title: Prophylactic probiotics reduce cow's milk protein intolerance in neonates after small intestine surgery and antibiotic treatment presenting symptoms that mimics postoperative infection.
abstract: BACKGROUND
  To examine occurrence of cow's milk protein intolerance (CMPI) in newborns that underwent small intestine surgery and the clinical profiles of those newborns with postoperative CMPI, and to evaluate the preventive effects of probiotics on CMPI.
  
  
  METHODS
  We retrospectively reviewed from 2000 to 2009, a total of 30 newborns required surgery on their small intestines. All of these patients had received antibiotics to prevent postoperative infection. Since 2005 we adopted a protocol of targeted probiotic therapy prophylaxis.
  
  
  RESULTS
  Eighteen patients received probiotic therapy, while twelve did not. One infant among those eighteen patients and eight patients among those twelve developed CMPI, a significantly lower rate for the group with probiotic therapy than that without it (p < 0.001). Patients with positive cultures for gram positive and gram negative organisms increased in number before and after surgery but then decreased after probiotics treatment. Poor weight gain, gastrointestinal symptoms, and rise in C reactive protein (CRP) levels were observed in all of those nine CMPI patients. Specific IgE antibodies were elevated in four of the nine subjects, and total IgE levels were elevated in seven of them. All CMPI patients had increased level of CRP without proven infections.
  
  
  CONCLUSIONS
  CMPI was induced in newborns after surgery on their small intestines and antibiotics treatment with presentation of symptoms that mimic postoperative infection. Development of CMPI in this population possibly involves disruption of intestinal flora. Administration of probiotics can reduce the incidence of CMPI after small intestine surgery. The elevated CRP level may be useful in the diagnosis of CMPI.
authors.affiliation: Division of Neonatal Medicine, Center for Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan. s_ezaki@saitama−med.ac.jp
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ezaki
authors.forename: Kanako
authors.initials: K
authors.lastname: Itoh
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kunikata
authors.forename: Keiji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Hisanori
authors.initials: H
authors.lastname: Sobajima
authors.forename: Masanori
authors.initials: M
authors.lastname: Tamura
mesh_terms: D000818:Animals; D019072:Antibiotic Prophylaxis; D002417:Cattle; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007421:Intestine, Small / Q000601:surgery*; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008894:Milk Proteins / Q000276:immunology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D019936:Probiotics / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008894:Milk Proteins