We occasionally have parents who request ‘alternative’ therapies for their babies in my unit, not many, as I think very often parents are rather overwhelmed by the efficacy and intensiveness of a modern NICU. On two occasions in my career I have had parents of a ‘long-stay’ patient request that we give their baby a herbal medicine. On each occasion after some discussion, and after trying to ensure that there was nothing harmful in the preparation (not an easy thing to do!), we organized to give the infant the preparation that they desired. On both occasions it was something readily available outside of the hospital for other babies, and from a probably reliable source.
More recently a parent asked us to give probiotics to her baby, an extremely immature infant who had an episode of possible NEC. The parents were users themselves of ‘alternative’ medicine and took probiotics also. The mother had been on the internet and seen the information about probiotics and NEC, and asked us, ‘if I buy some probiotics for my baby will you give them to him?’
For me the decision was easy: I had already approached our hospital committees about giving probiotics to all of our very immature infants, and had found a source of organisms that was reliable. So the response to the mother was ‘certainly’. She was very happy and then started to spread the word to other parents.
Our hospital had reasonably asked for an objective surveillance of the effects of the introduction of the probiotics and an analysis of the positive and negative effects, but while this was being prepared the situation in our NICU snowballed. Other parents asked for probiotics, I had to prepare a letter to give to all parents explaining the situation, and the hospital then got quite agitated about us giving out this letter, which helped me to finalize the plans to routinely give probiotics to infants less than 32 weeks gestation.
We had the advantage in Canada, that preparations with Health Canada approval, from approved production facilities, with registered DNA profiles etc. were available. A mixture known as Florababy (TM) has a lactobacillus rhamnosus GG, and 4 strains of bifidobacteria (B. infantis, bifidum, longum and breve). So this is what we decided to give to the babies in our unit.
The organisms are produced in a registered facility which follows “Good Manufacturing Practice” and has a proven track record with good quality control, and which has registered the DNA of the strains in the official database. The first 6 months showed a reduction in NEC, and I am just about to analyze the second 6 months.
So it is possible, in a tertiary /quaternary university teaching hospital in North America to find ways to give a product which is effective. It requires a hospital that is open to the innovation. We also have a group of infection control who were aware of the small risks of giving probiotics (possibly having patients with infections caused by the organisms), but were also well aware that the balance of the large benefit and the tiny risks was clearly in favour of the probiotics.