lactobacillus rhamnosus

Rheumatoid arthritis (RA) is an autoimmune and inflammatory disorder and the most common type of autoimmune arthritis that causes joint inflammation and synovial membrane hypertrophy. Synovium of RA patients contains fibroblast-like synoviocytes (FLS) which contribute to cartilage degradation and inflammation through producing inflammatory cytokines. Recent researches have reported that probiotics can induce immunomodulatory activity in inflammatory disorders. Therefore, this study was conducted to investigate the effects of Lactobacillus rhamnosus and Lactobacillus delbrueckii on the FLS of RA patients.

The therapeutic effects of probiotic strains on FLS and their related molecules in RA patients were evaluated. FLS of patients with RA were cocultured for 48 h with Lactobacillus rhamnosus, Lactobacillus delbrueckii and a mixture of both probiotics. The supernatants of FLS cultured with probiotics were collected for quantification of IL-6 and TNF-α cytokines by ELISA. The mRNA expression of IL-6, TNF-α, MMP3 and RelA was examined in FLS derived from RA patients by Real Time-PCR.

Live Lactobacillus rhamnosus and Lactobacillus delbrueckii, alone and in combination, significantly increased the expression of IL-6, TNF-α, MMP3 and RelA in FLS cells (p<0.05). However, a considerable difference was not observed among the groups that were treated with these two strains of Lactobacillus.

The current research may indicate these probiotics do not alleviate the inflammatory response of FLS cells in RA patients. Further investigation is needed to evaluate the probiotic effects of these bacteria on RA.

Osteoporosis is a chronic metabolic disease that leads to decreased bone mass due to an imbalance in bone resorption/formation. The aim of this research was to evaluate the effect of Lactobacillus rhamnosus and propranolol on disorders caused by this disease.

Forty female rats (250±15 g) were divided into control and ovariectomy groups, as well as ovariectomy treated with probiotics, propranolol, and probiotics with propranolol groups. Blood parameters, concentration of parathyroid hormone, alkaline phosphatase (ALP) activity, and bone calcium (Ca) and phosphorus (P) levels were measured after the treatment period. The histopathological changes in bone were compared among the experimental groups.

No significant changes were observed in the blood parameters among the groups. Despite the significant increase in the parathyroid hormone and ALP levels in ovariectomized rats, in the treatment groups (especially treatment with both probiotics and propranolol), the level of these two factors decreased significantly. Ca and P concentrations also showed a significant increase in the treatment group with probiotics and propranolol compared to the ovariectomy group. Histopathological studies demonstrated an increase in the thickness of trabeculae, the number of bone cells, and the repair of the diaphysis in rats treated with probiotics and propranolol.

It seems that L. rhamnosus and propranolol, by inhibiting the stimulation of the sympathetic system and increasing the reabsorption of minerals from the intestine, led to the inhibition of osteoclastogenesis and the increase of the bone mineral content, followed by the improvement of disorders caused by osteoporosis.

Regarding the appropriate effect of probiotics in treating acute diarrhea and the high prevalence of non-bacterial acute diarrhea among children in the population.

The present study evaluates the effect of synbiotic drops in children with acute diarrhea, including the number of hospitalization days, daily excreted diarrhea volume, duration of diarrhea, and reduction in the number of excretions between the case and control groups.

This was a prospective double-blinded and randomized-controlled clinical trial on children aged 6 - 24 months with non-bloody acute diarrhea were included. The reason for hospitalization was diarrhea. In the case group, the patients consume PediLact (Zisttakhmir, Tehran, Iran) drop ( Lactobacillus rhamnosus , Lactobacillus reuteri , and bifidobacterium infantis ) 10 9 CFU and fructooligosaccharides. PediLact drop was used with milk or lukewarm food for five days along with other routine hospital cares. The number of hospitalization days, the daily excreted diarrhea, diarrhea duration, and decreasing numbers of excretion in patients were compared.

In the current study, 114 children were included. The duration of hospitalization was 3.87 ± 0.9 days in the synbiotic group and 4.26 ± 0.12 days in the placebo group (P-value = 0.001). The time between the onset of diarrhea and recovery was significantly higher in the placebo group than in the synbiotic group (P = 0.032). The number of evacuations was 1.89 ± 0.13 in the synbiotic group and 2.52 ± 0.18 in the placebo group (P = 0.014).

Colorectal cancer (CRC) is a prevalent form of cancer worldwide. Recent studies suggest that postbiotics derived from probiotic bacteria have the potential as an adjunct therapy for CRC. This study investigates the anti-cancer effects of Bifidobacterium breve (B. breve) and Lactobacillus rhamnosus (L. rhamnosus) postbiotics on the HT-29 cell line.

Through MTT and scratch assay, we investigated the anti-proliferation and anti-migration effects of B. breve and L. rhamnosus postbiotics on HT-29 cells. Furthermore, postbiotic-mediated apoptosis was assessed by ana- lyzing the expression of Bax, Bcl-2, and caspase-3. We also investigated the effects of B. breve postbiotics on the expression of three important genes involved in metastasis, including RSPO2, NGF, and MMP7. Consequently, we validated the expres- sion of selected genes in twelve adenocarcinoma tissues.

The results demonstrated the significant impact of postbiotics on HT-29 cells, highlighting their ability to induce anti-proliferation, anti-migration, and apoptosis-related effects. Notably, these effects were more pronounced using B. breve postbiotics than L. rhamnosus. Additionally, B. breve postbiotics could inhibit metastasis through upregulation of RSPO2 while downregulating NGF and MMP7 expression in HT-29 cells.

Our research suggests that postbiotic metabolites may be effective biological products for the prevention and treatment of cancer.

Biofilm production is an important virulence factor in Staphylococcus aureus. Most of the infections associated with biofilms of this bacterium are very difficult to treat using antibiotics. The present research studied the effects of the two probiotic Lactobacillus species L. casei and L. rhamnosus on S. aureus biofilm.

Cell‑free supernatant (CFS) extracts of L. casei ATCC 39392 and L. rhamnosus ATCC 7469 culture were prepared. The effects of sub‑minimum inhibitory concentrations of the CFS extracts on cell surface hydrophobicity (CSH), initial attachment, biofilm formation, and their ability in eradicating S. aureus ATCC 33591 biofilms were assessed. In addition, the effects of CFS extracts on expression of the genes involved in formation of S. aureus biofilms (cidA, hld, sarA, icaA, and icaR) were also evaluated through real‑time polymerase chain reaction.

CFSs of both Lactobacillus spp. significantly reduced CSH, initial attachment, and biofilm formation and eradicated the biofilms. The above findings were supported by scanning electron microscopy results. These two Lactobacillus CFSs significantly changed the expression of all studied biofilm‑related genes. Expression levels of cidA, hld, and icaR genes significantly increased by 4.4, 2.3, and 4.76 fold, respectively, but sarA and icaA genes were significantly downregulated by 3.12 and 2.3 fold.

The results indicated that CFS extracts of L. casei and L. rhamnosus had desirable antagonistic and anti‑biofilm effects against S. aureus. Consequently, carrying out further research enables us to prepare pharmaceuticals from these CFSs in order to prevent and treat infections caused by S. aureus biofilms.

Nowadays, there is a great interest in using yogurt sauce as a flavored dressing for salads and foods. The current study aimed to determine the possibility of producing probiotic yogurt sauce and evaluate its physicochemical, microbiological, sensory and rheological properties throughout refrigeration storage. Lactobacillus rhamnosus was encapsulated with sodium alginate and resistant starch using the emulsion method. The survival of free and microencapsulated L. rhamnosus was studied in simulated gastrointestinal conditions. Two forms (free and microencapsulated) of L. rhamnosus were added to the yogurt sauce. The samples were kept for 30 days at 4 ˚C and evaluated on interval days (1st, 10th, 20th, and 30th) for the above mentioned properties. Survival improvement was demonstrated in microencapsulated L. rhamnosus compared to free L. rhamnosus.  After two hours, the free form of L. rhamnosus showed five logarithmic cycles decreasing in cell viability, while microencapsulated L. rhamnosus presented only one logarithmic cycle reduction. Similarly, on day 30 of storage, the number of viable microencapsulated L. rhamnosus cells in the probiotic yogurt sauce was 6.61 log CFU/g, while the viable count for a sample containing free L. rhamnosus was 5.00 log CFU/g. The produced probiotic yogurt sauce was considered a pseudo-plastic fluid and presented mayonnaise behaviour. Moreover, samples containing microencapsulated probiotic bacteria displayed lower post-acidification values than samples containing free bacteria. The microencapsulation of probiotic bacteria improved the sensory quality of the produced probiotic yogurt sauce.  Hence, producing a probiotic yogurt sauce with desirable properties is possible.

