We would like to thank to Kumar et al. both for their interest in our manuscript and their critical appraisal of the current trial [Citation1]. We see that there is a need for a certain clarification of the points they have raised in their letter.
We agree with Kumar et al. for their comment on the power analysis regarding invasive candidiasis [Citation1]. Rate for invasive candidiasis for preterm infants is very low in our NICU as a result of routinely usage of nystatin prophylaxis [Citation2]. Therefore, it was not possible to make power analysis for invasive candidiasis.
As for second question, colonization status among weeks for two groups did not mentioned because of confusion. If there is at least once Candida colonization occurs and/or growth of blood culture were only noted in result section. It would be better if we clearly wrote this issue in method section.
When it comes to third question, the intervention was not completely blinded because of the different number of doses per day of the drugs (L. reuteri 1 × 5 drops and nystatin 0.5 ml every 8 h). Caretakers therefore could not be blinded to the intervention [Citation3].
We suggested that [Citation3–5] further trials for prevention of necrotizing enterocolitis and Candida infection are necessary to accurately determine suitable probiotic preparations or combination, the optimal dose, the best timing of administration, and duration of treatment.
Declaration of interest
The authors have no potential conflicts of interest. Mehmet Yekta Oncel wrote the first draft of the manuscript and no any honorarium, grant, or other form of payment was given to anyone to produce the manuscript.
References
- Kumar S, Singhi S. Role of probiotics in prevention of Candida colonization and invasive candidiasis. J Matern Fetal Neonatal Med 2015. [Early online]
- Aydemir C, Oguz SS, Dizdar EA, Akar M, et al. Randomised controlled trial of prophylactic fluconazole versus nystatin for the prevention of fungal colonisation and invasive fungal infection in very low birth weight infants. Arch Dis Child Fetal Neonatal Ed 2011;96:F164–8
- Oncel MY, Arayici S, Sari FN, et al. Comparison of Lactobacillus reuteri and nystatin prophylaxis on Candida colonization and infection in very low birth weight infants. J Matern Fetal Neonatal Med 2014;9:1–5
- Oncel MY, Sari FN, Arayici S, et al. Lactobacillus Reuteri for the prevention of necrotising enterocolitis in very low birthweight infants: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2014;99:F110–15
- Oncel MY, Erdeve O, Dilmen U. Probiotics for necrotizing enterocolitis: not always a success story. J Pediatr 2014;165:417