Prevention of newborn infections and systemic sepsis by using probiotics in an India rural population

“Sepsis” is a clinical syndrome characterized by systemic inflammation and circulatory compromise initiated by an infection. For those of us who have experienced working in newborn and premie nurseries, especially in county hospitals or rural settings, we know well that sepsis is a major cause of neonatal morbidity and mortality, with case fatality rates ranging from 5 to 60% –– even with antibiotic treatment. In 2o13, of the 6.3 million children worldwide who died before the age of five years old, 2.76 million were in the neonatal period, with the bulk of these in developing countries. More than 600,000 of these neonatal deaths (22%) were due to possible severe bacterial infection alone.

Whereas the term ‘sepsis’ in the developed world refers to culture-confirmed bacterial or fungal infection, it is often used interchangeably with “possible severe bacterial infection” in the developing-world setting. Lacking culture and other diagnostic facilities, all infections (including viral) are grouped into one category, and modalities for the empirical management of neonatal sepsis are unambiguous. Although the death rate of children worldwide (1–59 months) decreased by 3.4% annually from 1990 to 2012, neonatal mortality in that period only dropped by 2% per year6. In addition to prematurity, sepsis (37%) and pneumonia (5%) continue to be major contributors to deaths in the neonatal period.

No efficient means of sepsis prevention is currently available. In the attached article and editorial, authors describe a randomized, double-blind, placebo-controlled trial of an oral synbiotic preparation (Lactobacillus plantarum plus fructo-oligosaccharide) in rural Indian newborns. They enrolled 4,556 infants that were at least 2,000 g (4.4 lb.) at birth, at least 35 weeks of gestation, and with no signs of sepsis or other morbidity, and monitored them for 60 days. They found a significant decrease in the primary outcome (combination of sepsis and death) in the treatment group [risk ratio (RR) = 0.60; 95% confidence interval 0.48–0.74], with few deaths (4 placebo, 6 synbiotic). Significant reductions were also observed for culture-positive and culture-negative sepsis and lower respiratory tract infections. These results suggest that a large proportion of neonatal sepsis in developing countries could be effectively prevented using a synbiotic preparation containing L. plantarum bacterial to help support the gut microbiome in newborn children.

Nature 24 Aug 2o17; 548: 407–412 [full article] and pp 404–405 [News’N’Views editorial]

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