Dendritic cells, (DCs) as one of the important immune cell populations, are responsible for the initiation, development, and control of acquired immune responses. Myeloid dendritic cells can be used as a vaccine for several autoimmune diseases and cancers. Tolerogenic probiotics with regulatory properties can affect the maturation and development of immature dendritic cells (IDC) into mature DCs with certain immunomodulatory effects. To assess the immunomodulatory effect of Lactobacillus rhamnosus and Lactobacillus delbrueckii, as two tolerogenic probiotics, in the differentiation and maturation of myeloid dendritic cells. The IDCs were derived from the healthy donors in GM-CSF and IL 4 medium. Mature DCs (MDC) were produced with L. delbrueckii, L. rhamnosus, and LPS from IDCs. Real-Time PCR and flow cytometry were used to confirm the DC maturation and to determine DC markers as well as IDO, IL10, and IL12 expression levels, respectively. Probiotic-derived DCs showed a significant reduction in the level of HLA-DR (P≤0.05), CD86 (P≤0.05), CD80 (P≤0.001), CD83 (P≤0.001), and CD1a. Also, the expression of IDO (P≤0.001) and IL10 increased while IL12 expression decreased (P≤0.001). Our findings revealed that tolerogenic probiotics could induce regulatory DCs by reducing co-stimulatory molecules along with increasing the expression of IDO and IL10 during the differentiation process. Therefore, the induced regulatory DCs probably can be used in the treatment of various inflammatory diseases.

Bacteriocins are heterogeneous inhibitory substances that could affect the bacteria belonging to the same genus. Both gram-positive and gram-negative bacteria produce bacteriocins. One of the best sources of producing bacteriocins is Lactobacillus. The aim of this study was to isolate and purify bacteriocin from Lactobacillus rhamnosus and assess its effects on Pseudomonas aeruginosa and synthesis of its lipopolysaccharide.

L. rhamnosus was prepared and cultured at MRS broth and incubated at 37ºC for 24 hours. Then, the medium was centrifuged for the isolation of bacteriocin and the supernatant was considered as bacteriocin. Antibacterial properties of different concentrations of bacteriocin (50, 100, 200, and 400 μg/mL) against P. aeruginosa were assayed by using agar diffusion and broth micro dilution methods. Also, the effect of bacteriocin against lipopolysaccharide synthesis in P. aeruginosa was analyzed by using one unit of minimum inhibitory concentration (MIC) for bacteriocin.

The results showed that all bacteriocin concentrations had antibacterial activity against P. aeruginosa. The MIC value was 31.25 μg/mL and minimal bactericidal concentration (MBC) was 62.5 μg/mL. Also, the synthesis of lipopolysaccharide decreased during P. aeruginosa growth period, and it reached zero after 5 hours.

The results of this study showed the antibacterial effect of bacteriocin isolated from L. rhamnosus against P. aeruginosa. In addition, this bacteriocin prevented the lipopolysaccharide synthesis in P. aeruginosa.

The present in vitro study aimed to evaluate whether Lactobacillus delbrueckii and Lactobacillus rhamnosus treatments can induce regulatory phenotype, together with modulating the expression of chemokine receptors (CRs) in dendritic cells (DCs). The CRs of DCs have been found to be involved in the pathogenesis of Systemic lupus erythematosus (SLE) through directing recruitment and migration of immune cells.

In brief, monocytes of patients with SLE and healthy donors were isolated and differentiated to regulatory or inflammatory mature DCs through treatment with L. delbrueckii, L. rhamnosus, mixed probiotics, and LPS. 

FACScan analysis showed that the expression of CRs including CXCR3, CCR5, CCR4, and CCR3, was significantly reduced in all probiotic-treated groups of SLE and healthy (control) donors when compared with the LPS treated group. 

The results demonstrated that tolerogenic probiotics could prevent or decrease the expression of inflammatory CRs on the surface of tolerogenic DCs during the maturation process.

Traditional fermented cereal beverages such as Obushera from sorghum and/or millet are commercialized owing to their popularity among consumers. However, Obushera separates into two phases after processing, which could be mistaken for spoilage. Additionally, Obushera has a limited shelf life of 4–7 days at room temperature. The objective of this study was to assess the potential of various stabilizers and preservatives for the production of acceptable shelf-stable Obushera.

