Therapy With Gastric Acidity Inhibitors Increases the Risk of Acute Gastroenteritis and Community-Acquired Pneumonia in Children Prevention of Neonatal Necrotizing Enterocolitis Lower Incidence of Necrotizing Enterocolitis in Infants Fed a Preterm Formula with Egg Phospholipids Effect of Omeprazole on Acid Gastroesophageal Reflux and Gastric Acidity in Preterm Infants With Pathological Acid Reflux Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants Oral Probiotics Prevent Necrotizing Enterocolitis in Very Low Birth Weight Preterm Infants: A Multicenter, Randomized, Controlled Trial The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach. The protective role of gastric acidity in neonatal bacterial translocation. The Effect of Neutral Oligosaccharides on Reducing the Incidence of Necrotizing Enterocolitis in Preterm infants: A Randomized Clinical Trial Oral Probiotics Reduce the Incidence and Severity of Necrotizing Enterocolitis in Very Low Birth Weight Infants Antacid and formula effects on gastric acidity in infants with gastroesophageal reflux. Effect of oral probiotics supplementation in the prevention of necrotizing enterocolitis among very low birth weight preterm infants. Synbiotics for decreasing incidence of necrotizing enterocolitis among preterm neonates – a randomized controlled trial Proton pump inhibitor-associated pneumonia: Not a breath of fresh air after all? Reduction in necrotizing enterocolitis and improved outcomes in preterm infants following routine supplementation with Lactobacillus GG in combination with bovine lactoferrin. Double-blind, randomised clinical assay to evaluate the efficacy of probiotics in preterm newborns weighing less than 1500 g in the prevention of necrotising enterocolitis Oropharyngeal Administration of Colostrum Increases Salivary Secretory IgA Levels in Very Low‐Birth‐Weight Infants
OBJECTIVE . Gastric acidity ( GA ) inhibitors , including histamine-2 receptor antagonists ( H2 blockers ) and proton pump inhibitors ( PPIs ) , are the mainstay of gastroesophageal reflux disease ( GERD ) treatment . A prolonged GA inhibitor – induced hypochlorhydria has been suggested as a risk factor for severe gastrointestinal infections . In addition , a number of papers and a meta- analysis have shown an increased risk of pneumonia in H2-blocker – treated intensive care patients . More recently , an increased risk of community-acquired pneumonia associated with GA inhibitor treatment has been reported in a large cohort of adult patients . These findings are particularly relevant to pediatricians today because so many children receive some sort of GA-blocking agent to treat GERD . To test the hypothesis that GA suppression could be associated with an increased risk of acute gastroenteritis and pneumonia in children treated with GA inhibitors  , we conducted a multicenter , prospect i ve study . METHODS . The study was performed by expert pediatric gastroenterologists from 4 pediatric gastroenterology centers . Children ( aged 4–36 months ) consecutively referred for common GERD-related symptoms ( for example , regurgitation and vomiting , feeding problems , effortless vomiting , choking ) , from December 2003 to March 2004 , were considered eligible for the study . Exclusion criteria were a history of GA inhibitors therapy in the previous 4 months , Helicobacter pylori infection , diabetes , chronic lung or heart diseases , cystic fibrosis , immunodeficiency , food allergy , congenital motility gastrointestinal disorders , neuromuscular diseases , or malnutrition . Control subjects were recruited from healthy children visiting the centers for routine examinations . The diagnosis of GERD was confirmed in all patients by st and ard criteria . GA inhibitors ( 10 mg/kg ranitidine per day in 50 children or 1 mg/kg omeprazole per day in 50 children ) were prescribed by the physicians for 2 months . All enrolled children were evaluated during a 4-month follow-up . The end point was the number of patients presenting with acute gastroenteritis or community-acquired pneumonia during a 4-month follow-up study period . RESULTS . We obtained data in 186 subjects : 95 healthy controls and 91 GA-inhibitor users ( 47 on ranitidine and 44 on omeprazole )  . The 2 groups were comparable for age , gender , weight , length , and incidence of acute gastroenteritis and pneumonia in the 4 months before enrollment . Rate of subjects presenting with acute gastroenteritis and community-acquired pneumonia was significantly increased in patients treated with GA inhibitors compared with healthy controls during the 4-month follow-up period . In the GA inhibitor-treated group , the rate of subjects presenting with acute gastroenteritis and community-acquired pneumonia was increased when comparing the 4 months before and after enrollment . No differences were observed between H2 blocker and PPI users in acute gastroenteritis and pneumonia incidence in the previous 4 months and during the follow-up period . On the contrary , in healthy controls , the incidence of acute gastroenteritis and pneumonia remained stable . CONCLUSIONS . This is the first prospect i ve study performed in pediatric patients showing that the use of GA inhibitors was associated with an increased risk of acute gastroenteritis and community-acquired pneumonia in GERD-affected children . It could be interesting to underline that we observed an increased incidence of intestinal and respiratory infection in otherwise healthy children taking GA inhibitors for GERD treatment . On the contrary , the majority of the previous data showed that the patients most at risk for pneumonia were those with significant comorbid illnesses such as diabetes or immunodeficiency , and this points to the importance of GA suppression as a major risk factor for infections . In addition , this effect seems to be sustained even after the end of therapy . The results of our study are attributable to many factors , including direct inhibitory effect of GA inhibitors on leukocyte functions and qualitative and quantitative gastrointestinal microflora modification . Additional studies are necessary to investigate the mechanisms of the increased risk of infections in children treated with GA inhibitors  , and prophylactic measures could be considered in preventing them Small premature infants are often hypochlorhydric , and frequently their stomachs are colonized by enteric , gram-negative bacteria . We tested a hypothesis that gastric pH affected the colonization of the stomach with enteric bacteria and that this colonization was causally related to the risk or severity of necrotizing enterocolitis . A prospect i ve , double-blind study was conducted that compared a group of infants supplemented with 0.01–0.02 ml of 1 N HCl/ml of milk to a group with a similar supplement of water .  Gastric pH , gastric enteric bacteria counts , and the incidence and severity of necrotizing enterocolitis were monitored . The median gastric pH of the HCl-supplemented group was lower ( 3.0 ) than controls ( 4.0 ) throughout the study ( p < 0.001 ) . The gastric enteric bacterial colonization rate and the quantitative bacterial counts were strongly correlated with gastric pH over 4 ( p < 0.001 ) . Somatic growth rates in infants in the HCl-supplemented group were equal to , or exceeded , those in the control group . There was 1 case of necrotizing entero-colitis among the 34 infants in the HCl-supplemented group and 8 cases among the 34 in the control group ( p = 0.02 ) . It appears that acidifying the feedings of small premature infants to a pH low enough to inhibit bacterial proliferation in the stomach significantly lowers the risk of necrotizing enterocolitis Necrotizing enterocolitis ( NEC ) causes approximately 4000 deaths/y and significant morbidity among U.S.-born preterm infants alone . Various combinations of inadequate tissue oxygenation , bacterial overgrowth , and enteral feeding with immaturity may cause the initial damage to intestinal mucosa that culminates in necrosis . Presently , there is not a way to predict the onset of the disease or to prevent its occurrence . As part of risk-benefit assessment , we compared disease in hospitalized preterm infants fed a commercial ( control ) preterm formula or an experimental formula with egg phospholipids  for a r and omized , double-masked , clinical study of diet and infant neurodevelopment . Infants fed the experimental formula developed significantly less stage II and III NEC compared with infants fed the control formula ( 2.9 versus 17.6 % , p < 0.05 ) , but had similar rates of bronchopulmonary dysplasia ( 23.4 versus 23.5 % ) , septicemia ( 26 versus 31 % ) , and retinopathy of prematurity ( 38 versus 40 % ) . Compared with the control formula , the experimental formula provided 7-fold more esterified choline , arachidonic acid ( AA , 0.4 % of total fatty acids ) , and docosahexaenoic acid ( 0.13 % ) . Phospholipids are constituents of mucosal membranes and intestinal surfactant , and their components , AA and choline , are substrates for intestinal vasodilatory and cytoprotective eicosanoids ( AA ) and the vasodilatory neurotransmitter , acetylcholine ( choline ) , respectively . One or more of these components of egg phospholipids may have enhanced one or more immature intestinal functions to lower the incidence of NEC in this study . Regardless of the potential mechanism , a larger r and omized trial design ed to test the effect of this egg phospholipid-containing formula on NEC seems warranted Introduction : Proton pump inhibitor ( PPI ) therapy is increasingly being used to treat premature infants with gastroesophageal reflux disease ( GERD ) ; however , the efficacy of PPI on acid production in this population has yet to be assessed in this patient group . The aim of this study was to determine the effect of 0.7 mg/kg/d omeprazole on gastric acidity and acid gastroesophageal reflux in preterm infants with reflux symptoms and pathological acid reflux on 24-h pH probe . Methods : A r and omized , double blind , placebo-controlled , crossover design trial of omeprazole therapy was performed in 10 preterm infants ( 34–40 weeks postmenstrual age ) . Infants were given omeprazole for 7 d and then placebo for 7 d in r and omized order . Twenty-four-hour esophageal and gastric pH monitoring was performed on days 7 and 14 of the trial . Results : Compared to placebo , omeprazole therapy significantly reduced gastric acidity ( % time pH < 4 , 54 % vs 14 % , P < 0.0005 ) , esophageal acid exposure ( % time pH < 4 , 19 % vs 5 % , P < 0.01 ) and number of acid GER episodes ( 119 vs 60 episodes , P < 0.05 ) . Conclusions : Omeprazole is effective in reducing esophageal acid exposure in premature infants with pathological acid reflux on 24-h pH probe ; however , the far more complex issues of safety and efficacy have yet to be addressed OBJECTIVE . We sought to determine if an association exists between the use of histamine-2 receptor ( H2 ) blockers and the incidence of  necrotizing enterocolitis ( NEC ) in infants of 401 to 1500 g in birth weight . STUDY DESIGN . Data from the National Institute of Child Health and Human Development Neonatal Research Network very low birth weight ( 401–1500 g ) registry from September 1998 to December 2001 were analyzed . The relation between the diagnosis of NEC ( Bell stage II or greater ) and antecedent H2-blocker treatment was determined by using case-control methodology . Conditional logistic regression was implemented , controlling for gender , site of birth ( outborn versus inborn ) , Apgar score of < 7 at 5 minutes , and postnatal steroids . RESULTS . Of 11072 infants who survived for at least 12 hours , 787 ( 7.1 % ) developed NEC ( 11.5 % of infants 401–750 g , 9.1 % of infants 751–1000 g , 6.0 % of infants 1001–1250 g , and 3.9 % of infants 1251–1500 g ) . Antecedent H2-blocker use was associated with an increased incidence of NEC ( P < .0001 ) . CONCLUSIONS . H2-blocker therapy was associated with higher rates of NEC , which is in agreement with a previous r and omized trial of acidification of infant feeds that result ed in a decreased incidence of NEC . In combination , these data support the hypothesis that gastric pH level may be a factor in the pathogenesis of NEC OBJECTIVE . The goal was to investigate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis for very low birth weight preterm infants . METHODS . A prospect i ve , blinded , r and omized , multicenter controlled trial was conducted at 7 NICUs in Taiwan , to evaluate the beneficial effects of probiotics in necrotizing enterocolitis among very low birth weight infants ( birth weight : < 1500 g ) . Very low birth weight infants who survived to start enteral feeding were eligible and were assigned r and omly to 2 groups after parental informed consent was obtained . Infants in the study group were given Bifidobacterium bifidum and Lactobacillus acidophilus , added to breast milk or mixed feeding ( breast milk and formula ) , twice daily for 6 weeks . Infants in the control group were fed with breast milk or mixed feeding . The clinicians caring for the infants were blinded to the group assignment . The primary outcome measurement was death or necrotizing enterocolitis ( Bell 's stage ≥2 ) . RESULTS . Four hundred thirty-four infants were enrolled , 217 in the study group and 217 in the control group . The incidence of death or necrotizing enterocolitis ( stage ≥2 ) was significantly lower in the study group ( 4 of 217 infants vs 20 of 217 infants ) . The incidence of necrotizing enterocolitis ( stage ≥2 ) was lower in the study group , compared with the control group ( 4 of 217 infants vs 14 of 217 infants ) . No adverse effect , such as sepsis , flatulence , or diarrhea , was noted . CONCLUSION . Probiotics , in the form of Bifidobacterium and Lactobacillus , fed enterally to very low birth weight preterm infants for 6 weeks reduced the incidence of death or necrotizing enterocolitis BACKGROUND / AIMS Intra-gastric bacterial proliferation is frequent in patients with hypochlohydria . However , status of gastric bacterial infection in patients receiving proton pump inhibitor or H2-receptor antagonist  remains controversial . The purpose of this study was to investigate the microbial condition of the stomach in patients who received H2-receptor antagonist or proton pump inhibitor .  METHODOLOGY Between November 2000 and January 2002 , 102 patients were enrolled in this study . Of these , 52 did not receive any treatment ( group I ) , 26 received H2-receptor antagonist ( group II ) , and 24 received proton pump inhibitor ( group III ) . Ten mL of gastric juice were aspirated for culture during endoscopic examination . The aerobic and anaerobic bacterial and fungal cultures were performed immediately . A glass pH meter measured the pH of the gastric juice . RESULTS The intra-gastric pH was 2.91+/-2.06 ( mean + /- SD ) , 4.12+/-2.83 , and 5.11+/-2.47 for groups I , II , and III , respectively ( p=0.001 between groups I and III , p>0.05 between groups I and II , and groups II and III ) . The positive bacterial culture rates were 66.7 % ( 16/24 ) in group III , 46.2 % ( 12/26 ) in group II , and 28.8 % ( 15/52 ) in group I ( p=0.007 between groups III and I , p>0.05 between groups I and II , and groups II and III ) . The positive c and idal culture rates were 12.5 % ( 3/24 ) in group III , 11.5 % ( 3/26 ) in group II , and 17.3 % ( 9/52 ) in group I ( p>0.05 ) . CONCLUSIONS Patients who received proton pump inhibitor had more acid suppression and intra-gastric bacterial infection than those of the control group . The intra-gastric c and idal infection was not related to intra-gastric pH or anti-secretory medication in this study The acid environment of the stomach serves as an important defense against intestinal colonization by potentially pathogenic bacteria . The purpose of this study was to examine the effect of increased gastric pH on bacterial translocation in a neonatal rabbit model . Fifty-nine rabbit pups were delivered by cesarean section and r and omly divided into normal acid ( NA ) and reduced acid ( RA ) groups . All were gavage fed and challenged with Enterobacter cloacae , 1 x 10(6 ) CFU/mL. The RA group received ranitidine , 20 mg/kg/d with all feeds . Gastric pH was measured by pH probe before and 4 hours after bacterial challenge . Mesenteric lymph node ( MLN ) , spleen , liver , midjejunum , and cecum were harvested for culture at 72 hours . Gastric pH in the RA group was significantly increased before and 4 hours after the bacterial challenge . The incidence of bacterial translocation to the MLN , spleen , and liver was significantly higher in the RA group . Log cecal and jejunal colony counts were significantly increased in the RA animals . The authors conclude that the gastric acidity is protective against intestinal colonization and translocation of potentially pathogenic bacteria in this neonatal rabbit model Background : Necrotizing enterocolitis ( NEC ) is one of the most destructive diseases associated with conditions of neonatal prematurity . Supplementation with enteral prebiotics may reduce the incidence of NEC , especially in infants who fed exclusively with breast-milk . Therefore , we compared the efficacy and safety of enteral supplementation of a prebiotic mixture ( short chain galacto-oligosaccharides/long chain fructo-oligosaccharides [ SCGOS/LCFOS ] ) versus no intervention on incidence of NEC in preterm infants . Methods : In a single-center r and omized control trial 75 preterm infants ( birth weight [ BW ] ≤1500 g , gestational age ≤34 weeks and were not fed with formula ) on 30 ml/kg/day volume of breast-milk were r and omly allocated to have enteral supplementation with a prebiotic mixture ( SCGOS/LCFOS ; 9:1 ) or not receive any prebiotic . The incidence of suspected NEC , feeding intolerance , time to full enteral feeds , duration of hospitalization were investigated . Results : Differences in demographic characteristics were not statistically important . SCGOS/LCFOS mixture significantly reduced the incidence of suspected NEC , ( 1 [ 4.0 % ] vs. 11 [ 22.0 % ] ; hazard ratio : 0.49 [ 95 % confidence interval : 0.29 - 0.84 ] ; P = 0.002 ) , and time to full enteral feeds ( 11 [ 7 - 21 ] vs. 14 [ 8 - 36 ] days ; P - 0.02 ] . Also duration of hospitalization was meaningfully shorter in the prebiotic group ( 16 [ 9 - 45 ] vs. 25 [ 11 - 80 ] ; P - 0.004 ] . Prebiotic oligosaccharides were well tolerated by very low BW ( VLBW ) infants . Conclusions : Enteral supplementation with prebiotic significantly reduced the incidence of NEC in VLBW infants who were fed exclusively breast-milk . This finding suggests that it might have been the complete removal of formula which caused a synergistic effect between nonhuman neutral oligosaccharides ( prebiotic ) and human oligosaccharides Objective . We evaluated the efficacy of probiotics in reducing the incidence and severity of necrotizing enterocolitis ( NEC ) in very low birth weight ( VLBW ) infants . Patients and Methods . A prospect i ve , masked , r and omized control trial was conducted to evaluate the beneficial effects of probiotics in reducing the incidence and severity of NEC among VLBW ( < 1500 g ) infants . VLBW infants who started to fed enterally and survived beyond the seventh day after birth were eligible for the trial . They were r and omized into 2 groups after parental informed consents were obtained . The infants in the study group were fed with Infloran ( Lactobacillus acidophilus and Bifidobacterium infantis ) with breast milk twice daily until discharged . Infants in the control group were fed with breast milk alone . The clinicians caring for the infants were blinded to the group assignment . The primary outcome was death or NEC ( ≥ stage 2 ) . Results . Three hundred sixty-seven infants were enrolled : 180 in the study group and 187 in the control group . The demographic and clinical variables were similar in both groups . The incidence of death or NEC ( ≥ stage 2 ) was significantly lower in the study group ( 9 of 180 vs 24 of 187 ) . The incidence of NEC ( ≥ stage 2 ) was also significantly lower in the study when compared with the control group ( 2 of 180 vs 10 of 187 ) . There were 6 cases of severe NEC ( Bell stage 3 ) in the control group and none in the study group . None of the positive blood culture grew Lactobacillus or Bifidobacterium species . Conclusion . Infloran as probiotics fed enterally with breast milk reduces the incidence and severity of NEC in VLBW infants A variety of peptic diseases are treated with antacids . Antacid dose requirements for young children have not been extensively evaluated . Moreover , the effects of formula feedings on antacid requirements are also unknown . We have investigated the effects of antacids and formula feedings on  gastric acidity  in infants less than 1 year of age .  Small formula feedings of 15 mL/kg per feeding significantly improve antacid buffering of 0.5 mL/kg per dose of st and ard magnesium-aluminum hydroxide antacids BACKGROUND Necrotizing enterocolitis ( NEC ) is the most serious gastrointestinal problem in very low birth weight preterm infants . Multiple risk factors activate the inflammatory cascade leading to high expressions of pro-inflammatory mediators causing bowel injury in NEC . The anti-inflammatory effect of probiotics is due to the inhibition and reduction of inflammatory signal in intestinal epithelium . OBJECTIVE To evaluate the efficacy of probiotics supplementation in the prevention of NEC among very low birth weight preterm infants . STUDY DESIGN A prospect i ve r and omized controlled trial . MATERIAL AND METHOD All preterm infants with gestational age less than or equal to 34 weeks and birth weight less than or equal to 1,500 grams admitted in neonatal care unit , Queen Sirikit National Institute of Child Health during June 1st , 2012 and January 31th , 2013 were enrolled in this study . They were r and omized into two groups , study and control group . Infants in the study group were fed Infloran ( Lactobacillus acidophilus 1 x 10(9 ) and Bifidobacterium bifidum 1 x 10(9 ) organisms ) dose 125 mg/kg/dose twice a day with breast milk or premature formula from the start of feeding until 6 weeks or discharge . Infants in the control group were fed with either breast milk or premature formula alone . The primary outcome was NEC stage ≥ 2 . RESULTS Sixty infants completed the study , 31 infants in the study group and 29 infants in the control group . The baseline characteristic data of infants were similar except for more males in the present study group . Incidence of NEC stage ≥ 2 were similar in both the groups , 3.2 vs. 3.4 % ( p = 0.74 ) . There were no deaths during the study period . Days to reach full feeding , 150 ml/kg/day , were no differences between the two groups , 12.03 ± 5.49 days vs. 13.76 ± 8.25 days ( p = 0.31 ) . No adverse effects such as sepsis , flatulence or diarrhea were noted . CONCLUSION In this study , there was no difference in incidence of NEC stage ≥ 2 between the two groups . No adverse effects of probiotics supplementation were observed Abstract Objective : To study the effect of synbiotics in reducing incidence and severity of necrotizing enterocolitis ( NEC ) among preterm neonates . Methods : This r and omized controlled trial conducted in a tertiary care teaching hospital , south India , included 220 enterally fed preterm neonates who were r and omized to receive either synbiotics or no intervention .  The synbiotic contained Lactobacillus , Bifidobacterium and fructo-oligosaccharide . The demographic parameters , risk factors for NEC and outcome including incidence of NEC , its severity , sepsis and mortality were evaluated . Results : Multiple pregnancies , preeclampsia and prolonged rupture of membranes were important maternal characteristics . The average birth weight and gestational age of the preterm neonates was 1.4 kg and 31 weeks , respectively . There was a 50 % reduction in the incidence of NEC of all stages in preterm infants who received synbiotics compared to the non-intervention group ( 7.4 % versus 14.5 % ) . Administration of synbiotics did not reduce the severity of NEC , sepsis or mortality . Conclusion : Enteral supplementation of synbiotics along with breastmilk results in a tendancy to decrease the incidence of NEC among preterm neonates Over the past two decades , proton pump inhibitors ( PPIs ) have emerged as highly effective and relatively safe agents for the treatment of a variety of gastrointestinal disorders . Unfortunately , this desirable pharmacological profile has also contributed to superfluous and widespread use in both the inpatient and outpatient setting s. While generally well-tolerated , research published over the last decade has associated these agents with increased risks of Clostridium difficile disease , fractures likely due to calcium malabsorption and both community-acquired ( CAP ) and hospital-acquired pneumonias ( HAP ) . The mechanism behind PPI-associated pneumonia may be multifactorial , but is thought to stem from compromising the stomach 's " acid mantle " against gastric colonization of acid-labile pathogenic bacteria which then may be aspirated . A secondary postulate is that PPIs , through their inhibition of extra-gastric H(+)/K(+)-ATPase enzymes , may reduce the acidity of the upper aerodigestive tract , thus result ing in increased bacterial colonization of the larynx , esophagus and lungs . To date , several retrospective case control studies have been published looking at the association between PPI use and CAP . Some studies found a temporal relationship between PPI exposure and the incidence of pneumonia , but only two could define a dose-response relationship . Furthermore , other studies found an inverse correlation between duration of PPI use and risk of CAP . In terms of HAP , we review ed two retrospective cohort studies and one prospect i ve study . One retrospective study in a medical ICU found no increased association of HAP in PPI-exposed patients compared to no acid-lowering therapy , while the other in cardiothoracic surgery patients showed a markedly increased risk compared to those receiving H(2)RAs . The one prospect i ve study in ICU patients showed an increased risk of HAP with PPIs , but not with H(2)RAs . In conclusion , the current literature shows a slight trend toward an association between PPI use and pneumonia and an increased risk with PPIs over H(2)RAs , but the findings are not consistent across all studies . Larger controlled trials still need to be done to better identify the risk that PPIs impart towards patients contracting CAP or HAP . Until these are completed , we will have to continue to extrapolate across smaller controlled trials to predict the associated risks in our respective patient population s. In the interim , it appears prudent to limit the use of PPIs to situations where they are clinical ly indicated and , in such cases , use them at the lowest effective dose . In the case of prescribing for stress ulcer prophylaxis in ICU patients , perhaps H(2)RAs should be used as the preferred agents over PPIs BACKGROUND Preterm infants remain at high risk of adverse outcomes following necrotizing enterocolitis  ( NEC ) and late onset sepsis ( LOS ) . Meta- analysis of r and omized trials has indicated a reduction in severe NEC following use of probiotics and bovine lactoferrin ( LF ) . Overall , however , uncertainty remains over which probiotic , or combination to use . The aim of this study was to compare the incidence of severe NEC and LOS before and after routine supplementation with Lactobacillus GG ( LGG ) and LF . METHODS In this retrospective cohort study , infants < 32 weeks or < 1500 g routinely received LGG and 100 mg lactoferrin daily from 2011 -2015 were compared with similar infants born from 2004 - 2008 . Cases of NEC were Bell stage 2 or greater and LOS was blood or spinal fluid culture positive after 48 hrs of age . RESULTS We noted a marked decline in the incidence of NEC from 3 % to 1 % with a RR of 0.29 ( CI 0.1 - 0.9 ) and a number needed to benefit of 50 . The cost of preventing one case of NEC was estimated to be NZ $ 2800 , considerably lower than the cost of treatment . LOS rates were not significantly different . There was a decrease in retinopathy treatment rates . During the period there was one case of LGG sepsis in a 23 week gestation infant with abdominal pathology and one infant developed NEC after stopping prophylaxis . CONCLUSION The rates of severe NEC was markedly reduced following prophylaxis . The case of LGG sepsis indicates caution is required in extremely preterm infants Background A r and omised , double-blind clinical trial was undertaken in order to assess the effectiveness of probiotics in the prevention of  necrotising enterocolitis ( NEC ) in newborns weighing < 1500 g. Methods We studied a group of 150 patients who were r and omised in two groups after parental consent was obtained , to receive either a daily feeding supplementation with a multispecies probiotic ( Lactobacillus acidophilus , Lactobacillus rhamnosus , Lactobacillus casei , Lactobacillus plantarum , Bifidobacteruim infantis , Streptococcus thermophillus ) 1 g per day plus their regular feedings or to receive their regular feedings with nothing added ( control group ) , over the period of January 2007 through June 2010 . Clinicians in care of the infants were blinded to the group assignment . Results The primary outcome was the development of NEC . Both groups were comparable , with no differences during hospitalisation , including the type of nutrition received . Blood cultures obtained from cases that developed sepsis did not reveal lactobacillus or Bifidobacteria growth . No differences were detected in terms of NEC risk reduction ( RR : 0.54 , 95 % CI 0.21 to 1.39 ) although we did observe a clear trend in the reduction of NEC frequency in the studied cases : 6 ( 8 % ) versus 12 ( 16 % ) in the control group . When the combined risk of NEC or death was calculated as a post hoc analysis , we found a significantly lower risk ( RR : 0.39 , 95 % CI 0.17 to 0.87 ) for the study group . Conclusions Probiotics may offer potential benefits for premature infants and are a promising strategy in the reduction of the risk of NEC in preterm newborns Aim Oropharyngeal administration of colostrum ( OAC ) has been proposed to provide mother 's early milk to very low‐birth‐weight ( VLBW ) infants in the first few days of life . The aim of this study was to test the hypothesis that OAC would increase salivary secretory IgA ( SsIgA ) . Patients and Methods Overall , 30 VLBW infants r and omized to receive OAC or sterile water  had salivary sampling for SsIgA on the day of life ( DOL ) 2 , 7 , and 14 . The incidence of late‐onset sepsis ( LOS ) and necrotizing enterocolitis ( NEC ) was determined prospect ively . Within and between‐group comparisons were made by paired and independent sample s t ‐tests . Results Baseline characteristics were similar between groups . SsIgA was higher in OAC versus the control group ( p < 0.05 ) on DOL 7 , but not subsequently on DOL 14 . There was no difference in LOS or NEC . Conclusion OAC  increased SsIgA at DOL 7 . A large , multicenter trial is needed to determine if OAC  decreases LOS or NEC in VLBW infants
Exposure to H2 receptor antagonists may be associated with increased risk of NEC and infections in preterm infants
BACKGROUND Inhibitors of gastric acid ( IGA ) are used for upper gastrointestinal bleeding or gastroesophageal reflux in preterm infants .
The result ant increase in gastric pH may enhance the growth of pathogens and increase the risk of necrotizing enterocolitis ( NEC ) .
Our systematic review examined the association between  IGA and NEC in preterm infants .