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Am J Perinatol 2024; 41(S 01): e2658-e2665
DOI: 10.1055/a-2140-8727
Original Article

Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey

Morcos Hanna 
1   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
Irfan Ahmad
2   Division of Neonatology, Children's Hospitals Orange County, Orange, California
,
Toby Yanowitz
3   Division of Neonatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Jae Kim
4   Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
,
Catherine Hunter
5   Division of Pediatric Surgery, Department of Surgery, Oklahoma Children's Hospital, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
,
Robert DiGeronimo
6   Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
,
Kaashif A. Ahmad
7   Department of Pediatrics, Pediatrix and Obstetrix Specialists of Houston, Houston, Texas
,
Kevin Sullivan
8   Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
9   Division of Neonatology, Nemours/AI duPont Hospital for Children, Wilmington, Delaware
,
Troy A. Markel
10   Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
,
Amy B. Hair
1   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
Hala Chaaban
11   Division of Neonatology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
,
Mohan Pammi 
1   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
Katie A. Huff
12   Division of Neonatology, Indiana University School of Medicine, Indianapolis, Indiana
,
Bonny Jasani
13   Division of Neonatology, Hospital for Sick Children, Toronto, Canada
,
Lynn Fuchs
8   Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
9   Division of Neonatology, Nemours/AI duPont Hospital for Children, Wilmington, Delaware
,
Alain Cuna
14   Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri
,
Parvesh M. Garg
15   Division of Neonatology, Wake Forest University, Winston Salem, North Carolina
,
Kristina Reber
1   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
Muralidhar H. Premkumar
1   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
,
On behalf of the Children's Hospital Neonatal Consortium Necrotizing Enterocolitis Focus Group › Author Affiliations Funding None.
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Abstract

Objective Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States.

Study Design A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact.

Results Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation.

Conclusion Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use.

Key Points

  • Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.

  • The AAP statement on probiotic use in preterm infants had a modest impact on current practices.

  • There's a need for better product regulation and consensus guidelines to ensure standardized use.

Keywords

probiotics - necrotizing enterocolitis - preterm infants - NICU

Authors' Contributions

M.H. and M.H.P. contributed to the conceptualization and design of this study, collection of data, and analysis of the results, drafted the initial manuscript, and critically reviewed and revised the manuscript. I.A., T.Y., J.K., C.H., R.D., K.A.A., K.S., T.M., A.H., K.A.H., H.C., and K.R. contributed significantly to the conceptualization and design of this study, analyses, and critically reviewed and revised the manuscript. M.P., B.J., L.F., A.C., P.M.G. carried out the analyses and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


* A complete list of group members appears in the Acknowledgments.


Supplementary Material



Publication History

Received: 19 May 2023

Accepted: 25 July 2023

Accepted Manuscript online:
26 July 2023

Article published online:
24 August 2023

© 2023. Thieme. All rights reserved.

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