Assessment of the role of probiotics in prevention of ventilator-associated pneumonia in neonates.

Purpose: Ventilator-associated pneumonia (VAP) is a severe complication in NICUs. It increases morbidity, mortality, and healthcare costs. The research purpose was to evaluate the preventive value of probiotics on the incidence of VAP among ventilated neonates.

Methods: This prospective randomized controlled study was done at the NICU of Tanta University Hospitals for one year. Eighty full-term neonates who required invasive mechanical ventilation for over 48 h were randomly divided into a probiotic group (n = 40) and a non-probiotic group (n = 40). Besides the standard treatment that was given to both groups, the probiotic group received a sachet containing 1 × 10 CFU of lactic acid bacteria twice a day, starting from the 1st day of recruitment until discharge. Neonates were screened for VAP incidence based on clinical and laboratory evidence.

Results: The incidence of VAP was significantly lower in the probiotics group (20%) compared to the non-probiotic group (47.5%) with an OR of 0.28 (95% CI: 0.10-0.75). Additionally, administration of probiotics was associated with a significantly lower incidence of feeding intolerance, vomiting, and abdominal distension (17.5%, 12.5%, and 10.0% vs. 44.0%, 40.0%, and 44.0% in probiotic and non-probiotic groups, respectively) with OR = 0.26, 0.21, and 0.18, respectively. On the other hand, there was a significantly shorter duration of mechanical ventilation in the probiotic group over the non-probiotic group (MD = 10 days, 95% CI: 6.30-13.70). Similarly, NICU stay was significantly shorter in the probiotic group compared to the non-probiotic group (MD = 8 days, 95% CI: 3.29-12.71).   Conclusion Probiotics seem to be effective in the prevention of VAP among mechanically ventilated neonates.

Clinical Trial Registration: Clinicaltrials.gov/ NCT07001163; registered May 23, 2025.

What Is Known: • VAP is a common and serious nosocomial infection in mechanically ventilated neonates, associated with prolonged hospitalization and increased mortality • Current VAP preventive strategies focus on infection control and supportive care measures • In neonatal care, probiotics have shown efficacy in reducing necrotizing enterocolitis (NEC) and late-onset sepsis incidence in preterms What is new: • Probiotics have shown potential in enhancing mucosal barrier function, competing with pathogenic bacteria, and supporting systemic immune responses. Therefore, probiotic supplementation could have clinical efficacy in the prevention of VAP in NICUs.