EVIDENCE BASED MEDICINE

 Question:

Can prebiotic and probiotic supplementation prevent Respiratory Tract Infections (RTIs) in

preterm infants?

 PICO Analysis:

P: preterm infants

I: giving specific prebiotic and probiotic from the first day of life to the age of two months

C: giving placebo from the first day of life to the age of two months

O: the incidence of clinically defined virus-associated RTI episodes confirmed from nasal

swabs

 Search the evidence:

Luoto R, Ruuskanen O, Waris M, Kalliomäki M, Salminen S, and Isolauri E. Prebiotic and

probiotic supplementation prevents rhinovirus infections in preterm infants: A randomized,

placebo-controlled trial. The Journal of Allergy and Clinical Immunology, 2014, 133: 405-13

doi: 10.1016/j.jaci.2013.08.020
 Appraisal the study using therapy worksheet

1. Validity

a. Was the assignment randomized and concealed? YES

b. Intention to treat? YES

c. Blinding? YES
d. Equal treatment aside from experimental Rx? YES
 e. Group similar at the start of trial? YES

2. Importance

Are the results important? YES

 Yes No Drop Out Total
Experimental 14 9 8 31

group prebiotic

(E1)
Experimental 10 11 10 31

group probiotics

(E2)
Control (C) 4 20 8 32
Total 28 40 26 94

9+8 17
EER1 = = = 0,55
31 31

11+10 21
EER2 = = = 0,67
31 31
 20+8 28
CER = = = 0,875
32 32

CER−EER 1 0,875−0,55 0,325

RRR1 = =¿ = = 0,37 = 37%
CER 0,875 0,875

CER−EER 2 0,875−0,67 0,205

RRR1 = =¿ = = 0,23 = 23%
CER 0,875 0,875

ARR1 = CER – EER1 = 0,875 – 0,55 = 0,325

ARR2 = CER – EER2 = 0,875 – 0,67 = 0,205

1
NNT1 =
0,325
= 3,08

1
NNT2 =
0,205
= 4,88

3. Applicability

Our NNT = f x NNT

If f=1 so Our NNT = 3,08 and 4,88

a. Is your patient similar to the patient?

YES, our patient similar to the patient in this study.

b. Is the treatment feasible in your setting?

YES, the treatment can be done in my setting.

c. How great the benefit?

 Respiratory Tract Infections (RTIs) is one of the most frequent disease in

children and rhinovirus is the most common cause of RTIs.

 If this interventions, giving prebiotic and probiotic, can prevents Respiratory

Tract Infections especially that was caused by rhinovirus in my patients, it will

 make a great benefit because it is a simple, cost effective and safe way to

prevent that disease.

d. Will the potential benefits of treatment outweigh the potential harms of treatment

for my patient?

YES, this interventions is safe enough to be applied in my patient.

 This study is valid, important, and applicable.

 Level of Evidence: 1B