Probiotics in the Prevention of Necrotizing Enterocolitis
- 1 November 2011
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Clinical Gastroenterology
- Vol. 45, S133-S138
- https://doi.org/10.1097/mcg.0b013e318228b799
Abstract
Necrotizing enterocolitis (NEC) is a common gastrointestinal inflammatory necrosis affecting almost exclusively premature infants usually after oral nutrition has been started, for example, 10 day plus postpartum. Although the pathogenesis is incompletely understood, major risk factors include prematurity and incomplete bacterial colonization. Evidence has been shown that the premature infant because of rapid passage through the birth canal or because of delivery by cesarean section has an inadequate initial ingestion of maternal colonic and vaginal flora and therefore, an inadequate initial colonization with less diversity of bacteria phylla and fewer species of bacteria in the microbiota. As a result, they are more susceptible to environmental pathogens. In addition, prematures have immature intestinal defenses (glycocalyx, tight junctions, innate immune response, etc.) resulting in excessive inflammation in response to luminal stimuli. Recently, we reported that genes mediating the innate inflammatory immune response are developmentally expressed with an increase in toll-like receptors, signaling molecules and transgenic factors and decreased negative regulators of inflammation, which undoubtedly contribute to an excessive inflammatory response. Several clinical studies have suggested that the use of probiotics and ingestion of expressed maternal breast milk containing probiotics can help to stabilize colonization and to reduce the incidence and severity of NEC when given to premature infants at risk. Meta-analyses of multiple small studies strongly suggest a protective effect in the use of probiotics. A multicenter study in Taiwan suggests that Bifidobacteria infantis and Lactobacillus acidophilus in combination may prevent NEC. These meta-analyses suggest that these probiotics should be used in routine care of premature infants. Other clinicians, however, suggest caution, holding out for a single protocol multicenter trial before routine use can be suggested.Keywords
This publication has 84 references indexed in Scilit:
- The Mechanism of Excessive Intestinal Inflammation in Necrotizing Enterocolitis: An Immature Innate Immune ResponsePLOS ONE, 2011
- Necrotizing EnterocolitisThe New England Journal of Medicine, 2011
- Neurodevelopment of Extremely Preterm Infants who had Necrotizing Enterocolitis with or without Late BacteremiaThe Journal of Pediatrics, 2010
- Intestinal Microbial Ecology in Premature Infants Assessed with Non–Culture-Based TechniquesThe Journal of Pediatrics, 2010
- The gut microbiota shapes intestinal immune responses during health and diseaseNature Reviews Immunology, 2009
- 16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitisThe ISME Journal, 2009
- Effects of Bifidobacterium lactis Bb12 Supplementation on Intestinal Microbiota of Preterm Infants: a Double-Blind, Placebo-Controlled, Randomized StudyJournal of Clinical Microbiology, 2006
- Obesity alters gut microbial ecologyProceedings of the National Academy of Sciences of the United States of America, 2005
- Negative regulation of Toll-like receptor-mediated immune responsesNature Reviews Immunology, 2005
- Gastrointestinal host defense and necrotizing enterocolitisThe Journal of Pediatrics, 1990