Effects of seven treatments of 1) 0.4% xanthan gum, 2) 0.4% carboxymethyl cellulose, 3) Lactobacillus rhamnosus yoba, 4) 0.4% xanthan gum and Lactobacillus rhamnosus yoba, 5) 0.4% carboxymethyl cellulose and Lactobacillus rhamnosus yoba, 6) 0.4% xanthan gum and 0.4% carboxymethyl cellulose and Lactobacillus rhamnosus yoba, and 7) a control (no stabilizers) on sedimentation rate were assessed within 120 h at room temperature. Effects of four treatments of 1) pasteurization (90 °C for 10 min) and 0.25% xanthan gum, 2) pasteurization and 0.25% xanthan gum and 0.2% potassium sorbate and 3) pasteurization and 0.25% xanthan gum and 0.1% sodium-benzoate and 4) control (pasteurized with no additives) on shelf stability and consumer acceptability were investigated.

Treatments with xanthan (sedimentation index of 0–25%) for stabilizing Obushera were significantly (p < 0.05) more effective than those with no xanthan (sedimentation index of 49–67%). Xanthan (0.25%) significantly (p < 0.05) improved consumer acceptability of Obushera. All preservation treatments (p > 0.05) prolonged the shelf life of the beverage up to four months. No microbial growth was detected in the products during storage while pH (3.7–4.0) and acidity (0.5–0.6%) did not change significantly (p > 0.05). All products were acceptable during storage.

Obushera and related products can be stabilized and preserved using xanthan (0.25%) and pasteurization (90 °C for 10 min) with no added preservatives.

Nowadays, probiotic bacteria have been considered as a factor in the prevention and treatment of cancer, especially by induction of apoptosis. This study aimed to evaluate the cytotoxic, anti-proliferative, and apoptotic effects of the supernatant of probiotic Lactobacillus rhamnosus on HT-29 cell line.

Molecular identification of probiotic L. rhamnosus was carried out using specific primers of 16S rRNA gene and sequencing. HT-29 cells were treated with different concentrations of bacterial supernatants at 24, 48, and 72 hours. MTT assay, Annexin V-FITC, real-time PCR, cell cycle analysis, and DAPI staining tests were conducted to evaluate the induction of apoptosis. The level of cyclin D1 protein was measured by immunocytochemistry method.

The supernatant of L. rhamnosus inhibited the growth of HT-29 cancer cells in a dose- and time-dependent manner. The results of flow cytometry confirmed apoptotic cell death. Probiotic bacterial supernatant caused up-regulation of pro-apoptotic genes including caspase-3, caspase-9, and Bax. In addition, they resulted in down-regulation of Bcl2 and a decrease in expression levels of cyclin D1, cyclin E, and ERBB2 genes. Cancer cells were arrested in the G0/G1 phase of the cell cycle. The results of immunocytochemistry showed significant down-regulation of cyclin D1 protein during the 48 hours treatment with bacterial supernatant compared to the untreated cells.

The supernatant of probiotic L. rhamnosus has a great potential to inhibit the proliferation of HT-29 cells and the induction of apoptosis. L. rhamnosus might be used as a biological anti-cancer factor in the prevention and treatment of colon cancer.

Biofilm formation is a pathogenicity factor of Pseudomonas aeruginosa, which causes inherent resistance to a wide range of antibiotics in the strains. The present study aimed to compare the inhibitory effects of Glycyrrhiza glabra (licorice) extract, iron oxide nanoparticles, and Lactobacillus rhamnosus suspension on a biofilm composed of P. aeruginosa in various levels of glass, wood, and polysteel. This descriptive, cross-sectional study assessed the effects of Glycyrrhiza glabra extract, iron oxide nanoparticles, and Lactobacillus rhamnosus suspension on the standard biofilm of P. aeruginosa 1601PTCC on glass, steel, and wood surfaces. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were also calculated. The obtained results showed that each antimicrobial agent had different effects on P. aeruginosa, and the MIC and MBC exerted inhibitory properties. In addition, the largest inhibition zone diameter was 28 mL due to the effect of the Glycyrrhiza glabra extract on free bacteria in the volume of 180 microliters, and the highest inhibitory level was observed on the polysteel and glass surfaces with the inhibition zone diameter of 20-20.66 millimeters in the volume of 180 microliters. The highest inhibition in the bacterial biofilm was observed on the polysteel surface, and a significant difference was also denoted in this regard with the glass and wood surfaces (p <0.05). Therefore, it could be concluded that licorice (Glycyrrhiza glabra L.) had more significant antimicrobial properties compared to the iron oxide nanoparticles and Lactobacillus rhamnosus suspension.

