Probiotics Help in Congenital Heart Disease
Published: Sep 16, 2013 | Updated: Sep 16, 2013, By Nancy Walsh, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
The oral administration of probiotic products to infants with cyanotic congenital heart disease was associated with improved outcomes, including better survival, a Turkish randomized study found.
Among 100 infants given Bifidobacterium lactis plus inulin or placebo, 8% of the active treatment group developed sepsis compared with 28% of the placebo group (P=0.01), according to Dilek Dilli, MD, and colleagues from the Dr. Sami Ulus Maternity and Children Research and Training Hospital in Ankara.
Use of the probiotic also appeared protective against necrotizing enterocolitis (NEC), as five cases occurred in the placebo group and none in the active treatment group. Moreover, mortality was almost three times higher in the placebo group (28% versus 10%, P=0.04), the researchers reported online in Pediatrics.
Children with congenital heart disease often have major surgery and long hospital stays that can increase their risk of sepsis, and those with cyanotic heart conditions have a high incidence of necrotizing enterocolitis, possibly because of alterations in mesenteric blood flow.
"Although the exact pathogenesis of NEC in infants with [cyanotic congenital heart disease] is not clear, it is likely that both the acute mesenteric blood-flow reduction and chronic cyanosis may alter the development of the gut microbiota and the integrity of the gut barrier, increasing risk for NEC," explained Dilli and colleagues.
Previous research has suggested that various effects of probiotics could be beneficial in these infants, through mechanisms such as alteration of cytokine expression, enzyme secretion, and inducing local and systemic immune and hormonal responses.
In addition, premature infants given probiotics have had lower rates of NEC.
To see if the administration of a probiotic-containing formulation could help introduce a healthy microbiota and protect against infection and NEC in these high-risk infants, the researchers gave half of their patients the active product, which contained 5 x 109 colony forming units of Bifidobacterium lactis plus inulin, 900 mg, or placebo in the form of maltodextrin.
The probiotic plus inulin, a prebiotic, is known as a synbiotic, because the combination has synergistic effects.
The most common type of cyanotic congenital heart disease was obstruction of the right ventricular outflow tract, seen in slightly more than half.
The median time the probiotic or placebo was given was 19 days. Mechanical ventilation was needed longer in the placebo group (5 versus 3 days, P=0.004), and the amount of time needed for total parenteral nutrition also was longer (12.5 versus 7 days, P=0.001).
For culture-proven sepsis, the number needed to treat was 7 (95% CI 4-68), while the numbers needed to treat to prevent NEC and death were 10 (95% CI 5-111) and 6 (95% CI 3-40), respectively.
In a multivariate analysis that included factors such as birth weight, Apgar score, blood transfusions, breast milk feeding, probiotic use halved the mortality risk (OR 0.5, 95% CI 0.25-0.93).
The gastrointestinal commensal bacteria that healthy babies acquire shortly after birth are crucial in the development of the immune system, but this colonization can be impaired in infants who remain in the hospital, allowing the possibility that the beneficial organisms may be replaced by pathogenic ones, the researchers explained.
"Although the underlying mechanisms of probiotics are still unclear, they may include strengthening of the non-immunologic gut barrier, interference with pathogen adhesion and growth inhibition, and the enhancement of the local mucosal immune system in the gut, as well as of the systemic immune response," they wrote.
Limitations of the study were the small number of enrollees and the inclusion of various types of cyanotic congenital heart disease.
Additional larger randomized studies should be undertaken to support the findings of this trial, they concluded.
The authors reported no financial conflicts.
Primary source: Pediatrics
Source reference: Dilli D, et al "Treatment outcomes of infants with cyanotic congenital heart disease treated with synbiotics" Pediatrics 2013; DOI: 10.1542/peds.2013-1262.