A notable reduction of sepsis cases in newborns from developing countries may be achieved by using a synbiotic supplement, according to a randomized trial in over 4,500 babies in India published in Nature this week. The synbiotic treatment, a combination of probiotic bacteria and a prebiotic nutrient to support the probiotic strain, costs around US $1 per baby.

Sepsis is a severe complication of bacterial infection that results in around one million infant deaths worldwide each year, mostly in developing countries. Probiotic bacteria, which can support the immune system, have been proposed as a potential preventative treatment, but only a few small trials have focused on newborn babies.

Pinaki Panigrahi and colleagues report the outcomes of a large, randomized, placebo-controlled trial in 4,556 infants from 149 villages in the Indian province of Odisha. The community-based trial recruited local volunteers to coordinate follow up. Either a placebo or the synbiotic (fructo-oligoaccharide and Lactobacillus plantarum, a strain of bacteria selected for being effective at colonizing the gut) were administered for seven days within the first two weeks of life. After 60 days of follow up, death and sepsis occurred in 5.4% of the infants in the treatment arm versus 9% in the placebo arm (only 10 deaths occurred in total, 6 in the treatment arm and 4 in the placebo).

The authors note that their trial did not include preterm babies (under 35 weeks of gestation) or newborns with severe medical conditions at birth, who are at a higher risk for developing sepsis. More testing would be needed to determine whether the results extend to all at-risk populations of infants in developing countries.