51
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Sharpe J, Way M, Koorts PJ, Davies MW. The availability of probiotics and donor human milk is associated with improved survival in very preterm infants. World J Pediatr 2018; 14:492-497. [PMID: 29951973 DOI: 10.1007/s12519-018-0168-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/29/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND To determine whether the introduction of pasteurized donor human milk and probiotics for infants born < 32 weeks gestational age or < 1500 g birthweight is associated with a reduction in mortality and the incidence of necrotising enterocolitis (NEC) and sepsis. METHODS We performed a retrospective analysis of two cohorts: before and after the introduction of probiotics and pasteurised donor human milk. Univariate analysis of primary and secondary outcomes was performed; variables impacting outcomes were assessed using multivariate logistic regression. RESULTS There were 1791 infants: 1334 in the pre-donor milk/probiotic cohort and 457 in the post-donor milk/probiotic cohort. On univariate analysis, mortality (7.6 vs. 2.4%, P < 0.001) and incidence of sepsis (6.2 vs. 3.5%, P = 0.028) were statistically significantly lower in the post-donor milk/probiotic group. NEC (2.8 vs. 1.5%, P = 0.14) and non-NEC associated gastrointestinal perforation (1.6 vs. 0.4%, P = 0.052) were lower in the post-donor milk/probiotics cohort, but these were not statistically significant. The difference in mortality remained statistically significant on multivariate analysis in the post-donor milk/probiotic cohort compared to those in the pre-donor milk/probiotic cohort (odds ratio 0.31, 95% confidence interval 0.16-0.61). The decrease in the incidence of NEC was consistent with previous observational studies but the difference was not statistically significant. CONCLUSION The availability of probiotics and pasteurised donor human milk is associated with a reduction in mortality in very preterm infants.
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Affiliation(s)
- Janet Sharpe
- Grantley Stable Neonatal Unit, Department of Neonatology, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, 4029, Australia
| | - Mandy Way
- Queensland Institute of Medical Research and Royal Brisbane and Women's Hospital Statistical Unit, Brisbane, QLD, Australia
| | - Pieter J Koorts
- Grantley Stable Neonatal Unit, Department of Neonatology, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, 4029, Australia
| | - Mark W Davies
- Grantley Stable Neonatal Unit, Department of Neonatology, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, QLD, 4029, Australia. .,Department of Pediatrics and Child Health, The University of Queensland, Brisbane, QLD, Australia.
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52
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Laing B, Barnett MPG, Marlow G, Nasef NA, Ferguson LR. An update on the role of gut microbiota in chronic inflammatory diseases, and potential therapeutic targets. Expert Rev Gastroenterol Hepatol 2018; 12:969-983. [PMID: 30052094 DOI: 10.1080/17474124.2018.1505497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The human microbiome plays a critical role in human health, having metabolic, protective, and trophic functions, depending upon its' exact composition. This composition is affected by a number of factors, including the genetic background of the individual, early life factors (including method of birth, length of breastfeeding) and nature of the diet and other environmental exposures (including cigarette smoking) and general life habits. It plays a key role in the control of inflammation, and in turn, its' composition is significantly influenced by inflammation. Areas covered: We consider metabolic, protective, and trophic functions of the microbiome and influences through the lifespan from post-partum effects, to diet later in life in healthy older adults, the effects of aging on both its' composition, and influence on health and potential therapeutic targets that may have anti-inflammatory effects. Expert commentary: The future will see the growth of more effective therapies targeting the microbiome particularly with respect to the use of specific nutrients and diets personalized to the individual.
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Affiliation(s)
- Bobbi Laing
- a Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences , The University of Auckland , Auckland , New Zealand.,b School of Nursing, Faculty of Medical and Health Sciences , The University of Auckland , Auckland , New Zealand
| | - Matthew P G Barnett
- c Food Nutrition & Health Team, Food & Bio-Based Products Group , AgResearch Limited , Palmerston North , New Zealand.,d Liggins Institute , The High-Value Nutrition National Science Challenge , Auckland , New Zealand.,e Riddet Institute , Massey University , Palmerston North , New Zealand
| | - Gareth Marlow
- f Institute of Medical Genetics , Cardiff University , Cardiff , Wales , UK
| | - Noha Ahmed Nasef
- e Riddet Institute , Massey University , Palmerston North , New Zealand.,g College of Health, Massey Institute of Food Science and Technology , Palmerston North , New Zealand
| | - Lynnette R Ferguson
- a Discipline of Nutrition and Dietetics, Faculty of Medical Health Sciences , The University of Auckland , Auckland , New Zealand.,h Auckland Cancer Research Society, Faculty of Medical and Health Sciences, Grafton Campus , The University of Auckland , Auckland , New Zealand
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53
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Strus M, Helwich E, Lauterbach R, Rzepecka-Węglarz B, Nowicka K, Wilińska M, Szczapa J, Rudnicka M, Sławska H, Szczepański M, Waśko A, Mikołajczyk-Cichońska A, Tomusiak-Plebanek A, Heczko PB. Effects of oral probiotic supplementation on gut Lactobacillus and Bifidobacterium populations and the clinical status of low-birth-weight preterm neonates: a multicenter randomized, double-blind, placebo-controlled trial. Infect Drug Resist 2018; 11:1557-1571. [PMID: 30288066 PMCID: PMC6160268 DOI: 10.2147/idr.s166348] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Probiotic bacteria administered directly after birth to preterm neonates may improve gastrointestinal function and may reduce the incidence of late-onset sepsis, which is a frequent complication in this group. Purpose The main objective of this study was to evaluate whether a new probiotic bacterial mixture of Lactobacillus rhamnosus KL53A and Bifidobacterium breve PB04 given to preterm, low-birth-weight neonates would influence composition of their gut microbiota and sepsis rates. Patients and methods This study was a multicenter, randomized, double-blind, placebo-controlled trial conducted in clinical centers of neonatal care in Poland. A probiotic or placebo preparation was given twice daily to 181 preterm low-birth-weight neonates who were eligible for enteral feeding between July 2012 and July 2013. The probiotic was given to 90 neonates, while placebo was given to 91 neonates. The gut microbiota was monitored by microbiological analysis of stool samples. Sepsis episodes were detected on the basis of clinical and laboratory findings and confirmed by blood cultures. Results Tested probiotic administration resulted in continuous increase of the Lactobacillus and Bifidobacterium counts in the gut microbiota. The applied tested strains successfully colonized the neonates gut since they were present in over 90% of stool samples, which was confirmed by molecular analysis. Regardless of the study group (probiotic or placebo), B. breve colonization correlated with lower staphylococcal sepsis incidence, which was irrespective of whether probiotics were given. No sepsis case caused by strains included in study probiotic was recorded. Conclusion Appropriately selected and characterized probiotic bacteria may be safely given to preterm neonates to normalize their distorted gut microbiota and may contribute to lower staphylococcal sepsis rates.
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Affiliation(s)
- Magdalena Strus
- Department of Microbiology, Jagiellonian University Medical College, Kraków, Poland,
| | - Ewa Helwich
- Department of Neonatology, Institute of Mother and Child, Warszawa, Poland
| | | | | | - Katarzyna Nowicka
- Department of Neonatology, Institute of Mother and Child, Warszawa, Poland
| | - Maria Wilińska
- Clinical Department of Neonatology, Independent Public Clinical Hospital CMKP, Warszawa, Poland
| | - Jerzy Szczapa
- Department of Neonatology, Gynecology and Obstetrics Clinical Hospital, Poznań, Poland
| | | | - Helena Sławska
- Department of Neonatology, Specialist Hospital No. 2, Bytom, Poland
| | - Marek Szczepański
- Clinic Department of Neonatology and Neonatal Intensive Care, University Clinical Hospital, Białystok, Poland
| | - Aneta Waśko
- Medical Department, IBSS BIOMED S.A., Kraków, Poland
| | | | | | - Piotr B Heczko
- Department of Microbiology, Jagiellonian University Medical College, Kraków, Poland,
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54
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Ma YP, Ma JY, Tong XM. [A review of the relationship between gut microbiome and necrotizing enterocolitis in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:680-685. [PMID: 30111480 PMCID: PMC7389748 DOI: 10.7499/j.issn.1008-8830.2018.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
Necrotizing enterocolitis (NEC) is a common severe gastrointestinal disease in preterm infants. The morbidity and mortality of NEC are negatively correlated with the gestational age and birth weight. In addition to causing a variety of gastrointestinal complications, NEC can also cause neurodevelopmental impairment. Recently, many studies have found that gut microbiome dysbiosis plays an important part in the pathogenesis of NEC. It is helpful to explore the relationship between gut microbiome and NEC for the early diagnosis and severity prediction of NEC. Researchers have paid much attention to the role of probiotics in reducing the morbidity and mortality of NEC in preterm infants. It's controversial as to whether probiotics is effective and safe in clinical application. This article will review the relationship between the development of gut microbiome and NEC in preterm infants, as well as the preventive effect of probiotics on NEC.
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Affiliation(s)
- Yuan-Pei Ma
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
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55
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Deshpande G, Athalye-Jape G, Patole S. Para-probiotics for Preterm Neonates-The Next Frontier. Nutrients 2018; 10:nu10070871. [PMID: 29976885 PMCID: PMC6073938 DOI: 10.3390/nu10070871] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/28/2018] [Accepted: 07/02/2018] [Indexed: 12/14/2022] Open
Abstract
Current evidence supports the use of probiotics in preterm neonates for prevention of necrotizing enterocolitis, mortality and late onset sepsis. Despite the strong evidence, the uptake of this intervention has not been universal due to concerns including probiotic sepsis, pro-inflammatory response and transmission of antibiotic resistance. Critically ill extremely preterm neonates with potentially compromised gut integrity are at higher risk of probiotic sepsis due to translocation. In most countries, probiotics are sold as food supplements with poor quality control. The traditional definition of probiotics as “live microorganisms” has been challenged as many experts have questioned the importance of viability in the context of the beneficial effects of probiotics. Paraprobiotics (ghost probiotics), are defined as non-viable microbial cells (intact or broken) or crude cell extracts (i.e., with complex chemical composition), which, when administered (orally or topically) in adequate amounts, confer a benefit on the human or animal consumer. Current evidence indicates that paraprobiotics could be safe alternatives to probiotics in preterm neonates. High-quality pre-clinical and clinical studies including adequately powered randomised controlled trials (RCTs) are warranted in preterm neonates to explore this new frontier.
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Affiliation(s)
- Girish Deshpande
- Department of Neonatology, Nepean Hospital, Kingswood, NSW 2747, Australia.
- Sydney Medical School Nepean, University of Sydney, Kingswood, NSW 2747, Australia.
| | - Gayatri Athalye-Jape
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, WA 6008, Australia.
| | - Sanjay Patole
- Department of Neonatology, King Edward Memorial Hospital for Women, Perth, WA 6008, Australia.
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56
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Escribano E, Zozaya C, Madero R, Sánchez L, van Goudoever J, Rodríguez JM, de Pipaon MS. Increased incidence of necrotizing enterocolitis associated with routine administration of Infloran™ in extremely preterm infants. Benef Microbes 2018; 9:683-690. [PMID: 29888655 DOI: 10.3920/bm2017.0098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We aimed to evaluate the isolation of strains contained in the Infloran™ probiotic preparation in blood cultures and its efficacy in reducing necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in extremely preterm infants. Routine use of probiotics was implemented in 2008. Infants born at <28 weeks gestational age were prospectively followed and compared with historical controls (HC) born between 2005 and 2008. Data on sepsis due to any of the two probiotic strains contained in Infloran and rates of LOS and NEC were analysed. A total of 516 infants were included. During the probiotic period (PC), none of the strains included in the administered probiotic product were isolated from blood cultures. Probiotic administration was associated with an increase in NEC stage II or higher (HC 10/170 [5.9%]; PC 46/346 [13.3%]; P=0.010). Surgical NEC was 12.1% in PC (42/346) versus 5.9% (10/170) in HC (P=0.029). Adjusting for confounders (sex, gestational age, antenatal steroids and human milk) did not change those trends (P=0.019). Overall, clinical LOS and the incidence of staphylococcal sepsis were lower in PC (172/342, 50.3, and 37%, respectively) compared with HC (102/169, 60.3 and 50.9%, respectively) (P=0.038 and P=0.003, respectively). No episodes of sepsis attributable to the probiotic product were recorded. The period of probiotic administration was associated with an increased incidence of NEC after adjusting for neonatal factors, but also with a reduction in the LOS rate.
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Affiliation(s)
- E Escribano
- 1 Department of Neonatology-Pediatrics, La Paz University Hospital, Autonomus University of Madrid, Paseo de la Castellana 261, Madrid 28046, Spain
| | - C Zozaya
- 1 Department of Neonatology-Pediatrics, La Paz University Hospital, Autonomus University of Madrid, Paseo de la Castellana 261, Madrid 28046, Spain
| | - R Madero
- 2 Biostatistics, La Paz University Hospital, Madrid, Spain.,3 Institute of Health Carlos III, Maternal and Infant Health and Development Network-SAMID, Madrid, Spain
| | - L Sánchez
- 1 Department of Neonatology-Pediatrics, La Paz University Hospital, Autonomus University of Madrid, Paseo de la Castellana 261, Madrid 28046, Spain
| | - J van Goudoever
- 4 Department of Pediatrics, VU University Medical Center, Amsterdam, the Netherlands; Department of Pediatrics, Emma Children's Hospital, AMC, Amsterdam, the Netherlands
| | - J M Rodríguez
- 5 Department of Nutrition, Food Science and Food Technology, Complutense University of Madrid, Madrid, Spain
| | - M Sáenz de Pipaon
- 1 Department of Neonatology-Pediatrics, La Paz University Hospital, Autonomus University of Madrid, Paseo de la Castellana 261, Madrid 28046, Spain.,3 Institute of Health Carlos III, Maternal and Infant Health and Development Network-SAMID, Madrid, Spain
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57
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Stinson LF, Payne MS, Keelan JA. A Critical Review of the Bacterial Baptism Hypothesis and the Impact of Cesarean Delivery on the Infant Microbiome. Front Med (Lausanne) 2018; 5:135. [PMID: 29780807 PMCID: PMC5945806 DOI: 10.3389/fmed.2018.00135] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
Numerous studies suggest that infants delivered by cesarean section are at a greater risk of non-communicable diseases than their vaginal counterparts. In particular, epidemiological studies have linked Cesarean delivery with increased rates of asthma, allergies, autoimmune disorders, and obesity. Mode of delivery has also been associated with differences in the infant microbiome. It has been suggested that these differences are attributable to the "bacterial baptism" of vaginal birth, which is bypassed in cesarean deliveries, and that the abnormal establishment of the early-life microbiome is the mediator of later-life adverse outcomes observed in cesarean delivered infants. This has led to the increasingly popular practice of "vaginal seeding": the iatrogenic transfer of vaginal microbiota to the neonate to promote establishment of a "normal" infant microbiome. In this review, we summarize and critically appraise the current evidence for a causal association between Cesarean delivery and neonatal dysbiosis. We suggest that, while Cesarean delivery is certainly associated with alterations in the infant microbiome, the lack of exposure to vaginal microbiota is unlikely to be a major contributing factor. Instead, it is likely that indication for Cesarean delivery, intrapartum antibiotic administration, absence of labor, differences in breastfeeding behaviors, maternal obesity, and gestational age are major drivers of the Cesarean delivery microbial phenotype. We, therefore, call into question the rationale for "vaginal seeding" and support calls for the halting of this practice until robust evidence of need, efficacy, and safety is available.
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Affiliation(s)
- Lisa F Stinson
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Matthew S Payne
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Jeffrey A Keelan
- Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
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58
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van Goudoever JB. Nutrition for Preterm Infants: 75 Years of History. ANNALS OF NUTRITION AND METABOLISM 2018; 72 Suppl 3:25-31. [PMID: 29635225 DOI: 10.1159/000487378] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
As technology has advanced, survival rates of preterm infants have improved dramatically. Human milk was the primary source of enteral nutrition during the early days of neonatology, but the HIV/AIDS epidemic resulted in an increased use of preterm formula. More recently, the benefits of human milk were rediscovered, resulting in increased use of donor human milk as well. The awareness that human milk does not contain the amounts of nutrients to meet the high requirements of infants born premature resulted in the development of human milk fortifiers. The development of these fortifiers is still ongoing, as are alternative methods of pasteurization of donor milk. Those initiatives will increase the use of human milk with consequently short- and long-term benefits for preterm infants.
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Happel AU, Barnabas SL, Froissart R, Passmore JS. Weighing in on the risks and benefits of probiotic use in HIV-infected and immunocompromised populations. Benef Microbes 2018; 9:239-246. [PMID: 29345159 DOI: 10.3920/bm2017.0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Probiotics are used in the prophylaxis and treatment of several conditions, including irritable bowel syndrome, diarrhoea, necrotising enterocolitis (NEC) and colic in infants. Despite the long history of probiotic use in humans, there is still significant debate about their efficacy and safety, particularly in HIV-infected and immunocompromised individuals. Here, we reviewed the safety and adverse event (AE) reporting from clinical trials that have tested probiotics in at risk populations, including HIV-infected individuals, the terminally ill and elderly, and neonates. Our analysis suggests that the benefits of probiotic therapy outweigh their potential risks in HIV-infected populations, and in the treatment of colic and NEC in low birth weight or premature neonates. Most case reports of severe AEs were in the elderly and terminally ill, or in those with additional severe medical conditions. We conclude that probiotic use, as adjunctive treatment, is effective and safe in the majority of patients including HIV-infected individuals, although special care should be taken in individuals with extreme immunosuppression and severe medical conditions in all ages.
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Affiliation(s)
- A U Happel
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925 Cape Town, South Africa
| | - S L Barnabas
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925 Cape Town, South Africa.,2 Desmond Tutu HIV Foundation, P.O. Box 13801, Mowbray, 7705 Cape Town, South Africa
| | - R Froissart
- 3 Maladies infectieuses et vecteurs: écologie, génétique, évolution et contrôle (MIVEGEC) UMR 5290, CNRS, IRD, Université Montpellier, 911 Avenue Agropolis, 34394 Montpellier, France
| | - J S Passmore
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Medical School, Anzio Road, Observatory, 7925 Cape Town, South Africa.,4 CAPRISA DST-NRF Centre of Excellence in HIV Prevention, University of KwaZulu-Natal, King George V Ave, Glenwood, Durban, 4041, South Africa.,5 National Health Laboratory Service, Private Bag X8, Sandringham 2131, Johannesburg, South Africa
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60
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Plaza-Díaz J, Ruiz-Ojeda FJ, Gil-Campos M, Gil A. Immune-Mediated Mechanisms of Action of Probiotics and Synbiotics in Treating Pediatric Intestinal Diseases. Nutrients 2018; 10:nu10010042. [PMID: 29303974 PMCID: PMC5793270 DOI: 10.3390/nu10010042] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/24/2017] [Accepted: 01/03/2018] [Indexed: 12/21/2022] Open
Abstract
The pediatric population is continually at risk of developing infectious and inflammatory diseases. The treatment for infections, particularly gastrointestinal conditions, focuses on oral or intravenous rehydration, nutritional support and, in certain case, antibiotics. Over the past decade, the probiotics and synbiotics administration for the prevention and treatment of different acute and chronic infectious diseases has dramatically increased. Probiotic microorganisms are primarily used as treatments because they can stimulate changes in the intestinal microbial ecosystem and improve the immunological status of the host. The beneficial impact of probiotics is mediated by different mechanisms. These mechanisms include the probiotics' capacity to increase the intestinal barrier function, to prevent bacterial transferation and to modulate inflammation through immune receptor cascade signaling, as well as their ability to regulate the expression of selected host intestinal genes. Nevertheless, with respect to pediatric intestinal diseases, information pertaining to these key mechanisms of action is scarce, particularly for immune-mediated mechanisms of action. In the present work, we review the biochemical and molecular mechanisms of action of probiotics and synbiotics that affect the immune system.
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Affiliation(s)
- Julio Plaza-Díaz
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain.
- Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Armilla, 18016 Granada, Spain.
- Instituto de Investigación Biosanitaria ibs GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain.
| | - Francisco Javier Ruiz-Ojeda
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain.
- Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Armilla, 18016 Granada, Spain.
- Instituto de Investigación Biosanitaria ibs GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain.
| | - Mercedes Gil-Campos
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition CB12/03/30028), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Pediatric Research and Metabolism Unit, Reina Sofia University Hospital, Maimonides Institute for Biomedical Research (IMIBIC), Av. Menendez Pidal s/n, 14010 Córdoba, Spain.
| | - Angel Gil
- Department of Biochemistry and Molecular Biology II, School of Pharmacy, University of Granada, 18071 Granada, Spain.
- Institute of Nutrition and Food Technology "José Mataix", Biomedical Research Center, University of Granada, Armilla, 18016 Granada, Spain.
- Instituto de Investigación Biosanitaria ibs GRANADA, Complejo Hospitalario Universitario de Granada, 18014 Granada, Spain.
- CIBEROBN (CIBER Physiopathology of Obesity and Nutrition CB12/03/30028), Instituto de Salud Carlos III, 28029 Madrid, Spain.
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61
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Microbiological monitoring of continuous positive airway pressure and resuscitation equipment in very-low birth weight infants. Pediatr Res 2018; 83:78-82. [PMID: 29019472 DOI: 10.1038/pr.2017.223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/29/2017] [Indexed: 11/08/2022]
Abstract
BackgroundTo investigate the colonization of respiratory equipment and the rate of respiratory infections of very-low birth weight (VLBW) infants.MethodsThe prospective study includes 26 VLBW infants on continuous airway pressure (CPAP) from September until December 2012. Swabs from respiratory equipment and colonization/infections were evaluated.ResultsA total of 603 swabs was cultured with 298 isolates; 59% of cultures from CPAP equipment (n=337; 95% confidence interval (CI; 54;64)) and 19% from ambu bags (n=51; 95% CI (14;24)) were positive. Overall, 181/201 CPAP prongs and masks hosted 221 microorganisms. Colonization on days 3 and 7 were 93% and 87%, respectively, with an increase in pathogens and a decrease in skin flora (79% vs. 68%). Comparing the 58 paired swab results from days 3 and 7 showed an increase in Gram-negative bacteria (P=0.014). Eighteen infants had positive weekly screening results, with similar colonization of CPAP equipment, dominated by Enterobacteriacae. Pneumonia was diagnosed in two infants.ConclusionOf the CPAP equipment close to the patient, 90% was colonized with microorganisms increasing during 1 week of CPAP. The pathogens were dominated by gastrointestinal bacteria, and persisted over weeks. Frequent cleaning did not prevent pneumonia, although pneumonia rates were rare.
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62
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Esaiassen E, Hjerde E, Cavanagh JP, Pedersen T, Andresen JH, Rettedal SI, Støen R, Nakstad B, Willassen NP, Klingenberg C. Effects of Probiotic Supplementation on the Gut Microbiota and Antibiotic Resistome Development in Preterm Infants. Front Pediatr 2018; 6:347. [PMID: 30505830 PMCID: PMC6250747 DOI: 10.3389/fped.2018.00347] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022] Open
Abstract
Objectives: In 2014 probiotic supplementation (Lactobacillus acidophilus and Bifidobacterium longum subspecies infantis; InfloranⓇ) was introduced as standard of care to prevent necrotizing enterocolitis (NEC) in extremely preterm infants in Norway. We aimed to evaluate the influence of probiotics and antibiotic therapy on the developing gut microbiota and antibiotic resistome in extremely preterm infants, and to compare with very preterm infants and term infants not given probiotics. Study design: A prospective, observational multicenter study in six tertiary-care neonatal units. We enrolled 76 infants; 31 probiotic-supplemented extremely preterm infants <28 weeks gestation, 35 very preterm infants 28-31 weeks gestation not given probiotics and 10 healthy full-term control infants. Taxonomic composition and collection of antibiotic resistance genes (resistome) in fecal samples, collected at 7 and 28 days and 4 months age, were analyzed using shotgun-metagenome sequencing. Results: Median (IQR) birth weight was 835 (680-945) g and 1,290 (1,150-1,445) g in preterm infants exposed and not exposed to probiotics, respectively. Two extremely preterm infants receiving probiotic developed NEC requiring surgery. At 7 days of age we found higher median relative abundance of Bifidobacterium in probiotic supplemented infants (64.7%) compared to non-supplemented preterm infants (0.0%) and term control infants (43.9%). Lactobacillus was only detected in small amounts in all groups, but the relative abundance increased up to 4 months. Extremely preterm infants receiving probiotics had also much higher antibiotic exposure, still overall microbial diversity and resistome was not different than in more mature infants at 4 weeks and 4 months. Conclusion: Probiotic supplementation may induce colonization resistance and alleviate harmful effects of antibiotics on the gut microbiota and antibiotic resistome. Clinical Trial Registration: Clinicaltrials.gov: NCT02197468. https://clinicaltrials.gov/ct2/show/NCT02197468.
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Affiliation(s)
- Eirin Esaiassen
- Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Erik Hjerde
- Department of Chemistry, Norstruct, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jorunn Pauline Cavanagh
- Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Tanja Pedersen
- Department of Paediatrics, Haukeland University Hospital, Bergen, Norway
| | - Jannicke H Andresen
- Department of Neonatal Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Siren I Rettedal
- Department of Paediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Ragnhild Støen
- Department of Paediatrics, St. Olavs University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, University of Science and Technology, Trondheim, Norway
| | - Britt Nakstad
- Department of Paediatric and Adolescents Medicine, Akershus University Hospital, Nordbyhagen, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nils P Willassen
- Department of Chemistry, Norstruct, UiT The Arctic University of Norway, Tromsø, Norway
| | - Claus Klingenberg
- Paediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
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Athalye-Jape G, Rao S, Patole S. Effects of probiotics on experimental necrotizing enterocolitis: a systematic review and meta-analysis. Pediatr Res 2018; 83:16-22. [PMID: 28949953 DOI: 10.1038/pr.2017.218] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 09/02/2017] [Indexed: 12/18/2022]
Abstract
BackgroundMeta-analyses of randomized controlled trials (RCTs) suggest that probiotics decrease the risk of necrotizing enterocolitis (NEC) in preterm infants. Many animal RCTs have evaluated probiotics for preventing NEC. We systematically reviewed the literature on this topic.MethodsThe protocol for systematic review of animal intervention studies (SYRCLE) was followed. Medline, Embase, ISI Web of Science, e-abstracts from the Pediatric Academic Society meetings, and other neonatal conferences were searched in December 2015 and August 2016. RCTs comparing probiotics vs. placebo/no probiotic were included.ResultsA total of 29 RCTs were included (Rats: 16, Mice: 7, Piglets: 3, Quail: 2, Rabbit: 1; N~2,310), with 21 reporting on histopathologically confirmed NEC; remaining 8 assessed only pathways of probiotic benefits. Twenty of the 21 RCTs showed that probiotics significantly reduced NEC. Pooling of data was possible for 16/21 RCTs. Meta-analysis using random-effects model showed that probiotics significantly decreased the risk of NEC (203/641 (31.7%) vs. 344/571 (60.2%); relative risk: 0.51; 95% confidence interval (CI): 0.42-0.62; P<0.00001; I2=44%; number needed to treat: 4; 95% CI: 2.9, 4.3).ConclusionProbiotics significantly reduced NEC via beneficial effects on immunity, inflammation, tissue injury, gut barrier, and intestinal dysbiosis.
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Affiliation(s)
- Gayatri Athalye-Jape
- Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Australia.,Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Shripada Rao
- Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Sanjay Patole
- Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
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Athalye-Jape G, Rao S, Simmer K, Patole S. Bifidobacterium breve M-16V as a Probiotic for Preterm Infants: A Strain-Specific Systematic Review. JPEN J Parenter Enteral Nutr 2017; 42:677-688. [PMID: 28796951 DOI: 10.1177/0148607117722749] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/30/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Bifidobacterium breve M-16V has been used as a probiotic in preterm infants. Probiotic strain-specific data are essential to guide clinical practice. OBJECTIVE To assess effects of B breve M-16V in preterm neonates. DESIGN A systematic review of randomized controlled trials (RCTs) and non-RCTs of B breve M-16V in preterm infants was conducted. Multiple databases, proceedings of Pediatric Academy Society, and other relevant conferences were searched in September 2016 and on January 5, 2017. RESULTS Five RCTs (n = 482) and 4 non-RCTs (n = 2496) were included. Of the 5 RCTs, 4 carried high/unclear risk of bias in many domains. Meta-analysis (fixed effects model) of RCTs showed no significant benefits on stage ≥2 necrotizing enterocolitis, late-onset sepsis, mortality, and postnatal age at full feeds. Meta-analysis of non-RCTs showed significant benefits on (1) late-onset sepsis-3 studies (n = 2452), odds ratio = 0.56 (95% CI, 0.45-0.71), P < .0001; (2) mortality-2 studies (n = 2319), odds ratio = 0.61 (95% CI, 0.44-0.84), P = .002; and (3) postnatal age at full feeds (days)-2 studies (n = 361), mean difference, -2.42 (95% CI, -2.55 to -2.3), P < .00001. There were no adverse effects from B breve M-16V. On Grading of Recommendations, Assessment, Development, and Evaluation analysis, the overall quality of evidence was deemed very low. CONCLUSIONS Current evidence is limited regarding the potential of B breve M-16V in preterm neonates. Adequately powered, preferably cluster RCTs are needed to confirm these findings.
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Affiliation(s)
- Gayatri Athalye-Jape
- Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Australia.,Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Shripada Rao
- Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Australia.,Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Karen Simmer
- Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Sanjay Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
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65
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Patel S, Chaudhari M, Kadam S, Rao S, Patole S. Standardized feeding and probiotic supplementation for reducing necrotizing enterocolitis in preterm infants in a resource limited set up. Eur J Clin Nutr 2017; 72:281-287. [PMID: 29255185 DOI: 10.1038/s41430-017-0040-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/19/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Necrotizing enterocolitis (NEC ≥ Stage II) is associated with high mortality and morbidity in preterm infants. To assess if introduction of standardized feeding regimen (SFR) and routine probiotic supplementation (RPS) was associated with reduced incidence of NEC in preterm infants in our nursery in a resource limited set up. SUBJECTS/METHODS This was a retrospective cohort study assessing the incidence of NEC ≥ Stage II before (Epoch 1: N = 144) vs. after (Epoch 2, N = 144) implementation of SFR and RPS in preterm infants < 35 weeks. RESULTS The median (IQR) gestation and birth weight in epoch 1 and epoch 2 was [32 (30, 33.5) vs. 31.5 (30, 34) weeks, p = 0.829], and [1350 (1100, 1700) vs. 1370 (1110, 1550) g, p = 0.363] respectively. Both groups had predominantly outborn infants (Epoch 1: 79.2% vs. Epoch 2: 78.2%; p = 1.00). Multivariate analysis after adjusting for potential confounders found a significantly lower incidence of NEC ≥ Stage II after implementing SFR and RPS (Epoch 1: 17.4% vs. Epoch 2:9.0%, adjusted odds ratio aOR: 0.19; 95% CI: 0.05, 0.71, p = 0.013). The incidence of the composite outcome of 'NEC or Mortality' was also significantly lower after the intervention (Epoch 1: 21.5% vs. Epoch 2: 14.6%; aOR 0.24, 95% CI: 0.07, 0.85, p = 0.027). CONCLUSIONS Introduction of SFR and RPS was associated with significant reduction in NEC ≥ Stage II and the composite outcome of NEC ≥ Stage II /mortality in preterm infants.
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Affiliation(s)
- Saurabh Patel
- Department of Neonatology, Ratna Memorial Hospital, Pune, India
| | - Mayur Chaudhari
- Department of Neonatology, Ratna Memorial Hospital, Pune, India
| | - Sandeep Kadam
- Department of Neonatology, Ratna Memorial Hospital, Pune, India.
| | - Shripada Rao
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia
| | - Sanjay Patole
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia
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Rodriguez J, Jordan S, Mutic A, Thul T. The Neonatal Microbiome: Implications for Neonatal Intensive Care Unit Nurses. MCN Am J Matern Child Nurs 2017; 42:332-337. [PMID: 29049058 PMCID: PMC5679116 DOI: 10.1097/nmc.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nursing care of the neonate in the neonatal intensive care unit (NICU) is complex, due in large part to various physiological challenges. A newer and less well-known physiological consideration is the neonatal microbiome, the community of microorganisms, both helpful and harmful, that inhabit the human body. The neonatal microbiome is influenced by the maternal microbiome, mode of infant birth, and various aspects of NICU care such as feeding choice and use of antibiotics. The composition and diversity of the microbiome is thought to influence key health outcomes including development of necrotizing enterocolitis, late-onset sepsis, altered physical growth, and poor neurodevelopment. Nurses in the NICU play a key role in managing care that can positively influence the microbiome to promote more optimal health outcomes in this vulnerable population of newborns.
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Affiliation(s)
- Jeannie Rodriguez
- Jeannie Rodriguez is an Assistant Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. She can be reached via e-mail at Sheila Jordan is a Pre-Doctoral Fellow, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Abby Mutic is a Certified Nurse Midwife, Doctoral Candidate, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA. Taylor Thul is a Doctoral Student, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
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Probiotic Supplementation in Preterm Infants Does Not Affect the Risk of Bronchopulmonary Dysplasia: A Meta-Analysis of Randomized Controlled Trials. Nutrients 2017; 9:nu9111197. [PMID: 29088103 PMCID: PMC5707669 DOI: 10.3390/nu9111197] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 12/24/2022] Open
Abstract
Probiotic supplementation reduces the risk of necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in preterm infants, but it remains to be determined whether this reduction translates into a reduction of other complications. We conducted a systematic review and meta-analysis to evaluate the possible role of probiotics in altering the risk of bronchopulmonary dysplasia (BPD). Fifteen randomized controlled trials (4782 infants; probiotics: 2406) were included. None of the included studies assessed BPD as the primary outcome. Meta-analysis confirmed a significant reduction of NEC (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.33 to 0.81, p = 0.004; random effects model), and an almost significant reduction of LOS (RR 0.82, 95% CI 0.65 to 1.03, p = 0.084). In contrast, meta-analysis could not demonstrate a significant effect of probiotics on BPD, defined either as oxygen dependency at 28 days of life (RR 1.01, 95% CI 0.91 to 1.11, p = 0.900, 6 studies) or at 36 weeks of postmenstrual age (RR 1.07, 95% CI 0.96 to 1.20, p = 0.203, 12 studies). Meta-regression did not show any significant association between the RR for NEC or LOS and the RR for BPD. In conclusion, our results suggest that NEC and LOS prevention by probiotics does not affect the risk of developing BPD in preterm infants.
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Cavallaro G, Villamor-Martínez E, Filippi L, Mosca F, Villamor E. Probiotic supplementation in preterm infants does not affect the risk of retinopathy of prematurity: a meta-analysis of randomized controlled trials. Sci Rep 2017; 7:13014. [PMID: 29026199 PMCID: PMC5638943 DOI: 10.1038/s41598-017-13465-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a vascular disorder of the developing retina in preterm infants and is a leading cause of childhood blindness. Perinatal infection plays a pathogenic role in ROP. Probiotic supplementation reduces the risk of late onset sepsis (LOS) in preterm infants but it remains to be determined whether this reduction translates into a reduction of other complications. We conducted a systematic review and meta-analysis to evaluate the possible role of probiotics in altering the risk of ROP. Eleven randomized controlled trials (4250 infants; probiotics: 2121) were included in the meta-analysis that showed a significantly decreased rate of LOS with a risk ratio (RR) of 0.807 and a 95% confidence interval (CI) of 0.705 to 0.924 (P = 0.010; fixed effects model) but could not demonstrate a significant effect of probiotics on any stage ROP (RR 1.053, 95% CI 0.903 to 1.228, P = 0.508, 4 studies), or severe ROP (RR 0.841, 95% CI 0.666 to 1.063, P = 0.148, 9 studies). Meta-regression did not show any significant association between the RR for LOS and the RR for severe ROP. In conclusion, our results suggest that infection prevention by probiotics does not affect the risk of developing ROP in preterm infants.