Inhibition of biofilm formation is essential for the prevention and treatment of urinary tract infection. This study was aimed to identify the probiotic potential of Lactobacillus strains isolated from kefir and evaluate their antimicrobial and antibiofilm activities against Uropathogenic Escherichia coli</em> (UPEC). 

Twelve Lactobacillus strains were evaluated. Antimicrobial and antibiofilm activities of Cell Free Supernatant (CFS) of the Lactobacillus strains against UPEC isolates were evaluated by agar well diffusion method and crystal violet assay, respectively. Probiotic potential of selected isolates was assessed by analyzing their tolerance to acidic pH and bile salts, auto-aggregation ability, co-aggregation with Escherichia coli (E. coli)</em> and hemolytic activity. The isolates were identified by phenotypic and 16S rRNA gene sequencing.

  The CFS of all lactobacilli strains was able to inhibit UPEC isolates even after neutralization. Four out of 12 isolates inhibited the biofilm formation by UPEC in the range 62-75%. The viability under acidic condition varied among the isolates ranging from 6-89.8%. All the isolates could tolerate the 0.3% bile and eight isolates showed the adaptation time of less than 1 hr</em>. All the strains exhibited co-aggregation with E. coli</em>. Auto-aggregation was highly correlated with co-aggregation of all lactobacilli strains with E. coli</em> (r=0.889, p<0.001). The isolates with satisfactory probiotic potential and higher ability of biofilm inhibition and antibacterial activity belonged to the species Lactobacillus</em> rhamnosus</em> and Lactobacillus paracasei</em>.

All four selected probiotic strains exhibited antimicrobial and antibiofilm activities, which suggest potential applications for controlling or preventing infections caused by UPEC.

The infantile colic is one of the most common complaints in the infancy; however, limited therapeutic approaches are described in the literature. Recently probiotics have been suggested as a potential strategy in the treatment of infantile colic. We conducted this study to investigate the efficacy of probiotics in relieving colic symptoms in Iranian infants. This double-blind clinical trial was performed among 70 infants aged 3 to 16 weeks with the presumed diagnosis of infantile colic according to Wessel criteria who were breastfed or formula fed. They were assigned at random to receive Pedilact® (Bifidobacterium infantis, Lactobacillus reuteri, and Lactobacillus rhamnosus) (N=33) or placebo (N=32). Demographic data were recorded in the questionnaires at the beginning of the study. The number of daily episodes of crying and fussiness, number of weekly crying days, and duration of crying were separately analyzed on 7, 21, and 30th  days of investigation. Baseline demographic data showed no statistically significant difference between intervention and placebo groups. Infants given Pedilact® showed a significant reduction in daily episodes of crying, duration of crying, and the weekly number of crying days at the end of the treatment period compared with those receiving placebo (P=0.000). On 21th day of the study, daily episodes of fuss and crying (P=0.032) and duration of crying reduced significantly in the intervention group in comparison to the placebo group (P=0.000). Administration of Pedilact® drop significantly improved colic symptoms by reducing crying and fussing times in breastfed or formula fed in Iranian infants with colic.

