Impact of probiotics on necrotizing enterocolitis.
A large number of randomized placebo-controlled clinical trials and cohort studies have demonstrated a decrease in the incidence of necrotizing enterocolitis with administration of probiotic microbes. These studies have prompted many neonatologists to adopt routine prophylactic administration of probiotics while others await more definitive studies and/or probiotic products with demonstrated purity and stable numbers of live organisms. Cross-contamination and inadequate sample size limit the value of further traditional placebo-controlled randomized controlled trials. Key areas for future research include mechanisms of protection, optimum probiotic species or strains (or combinations thereof) and duration of treatment, interactions between diet and the administered probiotic, and the influence of genetic polymorphisms in the mother and infant on probiotic response. Next generation probiotics selected based on bacterial genetics rather than ease of production and large cluster-randomized clinical trials hold great promise for NEC prevention.
Division of Neonatology, UC Davis School of Medicine, Ticon 2, 2516 Stockton Blvd, Sacramento, CA 95817. Electronic address: munderwood@ucdavis.edu.
Mark A
MA
Underwood
D020345:Enterocolitis, Necrotizing / Q000178:diet therapy* / Q000503:physiopathology / Q000517:prevention & control; D000069196:Gastrointestinal Microbiome / Q000276:immunology; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007263:Infusions, Parenteral; D007413:Intestinal Mucosa / Q000276:immunology / Q000382:microbiology*; D019936:Probiotics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
Bifidobacterium; Human milk oligosaccharide; Lactobacillus; Necrotizing enterocolitis; Prebiotic; Premature infant; Probiotic