title: Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis.
abstract: Necrotizing enterocolitis (NEC) is a devastating intestinal disease in preterm infants characterized by barrier disruption, intestinal microbial dysbiosis, and persistent inflammation of the colon, which results in high mortality rates. Current strategies used to manage this disease are not sufficient, although the use of human breast milk reduces the risk of NEC. Mother's milk is regarded as a fundamental nutritional source for neonates, but pasteurization of donor breast milk affects the composition of bioactive compounds. Current research is evaluating the benefits and potential pitfalls of adding probiotics and prebiotics to pasteurized milk so as to improve the functionality of the milk and thereby reduce the burden of illness caused by NEC. Probiotics (live micro-organisms that confer health to the host) and prebiotics (nondigestible oligosaccharides that stimulate the growth of healthy bacteria) are functional foods known to mediate immune responses and modulate microbial populations in the gut. Clinical research shows strain- and compound-specific responses when probiotics or prebiotics are administered in conjunction with donor breast milk for the prevention of NEC. Despite ongoing controversy surrounding optimal treatment strategies, randomized controlled studies are now investigating the use of synbiotics to reduce the incidence and severity of NEC. Synbiotics, a combination of probiotics and prebiotics, have been proposed to enhance beneficial health effects in the intestinal tract more than either agent administered alone. This review considers the implications of using probiotic-, prebiotic-, and synbiotic-supplemented breast milk as a strategy to prevent NEC and issues that could be encountered with the preparations.
authors.affiliation: Cell Biology Program, Research Institute, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children;
authors.forename: Kathene C
authors.identifier: 0000-0002-6046-550X
authors.initials: KC
authors.lastname: Johnson-Henry
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden.
authors.forename: Thomas R
authors.identifier: 0000-0002-0190-8294
authors.initials: TR
authors.lastname: Abrahamsson
authors.affiliation: Cell Biology Program, Research Institute, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine;
authors.forename: Richard You
authors.initials: RY
authors.lastname: Wu
authors.affiliation: Cell Biology Program, Research Institute, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children; Department of Laboratory Medicine and Pathobiology, Faculty of Medicine; Department of Nutritional Sciences; and Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; and philip.sherman@sickkids.ca.
authors.forename: Philip M
authors.identifier: 0000-0002-4733-6690
authors.initials: PM
authors.lastname: Sherman
mesh_terms: D001419:Bacteria; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D006801:Humans; D008895:Milk, Human / Q000737:chemistry / Q000382:microbiology; D009359:Neonatology; D009844:Oligosaccharides; D056692:Prebiotics; D019936:Probiotics; D058616:Synbiotics
chemical_list: D009844:Oligosaccharides; D056692:Prebiotics
keywords: breast milk; functional foods; human milk oligosaccharides; inflammation; necrotizing enterocolitis; neonatology; prebiotics; premature; probiotics; synbiotics