Prebiotic supplementation in full-term neonates: a systematic review of randomized controlled trials.
OBJECTIVE
To systematically review randomized controlled trials evaluating the efficacy and safety of prebiotic supplementation in full-term neonates.


METHODS
Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL databases and proceedings of relevant conferences.


METHODS
Eleven of 24 identified trials (n = 1459) were eligible for inclusion. Intervention Trials comparing formula milk supplemented with or without prebiotics, commenced at or before age 28 days and continued for 2 weeks or longer.


METHODS
Stool colony counts (bifidobacteria, lactobacilli, and pathogens), pH, consistency, frequency, anthropometry, and symptoms of intolerance.


RESULTS
Six trials reported significant increases and 2 reported a trend toward increases in bifidobacteria counts after supplementation. Meta-analysis estimated significant reduction in stool pH in infants who received prebiotic supplementation (weighted mean difference, -0.65; 95% confidence interval, -0.76 to -0.54; 6 trials). Infants who receive a supplement had slightly better weight gain than did controls (weighted mean difference, 1.07 g; 95% confidence interval, 0.14-1.99; 4 trials) with softer and frequent stools similar to breastfed infants. All but 1 trial reported that prebiotic supplementation was well tolerated. In that trial, diarrhea (18% vs 4%; P = .008), irritability (16% vs 4%; P = .03), and eczema (18% vs 7%; P = .046) were reported more frequently by parents of infants who received prebiotic supplements.


CONCLUSIONS
Prebiotic-supplemented formula is well tolerated by full-term infants. It increases stool colony counts of bifidobacteria and lactobacilli and results in stools similar to those of breastfed neonates without affecting weight gain. Larger trials with long-term follow-up are needed to determine whether these short-term benefits are sustained.
Rao
Shripada
S
Department of Neonatal Pediatrics, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Perth, Western Australia 6008, Australia. Shripada.Rao@health.wa.gov.au
Srinivasjois
Ravisha
R
Patole
Sanjay
S
D000886:Anthropometry; D001644:Bifidobacterium / Q000302:isolation & purification; D019587:Dietary Supplements; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D041943:Infant Formula; D007231:Infant, Newborn; D007778:Lactobacillus / Q000302:isolation & purification; D008297:Male; D019936:Probiotics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic