{
  "abstract": "Objective To compare mortality and morbidity in extremely preterm (EPT) and/or extremely low birthweight (ELBW) infants receiving or not receiving probiotic supplementation.Design Nationwide, population-based registry study.Setting All neonatal intensive care units (NICUs) in Norway.Participants All EPT (<28 weeks)/ELBW (<1000 g) infants born between 2014 and 2021, admitted to an NICU. Infants who within the first week of life died, underwent surgery for necrotising enterocolitis (NEC) or did not receive enteral feeds or started with probiotics after the first week of life were excluded from the main analyses. Logistic regression, propensity score matching, inverse probability of treatment weighting (IPTW) and clustering analyses were applied.Main outcome measures The primary outcome was all-cause mortality after the first week of life. Secondary outcomes were surgical NEC and late-onset sepsis after the first week of life, growth and probiotic sepsis.Results Among 1596 live-born EPT/ELBW infants, 1268 were included in the main analysis and 676 (53.5%) started probiotics in the first week of life. Probiotics were associated with lower all-cause mortality (IPTW analysis; adjusted OR (aOR) 0.65, 95% CI 0.43 to 0.97), but no reduction in surgical NEC (aOR 0.83, 95% CI 0.49 to 1.43). However, in an emulated intention-to-treat scenario, high (>80%) probiotic use versus low (< 30%) was associated with a reduction in surgical NEC (aOR 0.40, 95% CI 0.19 to 0.86). We found no association between probiotics and sepsis or growth. 5 out of 858 infants (0.58%) exposed to probiotics developed probiotic-associated sepsis, all survived.Conclusion Probiotic supplementation to EPT/ELBW infants was associated with lower all-cause mortality and possibly reduced NEC.",
  "authors": [
    {
      "affiliations": [
        "Paediatric Department, Stavanger University Hospital, Stavanger, Norway",
        "Department of Clinical Science, University of Bergen, Bergen, Hordaland, Norway"
      ],
      "name": "Nina Clare Hapnes"
    },
    {
      "affiliations": [
        "Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Hans Jørgen Stensvold"
    },
    {
      "affiliations": [
        "Department of Research, Stavanger University Hospital, Stavanger, Norway"
      ],
      "name": "Ingvild Dalen"
    },
    {
      "affiliations": [
        "Department of Paediatrics and Adolescents Medicine, Haukeland Universitetssjukehus, Bergen, Norway"
      ],
      "name": "Hans Jørgen Timm Guthe"
    },
    {
      "affiliations": [
        "Department of Paediatrics, St Olav’s Hospital HF, Trondheim, Trøndelag, Norway",
        "Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology Faculty of Medicine and Health Sciences, Trondheim, Trøndelag, Norway"
      ],
      "name": "Ragnhild Støen"
    },
    {
      "affiliations": [
        "Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway",
        "Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway"
      ],
      "name": "Anne Lee Solevåg"
    },
    {
      "affiliations": [
        "Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway"
      ],
      "name": "Sissel J Moltu"
    },
    {
      "affiliations": [
        "Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway",
        "Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway"
      ],
      "name": "Arild Rønnestad"
    },
    {
      "affiliations": [
        "Research Group for Child and Adolescent Health, UiT The Arctic University of Norway, Tromsø, Norway",
        "Department of Paediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway"
      ],
      "name": "Claus Klingenberg"
    }
  ],
  "title": "Probiotics for extremely preterm infants: a Norwegian population-based study",
  "uid": "ebaf2b2b-7912-535e-8298-f0c1b89188b0"
}