Vol. 5, Issue 2, Part A (2023)

Background and Objective: Bronchopulmonary dysplasia is a relatively common and severe complication of prematurity, and its pathogenesis remains ambiguous. Revolutionary advances in microbiological analysis techniques, together with the gut-lung axis hypothesis, have resulted in more studies linking gut microbiota dysbiosis to the occurrence and development of bronchopulmonary dysplasia. The present article based on findings to examine the intrinsic associations between gut microbiota and bronchopulmonary dysplasia. The gut microbiota affects bronchopulmonary dysplasia via several potential mechanisms including alteration of the gut-lung axis, promotion of inflammation and the ensuing growth effects. By evaluating the potential mechanisms, new therapeutic targets and therapeutic modalities for BPD can be identified from a microecological perspective. 
Methods: This was a prospective single center, double-blinded, placebo controlled, randomized trial done in department of Neonatology, NICU, BSMMU over 12 months period. Infants born ≤ 35 completed weeks, weighing ≤ 2000 gm admitted in NICU were included consecutively in this study. The probiotic - Each capsule contains (500 mg blend): Lactobacillus acidophilus: 2 billion cfu, Lactobacillus bulgaricus: 1 billion cfu, Bifidobacterium bifidum: 1 billion cfu, Fructo-Oligosaccharide: 100 mg and Placebo- Each capsule contains (500 mg blend) Pregelatinised Starch (Starch-1500) and/or Lactose. The study drug was dispenced in blister having one of the two identification number. The study drug provider group was assigned for the identification number and supply the study drug, which was of the same batch production. Study drug was introduced once daily along with first feeding (mixed with distilled water) by dropper or OG/NG tube and was continue till discharge. After intervention, decoding was done by drug provider group. Results was found as probiotics and placebo group. The number of study samples 59 and 60 in probiotics and placebo group. The primary outcome was the development of Bronchopulmonary dysplasia (BPD). Secondary outcomes include: feeding intolerance, mortality, time to establish full enteral feeds, days required to physiological weight gain, patent ductus arteriosus, intraventricular hemorrhage, retinopathy of prematurity, duration of hospital stay.
Results: Rates of development of BPD, mortality, feeding intolerance were statistically significant low in probiotics group than the placebo group. There was less hospital stay, less days required to reach full enteral feeds and more weight gain in probiotics group and it is statistically significant. 
Conclusions: This randomized, double blinded, placebo controlled trial has demonstrated clinically significant effects of the chosen probiotic mixture on the rate of development of BPD in LBW infants.
A large clinical trial is required to address outstanding issues regarding safety and efficacy in this vulnerable population.