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Affiliation(s)
- Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, 20122, Italy
| | - Eduardo Villamor-Martínez
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, 6202 AZ, Netherlands.
| | - Luca Filippi
- Neonatal Intensive Care Unit, Medical and Surgical Feto-Neonatal Department, "A. Meyer" University Children's Hospital, 50139, Florence, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, 20122, Italy
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, 6202 AZ, Netherlands
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69
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Sohn K, Underwood MA. Prenatal and postnatal administration of prebiotics and probiotics. Semin Fetal Neonatal Med 2017; 22:284-289. [PMID: 28720399 PMCID: PMC5618799 DOI: 10.1016/j.siny.2017.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Colonization of the neonatal gut by beneficial bacteria is important for the establishment and maintenance of the mucosal barrier, thus protecting the neonate from enteric pathogens and local and systemic inflammation. The neonatal microbiome is influenced by infant diet, environment, and the maternal microbiome. Dysbiosis in pregnancy increases the risk of pre-eclampsia, diabetes, infection, preterm labor, and later childhood atopy. Dysbiosis of the neonatal gut plays an important role in colic in the term infant, in the disease processes which plague preterm infants, including necrotizing enterocolitis and sepsis, and in the long-term outcomes of neonates. Administration of enteral prebiotics, probiotics, and synbiotics during pregnancy, lactation, and postnatal life appears to be a safe and feasible method to alter the maternal and neonatal microbiome, thus improving pregnancy and neonatal outcomes.
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Affiliation(s)
| | - Mark A. Underwood
- Corresponding author. Address: Department of Pediatrics, University of California Davis School of Medicine, 2516 Stockton Blvd, Suite 253, Sacramento, CA 95817, USA. Tel.: +1 916 734 8672; fax: +1 916 456 4490. (M.A. Underwood)
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70
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Mϋller MJ, Paul T, Seeliger S. Necrotizing enterocolitis in premature infants and newborns. J Neonatal Perinatal Med 2017; 9:233-42. [PMID: 27589549 DOI: 10.3233/npm-16915130] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Necrotizing enterocolitis (NEC) is the most common acquired disease of the gastrointestinal tract (GIT) in premature infants and newborns. It is defined as an ulcerative inflammation of the intestinal wall. The clinical signs of incipient NEC are often very discrete, and range from localized intestinal symptoms to generalized signs of sepsis. NEC is classified depending on its severity into disease states according to the modified Bell's Classification. Treatment of NEC ranges, depending on its severity, from a conservative therapeutic approach to surgery with resection of the affected parts of the intestine. Mortality is considerably high in extremely small preterm infants reaching up to 42% of the affected children. Measures such as breastfeeding or alternatively nutrition with pasteurized human donor milk from a milk bank, administration of probiotics, avoidance of histamine type II receptor antagonists, and restrictive antibiotic treatment should be considered early on for prevention of NEC.
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Affiliation(s)
- M J Mϋller
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical Center Georg August University Göttingen, Germany
| | - T Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical Center Georg August University Göttingen, Germany
| | - S Seeliger
- Department of Pediatric Cardiology and Intensive Care Medicine, Medical Center Georg August University Göttingen, Germany.,St. Elisabeth Children's Hospital, Neuburg/Donau, Germany
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Härtel C, Pagel J, Spiegler J, Buma J, Henneke P, Zemlin M, Viemann D, Gille C, Gehring S, Frommhold D, Rupp J, Herting E, Göpel W. Lactobacillus acidophilus/Bifidobacterium infantis probiotics are associated with increased growth of VLBWI among those exposed to antibiotics. Sci Rep 2017; 7:5633. [PMID: 28717131 PMCID: PMC5514087 DOI: 10.1038/s41598-017-06161-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 06/08/2017] [Indexed: 12/15/2022] Open
Abstract
We performed an observational study with very-low-birth weight infants (VLBWI) ≤33 weeks of gestation born in centers of the German Neonatal Network (GNN; (total n = 8534, n = 6229 received probiotics). The primary objectives of our study were (a) to assess the effect of Lactobacillus acidophilus/Bifidobacterium infantis probiotics on growth in VLBWI during primary stay in hospital and (b) to determine whether this effect is modified by antibiotic exposure. In linear regression models the administration of probiotics was independently associated with improved weight gain [g/d; effect size B = 0.62 (95% CI: 0.37-0.87), p < 0.001], and higher growth rates for body length [(mm/d; B = 0.06 (95% CI: 0.04-0.08), p < 0.001] and head circumference [mm/d; B = 0.03, 95% CI: 0.02-0.04, p < 0.001]. This effect was pronounced in infants with postnatal exposure to antibiotics; i.e. weight gain [g/d; B = 0.66 (95% CI: 0.32-1), p < 0.001], growth rate body length [(mm/d; B = 0.09 (95% CI: 0.06-0.12), p < 0.001] and head circumference [mm/d; B = 0.04, 95% CI: 0.02-0.06, p < 0.001]. In the small subgroup that was available for analysis at 5-year-follow-up (with probiotics: n = 120 vs. without probiotics: n = 54) we noted a sustained effect of probiotics in infants who received postnatal antibiotics. Probiotics may improve growth in antibiotic-treated infants which needs to be confirmed in randomized-controlled trials.
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Affiliation(s)
- Christoph Härtel
- Department of Pediatrics, University of Lübeck, Lubeck, Germany.
| | - Julia Pagel
- Department of Pediatrics, University of Lübeck, Lubeck, Germany
| | | | - Janne Buma
- Department of Pediatrics, University of Lübeck, Lubeck, Germany
| | - Philipp Henneke
- Center for Pediatrics and Adolescent Medicine and Center for Chronic, Immunodeficiency, University Medical Center, Freiburg, Germany
| | - Michael Zemlin
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Dorothee Viemann
- Department of Neonatology, Hanover Medical School, Hanover, Germany
| | - Christian Gille
- Department of Neonatology, University of Tübingen, Tubingen, Germany
| | - Stephan Gehring
- Department of Infectious Diseases, Gastroenterology and Pediatric Intensive Care, University of Mainz, Mainz, MD, Germany
| | - David Frommhold
- Department of Neonatology, University of Heidelberg, Heidelberg, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Lubeck, Germany
| | - Egbert Herting
- Department of Pediatrics, University of Lübeck, Lubeck, Germany
| | - Wolfgang Göpel
- Department of Pediatrics, University of Lübeck, Lubeck, Germany
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Jasani B, Patole S. Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol 2017; 37:827-833. [PMID: 28358382 DOI: 10.1038/jp.2017.37] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/31/2016] [Accepted: 02/21/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A systematic review (2005) of observational studies has reported 87% reduction in the incidence of necrotizing enterocolitis (NEC) after introducing standardized feeding regimen (SFR) in preterm infants. Considering the many new studies in this field since 2005 and the continued health burden of NEC, we aimed to systematically review the incidence of NEC in preterm infants 'before' vs 'after' implementing a SFR. STUDY DESIGN PubMed, EMBASE, CINAHL and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in May 2016. Observational studies reporting incidence of NEC before and after implementing a SFR were included. Relevant data were extracted independently by two reviewers. Meta-analysis was conducted using random effects model (REM) and results rechecked with fixed effects model. RESULTS Pooled results from 15 observational studies (N=18 160) using REM showed that SFR significantly reduced the incidence of NEC (risk ratio 0.22; 95% confidence interval 0.13 to 0.36; P<0.00001; I2=74%). The results remained significant after comparing studies in two epochs (1978 to 2003 vs 2004 to 2016). CONCLUSION SFR continues to be an important tool in prevention of NEC in preterm infants.
