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Systematic Review
Probiotics for preventing neonatal sepsis in preterm neonates: a systematic review and meta-analysis for clinical practice
Rizka Maulida, Radhian Amandito, Rinawati Rohsiswatmo, Amarila Malik
Epidemiol Health. 2025;47:e2025051.   Published online September 3, 2025
DOI: https://doi.org/10.4178/epih.e2025051
  • 4,945 View
  • 163 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Late-onset sepsis (LOS), occurring after 72 hours of birth, is a significant cause of morbidity and mortality especially in preterm neonates. Probiotics have been proposed as a preventive strategy to enhance gut health, modulate immune responses, and reduce the incidence of neonatal sepsis. We aimed to evaluate the effectiveness of probiotics in preventing neonatal sepsis in preterm neonates, with particular attention to the impact of different strains and dosage regimens. Eligible studies included preterm neonates (≤36 weeks gestational age) with culture-proven LOS and focused on probiotic supplementation. Comprehensive searches were conducted in MEDLINE via PubMed, Cochrane CENTRAL, Scopus, and ProQuest up to July 28, 2024. The Revised Cochrane Risk of Bias Tool (RoB 2.0) was applied to assess study quality, and a random-effects meta-analysis was performed using Review Manager version 5.4. Additionally, the certainty of the body of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Thirty-one studies including 8,040 preterm neonates were reviewed. Meta-analysis demonstrated that probiotics significantly reduced the incidence of LOS (pooled risk ratio [RR], 0.83; 95% confidence interval [CI], 0.72 to 0.95). Greater efficacy was observed with multistrain formulations (RR, 0.76; 95% CI, 0.72 to 0.95) and low-dose regimens (RR, 0.72; 95% CI, 0.56 to 0.91). Probiotic supplementation was also associated with shorter hospital stays and a trend toward lower mortality, although the latter did not reach statistical significance. To effectively reduce LOS in preterm neonates, specific combinations of multistrain probiotics and optimized dosing strategies may provide the most benefit.
Summary
Key Message
• Late-onset sepsis (LOS) is a major cause of morbidity and mortality in preterm neonates, and the optimal approach for using probiotics to prevent LOS remains uncertain. • Probiotics significantly reduce LOS risk (RR, 0.83; 95% CI, 0.72 to 0.95), with multistrain (RR, 0.76; 95% CI, 0.72 to 0.95) and low-dose formulations (RR, 0.72; 95% CI, 0.56 to 0.91) showing greater efficacy. Supplementation shortens hospital stays. • These findings support the use in probiotics in neonatal care, as they enhance immune defense and reduce infection burden. • This study informs clinical guidelines and highlights probiotics’ potential to improve neonatal outcomes and reduce healthcare costs.
Brief Communication
Prophylactic efficacy of probiotics on travelers’ diarrhea: an adaptive meta-analysis of randomized controlled trials
Jong-Myon Bae
Epidemiol Health. 2018;40:e2018043.   Published online August 29, 2018
DOI: https://doi.org/10.4178/epih.e2018043
  • 37,230 View
  • 502 Download
  • 24 Web of Science
  • 25 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The 2017 guideline for the prevention of travelers’ diarrhea (TD) by the International Society of Travel Medicine suggested that ‘there is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat TD.’ However, a meta-analysis published in 2007 reported significant efficacy of probiotics in the prevention of TD (summary relative risk [sRR], 0.85, 95% confidence interval [CI], 0.79 to 0.91). This study aimed to synthesize the efficacy of probiotics on TD by updating the meta-analysis of double-blind, placebo-controlled, randomized human trials.
METHODS
The search process was conducted by the adaptive meta-analysis method using the ‘cited by’ and ‘similar articles’ options provided by PubMed. The inclusion criteria were double-blind, placebo-controlled, randomized human trials with hypotheses of probiotics as intervention and TD as an outcome. The adaptive meta-analysis was conducted using Stata software using the csi, metan, metafunnel, and metabias options.
RESULTS
Eleven articles were selected for the meta-analysis. The sRR was 0.85 (95% CI, 0.79 to 0.91) and showed statistical significance. There was no heterogeneity (I-squared=28.4%) and no publication bias.
CONCLUSIONS
Probiotics showed statistically significant efficacy in the prevention of TD.
Summary
Korean summary
활생제가 여행자설사를 예방하는 효과가 있는가에 대한 기존 메타분석결과들과 지침간의 괴리가 확인되어서 갱신용 메타분석을 수행하였다. 총 11편의 무작위배정, 위약대조비교 임상시험결과에 대한 메타분석결과 통계적으로 유의한 효과가 있는 것으로 산출되었다 (summary relative risk =0.85; 95% confidence interval: 0.77-0.91).

Citations

Citations to this article as recorded by  
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