yeasts that keep the bowel healthy and are especially good for the digestive system. In recent years, probiotics have been gaining popularity for their health benefits.

According to Dr. Henry Roukema, Medical Director at Children’s Hospital’s NICU, the cause of NEC is not well understood, but involves immaturity of the intestinal lining which allows harmful bacteria to cross into the bowel wall and bloodstream. Currently, there are not many effective treatments, so prevention is the best option. 

In the last year, based on worldwide research results, the NICU at Children’s Hospital has started using a probiotic supplement for babies at risk for NEC – those born weighing less than three pounds and three ounces, or who are born seven or more weeks premature. Around 180 babies that fall into this category are admitted to the NICU each year, and on average nine of these babies develop NEC. Surgery is required in about half of all cases to remove the damaged part of the bowel, and devastatingly, one-third die.

Niko, a baby born 15 weeks premature and weighing only one pound and seven ounces, was the first baby at Children’s Hospital’s NICU to receive probiotic treatment. Niko was at high risk for developing NEC due to his extreme prematurity. His parents, both physicians themselves, requested that Niko be given the probiotic FloraBaby™. Niko did not develop NEC and has continued to flourish in his development. Niko’s success and his parents’ initiative led to the decision to start using probiotics, and particularly FloraBaby™, on all very low birth weight babies at LHSC. 

Probiotics have been in use in many NICUs outside of North America for the past decade. Studies in these areas have shown a reduction in the risk of NEC and death by approximately 50 percent, as well as better tolerance to milk feedings, fewer days on intravenous nutrition, and shorter hospital stays.

The NICU at Children’s Hospital is part of a national collaboration called EPIQ (Evidenced-based Practices for Improving Quality). Cindy Ulrich, Registered Dietitian at LHSC and co-chair of the EPIQ NEC Outcome group, identifies the introduction of probiotics as one of several evidenced-based feeding related practices recommended by the national group to target a reduction in NEC cases among very low weight at birth babies. Children’s Hospital is one of roughly a dozen Canadian NICU’s that have implemented probiotics.

Recognized around the globe as a leader in probiotic research, Lawson Health Research Institute’s Dr. Gregor Reid was consulted throughout the implementation process by the NICU team at LHSC. “The peer-reviewed published evidence in favour of probiotics is exemplary and certainly outweighs any risks in taking these products.”

The research study is about six months away from completion as the team would like to recruit a total of 300 preterm babies to receive probiotics. To date, about 200 very low birth weight babies have received probiotic treatment and since implementing probiotics into the NICU, only four babies have developed NEC. This is a reduction of more than 50 per cent versus the number of cases expected.

Dr. Beth Ellen Brown, pediatric resident, will formally evaluate and report on the outcomes regarding this important practice change within the next year. While it is important to use caution in interpreting the lower number of NEC cases since probiotic implementation, this impressive reduction is consistent with reports in the literature.

Dr. Roukema recognizes the importance of this practice change. “NEC is not only devastating for the infant and the family, but it results in a tremendous burden to our health-care system. There is minimal cost associated with probiotic therapy compared to the cost savings to be realized by preventing even one case of NEC.”  

For Niko’s parents, Kristy and George, knowing that their baby was receiving a probiotic supplement gave them a peace of mind. “Niko is doing wonderfully. We can’t be more pleased with the outcome.”

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Kristy and George pose with their son, Niko, who was the first premature baby to receive probiotic therapy in the neonatal intensive care unit at Children's Hospital.