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Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution SurveyFunding None.
Objective Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States.
Study Design A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact.
Results Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation.
Conclusion Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use.
Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.
The AAP statement on probiotic use in preterm infants had a modest impact on current practices.
There's a need for better product regulation and consensus guidelines to ensure standardized use.
M.H. and M.H.P. contributed to the conceptualization and design of this study, collection of data, and analysis of the results, drafted the initial manuscript, and critically reviewed and revised the manuscript. I.A., T.Y., J.K., C.H., R.D., K.A.A., K.S., T.M., A.H., K.A.H., H.C., and K.R. contributed significantly to the conceptualization and design of this study, analyses, and critically reviewed and revised the manuscript. M.P., B.J., L.F., A.C., P.M.G. carried out the analyses and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
* A complete list of group members appears in the Acknowledgments.
Received: 19 May 2023
Accepted: 25 July 2023
Accepted Manuscript online:
26 July 2023
Article published online:
24 August 2023
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