This study examines the effect of oral probiotic treatment to newborns on preventing hospitalizations, death and colonization with Extended-spectrum beta-lactamase-producing Gram negative bacteria. Half of the babies will receive 4 weeks treatment with an oral mixture of the probiotic Labinic (R) while the other half will receive a placebo mixture.
Studies show that probiotics given to prematurely born babies prevents sepsis and is widely used in the western world for this purpose. Probiotics consists of one or more normal gut-bacteria. A large study in India showed that giving probiotics to full-born babies reduced hospitalizations and morbidity. This study investigates giving a probiotic mixture with different combination of bacteria, Lactobacillus acidophilus, Bifidobacterium infantis and Bifidobacterium breve, for a longer duration (4 weeks instead of 7 days). Infections with antibiotic-resistant bacteria is a major threat to health-care world-wide, and sepsis/severe infection caused by such bacteria is a major cause of neonatal death. The study hypothesis is that giving probiotics to newborns prevents them from getting colonized with antibiotic-resistant bacteria, such as Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE). By preventing colonization with ESBL-PE, severe infections such as sepsis may be prevented, and thereby survival may be improved.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
QUADRUPLE
Enrollment
2,000
Labinic (R) probiotic mixture containing Lactobacillus acidophilus and Bifidobacterium infantis and B. breve
Placebo mixture
Haydom Lutheran Hospital
Babati, Manyara Region, Tanzania
Composite outcome hospitalization and death
Primary outcome is hospitalization and/or death of study subject
Time frame: 6 months from inclusion
ESBL colonization
Faecal colonisation with Extended-spectrum beta-lactamase-producing Enterobacteriaceae as detected by fecal swab
Time frame: 6 weeks and 6 months
Hospitalisation
Hospitalisation
Time frame: 6 weeks and 6 months
Death
Death during study period
Time frame: 6 months
Body weight
Growth monitored by weight
Time frame: 6 months
Body length
Growth monitored by length
Time frame: 6 months
Stool microbiota
Stool microbiota composition including resistome analysis (metagenome sequencing)
Time frame: 6 weeks and 6 months
Stool metabolome
Stool metabolome composition
Time frame: 6 weeks and 6 months
Stool inflammatory markers - Calprotectin
Levels of Calprotectin in participants' stool samples
Time frame: 6 weeks and 6 months
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Stool inflammatory markers - alpha-1 antitrypsin
Levels of alpha-1 antitrypsin (AAT) in participants' stool samples
Time frame: 6 weeks and 6 months
Stool inflammatory markers - myeloperoxidase
Levels of human myeloperoxidase (MPO) in participants' stool samples
Time frame: 6 weeks and 6 months
Number of participants with culture-confirmed bacteremia
Bacteremia confirmed by blood culture
Time frame: 6 months
Genetic characteristics of ESBL-producing Enterobacteriaceae
Genetic characteristics of ESBL-E from colonization and clinical samples (targeted screening)
Time frame: 6 weeks and 6 months