1633 The Effects of Synbiotics on Morbidity and Mortality in Newborns with Cyanotic Congenital Heart Disease: A Prospective Randomized Controlled Trial

Background and Aim In cyanotic congenital heart diseases (CCHD), with the changes in intestinal flora, necrotizing enterocolitis (NEC) and sepsis frequency increases. In this study, the effect of synbiotic use on morbidity and mortality in newborns with CCHD is evaluated. Methods Fifty-seven newborns with CCHD were randomly assigned to receive either synbiotic [probiotic: Bifidobacterium lactis, 5x10 colony forming unit, 30mg+prebiotic: Chicory inulin, 900 mg (1 sachet/day Maflor®, Cidex), n=29] (Group-1) or placebo (n=28) (Group-2). Synbiotic or placebo was started with the first enteral feeding after hospitalization in NICU and continued until the infants were discharged. Results There was no difference regarding the demographic and clinical features between groups. No difference was stated considering the first enteral feeding age and the time interval to reach full enteral feeding between groups. It was also observed that the duration of mechanical ventilation in Group-1 was shorter (p=0.007). Early and late clinical sepsis rate and late culture proven sepsis were lower in Group-1 (p=0.001). NEC (stage≥2) was significantly higher in Grup-2 (p=0.01). The frequency of increased gastric residuals during enteral feding was less in Group-1 (p=0.001). The mortality rate was significantly lower in Group-1 (p=0.02). In multiple regression analysis it was observed that synbiotic use reduces mortality independently from birth weight, gender and surgical attempt (p=0.01). Conclusion Introduction of synbiotics with the first enteral feeding in newborns with CCHD after hospitalization in NICU shows a positive effect on morbidity and mortality.