The Effect of Enteral Nutrition with Low-Dose Lactulose on the Occurrence of Late-Onset Neonatal Sepsis in Infants with Very Low Birth Weight

Document Type : Original Article (s)

Authors

1 Associate Professor, Child Growth and Development Research Center AND Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Resident, Child Growth and Development Research Center AND Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 General Practitioner, Department of Health, Almahdi Mehr Higher Education Institute, Isfahan, Iran

Abstract

Background: This study aimed to investigate the effect of low-dose lactulose as a prebiotic on the prevention of sepsis in infants with very low birth weight.Methods: In a clinical trial study, 50 infants with very low birth weight were selected, and randomly divided into two groups of 25. The first group received low-dose lactulose feeding, and the second group received distilled water feeding as placebo. The frequency of late-onset neonatal sepsis was determined and compared between the two groups.Findings: Late onset neonatal sepsis was seen in 14.8% and 40.0% of infants in lactulose and placebo group, respectively (P = 0.040). Moreover, the time to reach full dose enteral nutrition was significantly shorter in the lactulose group (12.85 ± 3.33 days) compared to placebo group (15.20 ± 5.24 days) (P = 0.030).Conclusion: As a prebiotic in infants with very low birth weight, lactulose feeding is beneficial and without side effects in late-onset neonatal sepsis. These findings show the possible beneficial effects of prebiotics, and requires further studies with larger sample sizes.

Keywords

References

  1. Verma P, Berwal PK, Nagaraj N, Swami S, Jivaji P, Narayan S. Neonatal sepsis: Epidemiology, clinical spectrum, recent antimicrobial agents and their antibiotic susceptibility pattern. Int J Contemp Pediatr 2015; 2(3): 176-80.
  2. Montaldo P, Rosso R, Santantonio A, Chello G, Giliberti P. Presepsin for the detection of early-onset sepsis in preterm newborns. Pediatr Res 2017; 81(2): 329-34.
  3. Ohlsson A, Lacy JB. Intravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants. Cochrane Database Syst Rev 2004; (1): CD000361.
  4. Schlapbach LJ, Aebischer M, Adams M, Natalucci G, Bonhoeffer J, Latzin P, et al. Impact of sepsis on neurodevelopmental outcome in a Swiss National Cohort of extremely premature infants. Pediatrics 2011; 128(2): e348-e357.
  5. Westerbeek EA, van Elburg RM, van den Berg A, van den Berg J, Twisk JW, Fetter WP, et al. Design of a randomised controlled trial on immune effects of acidic and neutral oligosaccharides in the nutrition of preterm infants: Carrot study. BMC Pediatr 2008; 8: 46.
  6. Westerbeek EA, van den Berg JP, Lafeber HN, Fetter WP, Boehm G, Twisk JW, et al. Neutral and acidic oligosaccharides in preterm infants: A randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2010; 91(3): 679-86.
  7. Nair V, Soraisham AS. Probiotics and prebiotics: Role in prevention of nosocomial sepsis in preterm infants. Int J Pediatr 2013; 2013: 874726.
  8. Gibson GR, Roberfroid MB. Dietary modulation of the human colonic microbiota: Introducing the concept of prebiotics. J Nutr 1995; 125(6): 1401-12.
  9. Marini A, Negretti F, Boehm G, Li DM, Clerici-Bagozzi D, Mosca F, et al. Pro- and pre-biotics administration in preterm infants: Colonization and influence on faecal flora. Acta Paediatr Suppl 2003; 91(441): 80-1.
  10. Armanian AM, Sadeghnia A, Hoseinzadeh M, Mirlohi M, Feizi A, Salehimehr N, et al. The effect of neutral oligosaccharides on fecal microbiota in premature infants fed exclusively with breast milk: A randomized clinical trial. J Res Pharm Pract 2016; 5(1): 27-34.
  11. Srinivasjois R, Rao S, Patole S. Prebiotic supplementation in preterm neonates: updated systematic review and meta-analysis of randomised controlled trials. Clin Nutr 2013; 32(6): 958-65.
  12. Armanian AM, Kazemipour S, Mirbod SM, Hassanzade A. Comparison of prolonged low volume milk and routine volume milk on incidence of necrotizing enterocolitis in very low birth weight neonates. Pak J Med Sci 2013; 29(1 Suppl): 312-6.
  13. Armanian AM, Barekatain B, Hoseinzadeh M, Salehimehr N. Prebiotics for the management of hyperbilirubinemia in preterm neonates. J Matern Fetal Neonatal Med 2016; 29(18): 3009-13.
  14. Armanian AM, Mohammadzadeh M, Soleimani R, Salehimehr N, Hasanzadeh A. The duration of hospitalization and readmission rate of low birth weight infants in a tertiary referral hospital in Isfahan, Iran. Iran J neonatal 2015; 6(3): 17-21.
  15. Armanian AM, Sadeghnia A, Hoseinzadeh M, Mirlohi M, Feizi A, Salehimehr N, et al. The effect of neutral oligosaccharides on reducing the incidence of necrotizing enterocolitis in preterm infants: A randomized clinical trial. Int J Prev Med 2014; 5(11): 1387-95.
  16. De Souza Oliveira RP, Rodrigues Florence AC, Perego P, De Oliveira MN, Converti A. Use of lactulose as prebiotic and its influence on the growth, acidification profile and viable counts of different probiotics in fermented skim milk. Int J Food Microbiol 2011; 145(1): 22-7.
  17. Macfarlane S, Macfarlane GT, Cummings JH. Review article: Prebiotics in the gastrointestinal tract. Aliment Pharmacol Ther 2006; 24(5): 701-14.
  18. Riskin A, Hochwald O, Bader D, Srugo I, Naftali G, Kugelman A, et al. The effects of lactulose supplementation to enteral feedings in premature infants: A pilot study. J Pediatr 2010; 156(2): 209-14.
  19. Modi N, Uthaya S, Fell J, Kulinskaya E. A randomized, double-blind, controlled trial of the effect of prebiotic oligosaccharides on enteral tolerance in preterm infants (ISRCTN77444690). Pediatr Res 2010; 68(5): 440-5.
  20. Dilli D, Aydin B, Fettah ND, Ozyazici E, Beken S, Zenciroglu A, et al. The propre-save study: Effects of probiotics and prebiotics alone or combined on necrotizing enterocolitis in very low birth weight infants. J Pediatr 2015; 166(3): 545-51.
  21. Mihatsch WA, Hoegel J, Pohlandt F. Prebiotic oligosaccharides reduce stool viscosity and accelerate gastrointestinal transport in preterm infants. Acta Paediatr 2006; 95(7): 843-8.
Journal of Isfahan Medical School
Volume 36, Issue 510 - Serial Number 510
November and December 2019
Pages 1591-1596

Files

History

  • Receive Date: 13 October 2018
  • Revise Date:
  • Accept Date: 06 April 2022

Share

How to cite

Statistics