Abstract
Objectives: The primary objective was to describe probiotic exposure in a nationwide cohort of very preterm infants cared for in neonatal intensive care units (NICUs) in France. Secondary outcomes were to describe prescription practices across centers and associated clinical outcomes.
Methods: This retrospective multicentre study included 18,146 infants born at less than 32 weeks of gestation and admitted to NICUs using the same Computer Prescribing Order Entry-Clinical Decision Support system, Logipren®, between January 2019 and December 2023. Linear and logistic regression assessed the association between probiotic exposure and several outcomes, adjusted for sex, gestational age, intrauterine growth restriction, and center-specific effects.
Results: The rate of probiotic exposure in the study cohort was 14.3%, and significantly decreased from 16.2% to 12.7% over the study period. Prescribing practices were highly heterogeneous in terms of: choice of probiotic strains, timing of initiation, duration of treatment, dosing regimens, and pharmaceutical formulations. Limosilactobacillus reuteri DSM 17938 (65.6%) was most frequently used, followed by Lacticaseibacillus (L.) rhamnosus lcr35 (30.0%) and L. rhamnosus GG ATCC 53103 (4.5%). Only one center prescribed the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)-recommended combination (Bifidobacterium (B.) infantis Bb-02, B. lactis Bb-12, and Streptococcus thermophilus TH-4). After multivariate analysis, mortality was significantly lower in the probiotic group (5.2% vs. 7.4%; adjusted odds ratio: 0.20, 95% confidence interval [0.15-0.26]).
Conclusions: Probiotic use in French NICUs remains limited and practice patterns are heterogeneous, with minimal adherence to ESPGHAN recommendations. These results underscore the need for standardized national guidelines and prospective trials.
Keywords: critical care; enteral nutrition; mortality; prescription; supplemental food.