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Affiliation(s)
- B Jasani
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, WA, Australia
| | - S Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, WA, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
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73
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Garg BD, Kabra NS. Role of amino acid supplementation in the prevention of necrotizing enterocolitis in preterm neonates – a review of current evidences. J Matern Fetal Neonatal Med 2017; 31:2349-2366. [DOI: 10.1080/14767058.2017.1342797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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74
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Abstract
Colonization of the extremely preterm infant's gastrointestinal tract and skin begins in utero and is influenced by a variety of factors, the most important including gestational age and environmental exposures. The composition of the intestinal and skin microbiota influences the developing innate and adaptive immune responses with short-term and long-term consequences including altered risks for developing necrotizing enterocolitis, sepsis, and a wide variety of microbe-related diseases of children and adults. Alteration of the composition of the microbiota to decrease disease risk is particularly appealing for this ultra-high-risk cohort that is brand new from an evolutionary standpoint.
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Abstract
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.
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Affiliation(s)
- Mark A Underwood
- Division of Neonatology, UC Davis School of Medicine, Ticon 2, 2516 Stockton Blvd, Sacramento, CA 95817.
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Kern M, Carlson NS. Current Resources for Evidence-Based Practice, March/April 2017. J Obstet Gynecol Neonatal Nurs 2017; 46:e27-e36. [PMID: 28141995 DOI: 10.1016/j.jogn.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Baumgartel KL, Groer MW, Cohen SM, Ren D, Spatz DL, Conley YP. Maternal Interleukin Genotypes Are Associated With NICU Outcomes Among Low-Birth-Weight Infants. Biol Res Nurs 2017; 19:36-44. [PMID: 27605567 PMCID: PMC5406263 DOI: 10.1177/1099800416664585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maternal interleukin (IL) single nucleotide polymorphisms (SNPs) are associated with obstetrical outcomes. Conversely, infant SNPs are associated with subsequent neonatal intensive care unit (NICU) outcomes. Little is known about relationships between maternal SNPs and neonatal outcomes. PURPOSE To examine the relationships between maternal IL genotypes and neonatal outcomes. METHODS An ancillary study was conducted among mothers ( N = 63) who delivered very low-birth-weight infants ( N = 74). Maternal DNA was extracted from breast milk and genotyped. Outcomes included fecal calprotectin, length of stay, scores for neonatal acute physiology with perinatal extension (SNAPPE-II), weight gain, oxygen needs, necrotizing enterocolitis, intraventricular hemorrhage, sepsis, retinopathy of prematurity, blood transfusions, and feeding intolerance. Multivariate analyses examined the relationships between maternal IL SNPs and outcomes, controlling for gestational age and the ratio of maternal milk to total milk. RESULTS Absence of a minor allele in 2 IL6 SNPs was associated with fecal calprotectin ( p = .0222, p = .0429), length of stay ( p = .0158), SNAPPE-II ( p = .0497), weight gain ( p = .0272), and days on oxygen ( p = .0316). IL6 genotype GG (rs1800795) was associated with length of stay ( p = .0034) and calprotectin ( p = .0213). Minor-allele absence in 2 IL10 SNPs was associated with days on oxygen ( p = .0320). There were associations between IL10 genotype TT (rs1800871) and calprotectin ( p = .0270) and between IL10 genotypes AA (rs1800872 and rs1800896) and calprotectin ( p = .0158, p = .0045). CONCLUSION Maternal IL SNPs are associated with NICU outcomes. A potential clinical application includes an antenatal risk profile to identify neonatal needs.
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Affiliation(s)
- Kelley L. Baumgartel
- Health Promotion & Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maureen W. Groer
- College of Nursing, University of South Florida, Tampa, FL, USA
- College of Medicine Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Susan M. Cohen
- Health Promotion & Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Diane L. Spatz
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Yvette P. Conley
- Health Promotion & Development, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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78
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Dermyshi E, Wang Y, Yan C, Hong W, Qiu G, Gong X, Zhang T. The "Golden Age" of Probiotics: A Systematic Review and Meta-Analysis of Randomized and Observational Studies in Preterm Infants. Neonatology 2017; 112:9-23. [PMID: 28196365 DOI: 10.1159/000454668] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Over the last few years, probiotics have been one of the most studied interventions in neonatal medicine. OBJECTIVES The aim of this work was to analyse all studies (randomized controlled trials, RCTs, and observational studies) assessing the use of probiotics in very low birth weight (VLBW) preterm infants. SEARCH METHODS A systematic literature search was conducted using PubMed, Embase, Cochrane Library, and Web of Science. The data from RCTs and observational studies were pooled and analysed separately. SELECTION CRITERIA RCTs and observational studies that enrolled VLBW infants with enteral administration of probiotics were considered. Extracted study data included probiotic characteristics and at least 1 clinical outcome (necrotizing enterocolitis [NEC], late-onset sepsis or all-cause mortality). DATA COLLECTION AND ANALYSIS Forty-four studies were eligible for our review: 30 RCTs and 14 observational studies. Severe NEC rates (stage II or more) and all-cause mortality were reduced among the probiotic groups in both the RCTs (RR 0.57, 95% CI 0.47-0.70, and RR 0.77, 95% CI 0.65-0.92, respectively) and the observational studies (RR 0.51, 95% CI 0.37-0.70, and RR 0.71, 95% CI 0.62-0.81, respectively). Furthermore, there was a 12% reduction in the risk of sepsis in RCTs and a 19% reduction in observational studies. The meta-analysis of observational studies showed a reduction in the risk of NEC in extremely low birth weight infants. However, this was not statistically significant. CONCLUSIONS This meta-analysis of RCT and observational studies found that the use of probiotics was beneficial for the prevention of severe NEC, late-onset sepsis, and all-cause mortality in VLBW infants.
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Affiliation(s)
- Elda Dermyshi
- Department of Gastroenterology, Hepatology, and Nutrition, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, PR China
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79
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Abstract
Although largely deprived from exogenous stimuli in utero, the mucosal barriers of the neonate after birth are bombarded by environmental, nutritional, and microbial exposures. The microbiome is established concurrently with the developing immune system. The nature and timing of discrete interactions between these two factors underpins the long-term immune characteristics of these organs, and can set an individual on a trajectory towards or away from disease. Microbial exposures in the gastrointestinal and respiratory tracts are some of the key determinants of the overall immune tone at these mucosal barriers and represent a leading target for future intervention strategies. In this review, we discuss immune maturation in the gut and lung and how microbes have a central role in this process.
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80
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Abstract
The probiotic definition requires the administration of an 'adequate amount' in order to obtain a health benefit. What that amount should be is not indicated. Here, an overview is given of studies that investigated the dose-response relation of probiotics in human interventions. Studies were divided in; meta-analyses, meta-analyses on specific probiotic strains, and studies testing two or more doses of a probiotic (combination) in the same study. Meta-analyses on the effect of probiotics on antibiotic associated diarrhoea (AAD) suggest a dose-response effect; for Clostridium difficile-associated diarrhoea on the other hand no dose-response was observed. For other end-points; such as necrotising enterocolitis, prevention of atopic dermatitis and slow intestinal transit, no dose-response relation was identified in meta-analyses. For prophylaxis in colorectal cancer and relief of irritable bowel syndrome, no dose-response relation was determined. However, for blood pressure, a meta-analysis observed that higher doses (greater than 1011 cfu) were more effective than lower doses. Meta-analyses of specific strains suggest a break-point for effectiveness of Lactobacillus rhamnosus GG in the treatment of acute gastroenteritis in children; no dose-response was observed for two other probiotics assessed. Studies comparing two or more doses indicate that faecal recovery and risk reduction of AAD follow a positive dose-response relationship. Other end-points such as immune markers, general health, and bowel function did not exhibit clear dose-response relations. For AAD, the findings are very compelling; both meta-analyses and dedicated dose-response studies observe a positive correlation between dose and AAD risk. These findings do not allow for extrapolation, but suggest that studying higher doses for this end-point would be worthwhile. The lack of a clear dose-response for other end-points, does not mean it does not exist; present data does just not allow drawing any conclusions.