It is cleared that some probiotic strains inhibit biofilm formation of oral bacteria, but its mechanisms are not clearly understood yet. It is proposed that one of the mechanisms can be biosurfactant production, a structurally diverse group of surface‑active compounds synthesized by microorganisms. Hence, this study focused on the evaluation of the anti‑biofilm and antiadhesive activities of the L. rhamnosus derived‑biosurfactant against Streptococcus mutans and its effect on gtfB/C and ftf genes expression level. In this in vitro study Lactobacillus rhamnosus ATCC7469 overnight culture was used for biosurfactant production. The biosurfactant effect on the surface tension reduction was confirmed by drop collapse method. Chemical bonds in the biosurfactant were identified by Fourier transform infrared (FTIR). Anti‑biofilm and antiadhesive activities of the biosurfactant were determined on glass slides and in 96-well culture plates, respectively. The effect of the biosurfactant on gtfB/C and ftf genes expression level was also investigated after biofilm formation, total RNA extraction, and reverse transcription by quantitative real‑time reverse transcriptase polymerase chain reaction (PCR) assay (quantitative PCR). The data were assessed by one‑way analysis of variance in the Tukey–Kramer postdeviation test for all pairs. P < 0.05 was considered statistically significant. The FTIR results of biosurfactant showed that it was protein rich. It also showed anti‑biofilm formation activity on the glass slide and antiadhesive activity till 40% on microtiter plate wells. It also showed a significant reduction (P < 0.05) in gtfB/C and ftf genes expression level. L. rhamnosus‑derived biosurfactant exhibits a significant inhibitory effect on biofilm formation ability of S. mutans due to downregulation of biofilm formation associated genes, gtfB/C and ftf. L. rhamnosus‑derived biosurfactant with substantial antiadhesive activity is suitable candidates for use in new generations of microbial antiadhesive agents.

The objective of this study was to evaluate the antimicrobial activity of the essential oil obtained from oleo-gum-resin and seeds of Ferula assa-foetida. Ferula assa-foetida plants were collected from Tabas, Yazd Province, Iran, during summer 2017. Then, essential oils were obtained from its seeds and oleo-gum-resin using hydrodistillation. Gas chromatography-mass spectrometry (GC-MS) test was performed to determine the contents of the essential oils. Four different doses of each oil were prepared (2.5, 5, 10, and 20 μg/ml), and the antimicrobial activity of each dose against four oral bacteria (Streptococcus mutans, Streptococcus sobrinus, Streptococcus sanguis, Streptococcus salivarius, and Lactobacillus rhamnosus) was evaluated using the disk diffusion method. The data were analyzed using analysis of variance (ANOVA) and Kruskal-Wallis test in SPSS 17 software. The GC-MS findings exhibited that the main compounds found in essential oils yielded from the seeds and oleo gum resin were (Z) -1-propenyl sec-butyl disulfide and (E) -1-propenyl sec-butyl disulfide. Ferula assa-foetida plant showed a significant antimicrobial effect (P<0.05). The essential oil from Ferula assa-foetida oleo-gum-resin had significantly stronger antibacterial properties compared to the essential oil from Ferula assa-foetida seeds (P<0.001). Both essential oils showed antibacterial properties similar to that of Chlorhexidine. The growth inhibition zone was significantly dependent on the essential oil concentration for all bacteria (P<0.05). Our study revealed that essential oils from seeds and oleo-gum-resin of Ferula assa-foetida have antimicrobial properties. More laboratory studies are required to reach a definitive conclusion.

Aim of the study was to analyze the use of a prophylactic multimodal anti-infective regimen including the probiotic Lactobacillus casei rhamnosus (LCR35) in critically ill term neonates with respect to complications and possible side effects.
This was a retrospective observational STROBE compliant single-center cohort study of all term infants born between 2005 and 2015 that have been admitted within the first 24 hours of life to the neonatal intensive care unit (NICU) and having been hospitalized for at least 7 days. All neonates received a standardized prophylactic anti-infective treatment with enteral probiotics (LCR35), antifungal agents, and oral gentamycin over the study time starting at the first day of life. Perinatal and neonatal data were collected for descriptive analysis. Complications of neonatal intensive care therapy included late-onset necrotizing enterocolitis (NEC), multiple organ dysfunction syndrome (MODS), ventilator associated pneumonia (VAP), antibiotic-associated diarrhea (AAD), and late-onset sepsis (LOS).
Out of 2940 neonates admitted to the neonatal wards 403 fulfilled the inclusion criteria and comprised the study population. Median gestational age was 38 weeks and birth weight 3300 grams, median length of stay 10 days; 246 (61%) neonates needed ventilatory support and 334 (83%) received antibiotic treatment. None of the neonates developed NEC, MODS, VAP, or AAD. Sixteen (4.0%) neonates developed LOS. Blood cultures were all negative for LCR. Breast milk feeding was evident in 13% (2/16) of the neonates with LOS compared to 30% (121/387) in those without LOS (P = 0.055).
Over an 11-year period use of a standardized prophylactic anti-infective regimen was safe and resulted in a very low incidence of predefined complications in critically ill term neonates.