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Affiliation(s)
- A C Ouwehand
- 1 Active Nutrition, DuPont Nutrition & Health, Sokeritehtaantie 20, 02460 Kantvik, Finland
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81
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Belling-Dierks F, Glaser K, Wirbelauer J, Rücker V, Frieauff E. Does rapid enteral feeding increase intestinal morbidity in very low birth weight infants? A retrospective analysis. J Matern Fetal Neonatal Med 2016; 30:2690-2696. [PMID: 27844493 DOI: 10.1080/14767058.2016.1261284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the association of a standardized rapid enteral feeding strategy (established in 2011 in our unit) with intestinal morbidity in very low birth weight (VLBW) infants. METHODS A total of 301 inborn VLBW infants were included in this single-centre retrospective cohort study. We compared the incidence of intestinal morbidity (defined as necrotizing enterocolitis or intestinal perforation) in slowly enterally fed infants in 2008-2010 (10 ml/kg/day increase of milk feeds) to a corresponding cohort of rapidly enterally fed infants in 2011-2013 (20 ml/kg/day increase of milk feeds). Univariate and multivariable logistic and linear regression analyses, respectively, were performed to control for confounding variables. RESULTS Both groups were similar regarding baseline demographic and perinatal characteristics. In univariate modeling, intestinal morbidity did not significantly differ between the two groups (p = 0.25), neither did all-cause mortality nor incidence of late onset sepsis in multivariable modeling. In contrast, length of hospital stay (HS) and duration of parenteral nutrition (PEN) were significantly shorter in the rapid group (HS: -8.35 days, p = 0.012 and PEN: -7.13 days, p < 0.001). CONCLUSIONS Implementation of a more rapid enteral feeding regime is safe in VLBW infants and may significantly shorten length of HS and PEN in this cohort.
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Affiliation(s)
| | - Kirsten Glaser
- a University Children's Hospital, University of Würzburg , Würzburg , Germany
| | - Johannes Wirbelauer
- a University Children's Hospital, University of Würzburg , Würzburg , Germany
| | - Viktoria Rücker
- b Institute of Clinical Epidemiology and Biometry, University of Würzburg , Würzburg , Germany
| | - Eric Frieauff
- a University Children's Hospital, University of Würzburg , Würzburg , Germany
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82
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Perinatal Microbiomes' Influence on Preterm Birth and Preterms' Health: Influencing Factors and Modulation Strategies. J Pediatr Gastroenterol Nutr 2016; 63:e193-e203. [PMID: 27019409 DOI: 10.1097/mpg.0000000000001196] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Microbial communities inhabiting the human host play important roles in maintaining health status, including reproduction and early life programming, which is particularly important in the context of preterm neonates' health. Preterm birth (PTB) is often the result of a microbial dysbiosis or infection. In addition, preterm neonates experience different levels of organ immaturity and an abnormal gut microbiota establishment, as compared to full-term neonates. This exacerbates their developmental problems and can have negative consequences at systemic level. In addition, preterm babies are commonly exposed to delayed enteral feeding and hospital environments, which increases the risk of short- and long-term health problems. Some of these clinical conditions, such as necrotizing enterocolitis or sepsis, may be life threatening, whereas others may translate into life-long conditions, including cognitive problems. Increasing scientific interest has focused on understanding developmental problems in preterm neonates related to abnormalities in the settlement of their microbial communities, with the final goal of selecting appropriate microbiome-targeted strategies (eg, probiotics), to reduce preterm health risks and improve overall quality of life.This review aims to summarize current knowledge on microbiological factors influencing PTB initiation and gastrointestinal development, and on the health consequences to the preterm neonate. Scientific evidences on dietary strategies reducing PTB incidence and minimizing sequelae in this particularly sensitive human group subpopulation are also discussed.
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83
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Lenoir-Wijnkoop I, Gerlier L, Roy D, Reid G. The Clinical and Economic Impact of Probiotics Consumption on Respiratory Tract Infections: Projections for Canada. PLoS One 2016; 11:e0166232. [PMID: 27832195 PMCID: PMC5104466 DOI: 10.1371/journal.pone.0166232] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION There is accumulating evidence supporting the use of probiotics, which are defined as "live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host", as a preventive measure against respiratory tract infections (RTI). Two recent meta-analyses showed probiotic consumption (daily intake of 107 to 1010 CFU in any form for up to 3 months) significantly reduced RTI duration, frequency, antibiotic use and work absenteeism. OBJECTIVES The aim of this study was to assess the impact of probiotic use in terms of number of RTI episodes and days averted, and the number of antibiotic prescriptions and missed workdays averted, in the general population of Canada. In addition, the corresponding economic impact from both a healthcare payer and a productivity perspective was estimated. METHODS A microsimulation model was developed to reproduce the Canadian population (sample rate of 1/1000 = 35 540 individuals) employing age and gender. RTI incidence was taken from FluWatch consultation rates for influenza-like illness (2013-14) and StatCan all-cause consultations statistics. The model was calibrated on a 2.1% RTI annual incidence in the general population (5.2 million RTI days) and included known risk factors (smoking status, shared living conditions and vaccination status). RTI-related antibiotic prescriptions and work absenteeism were obtained from the literature. RESULTS The results indicate that probiotic use saved 573 000-2.3 million RTI-days, according to the YHEC-Cochrane scenarios respectively. These reductions were associated with an avoidance of 52 000-84 000 antibiotic courses and 330 000-500 000 sick-leave days. A projection of corresponding costs reductions amounted to Can$1.3-8.9 million from the healthcare payer perspective and Can$61.2-99.7 million when adding productivity losses. CONCLUSION The analysis shows that the potential of probiotics to reduce RTI-related events may have a substantial clinical and economic impact in Canada.
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Affiliation(s)
- Irene Lenoir-Wijnkoop
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Director Public Health &Scientific Relations, Danone Company, Paris, France
| | | | - Denis Roy
- Department of Food Sciences, Laval University, Quebec, Canada
| | - Gregor Reid
- Canadian Research and Development Centre for Probiotics, University of Western Ontario, London, Ontario, Canada
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84
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Slattery J, MacFabe DF, Frye RE. The Significance of the Enteric Microbiome on the Development of Childhood Disease: A Review of Prebiotic and Probiotic Therapies in Disorders of Childhood. Clin Med Insights Pediatr 2016; 10:91-107. [PMID: 27774001 PMCID: PMC5063840 DOI: 10.4137/cmped.s38338] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 02/07/2023] Open
Abstract
Recent studies have highlighted the fact that the enteric microbiome, the trillions of microbes that inhabit the human digestive tract, has a significant effect on health and disease. Methods for manipulating the enteric microbiome, particularly through probiotics and microbial ecosystem transplantation, have undergone some study in clinical trials. We review some of the evidence for microbiome alteration in relation to childhood disease and discuss the clinical trials that have examined the manipulation of the microbiome in an effort to prevent or treat childhood disease with a primary focus on probiotics, prebiotics, and/or synbiotics (ie, probiotics + prebiotics). Studies show that alterations in the microbiome may be a consequence of events occurring during infancy and/or childhood such as prematurity, C-sections, and nosocomial infections. In addition, certain childhood diseases have been associated with microbiome alterations, namely necrotizing enterocolitis, infantile colic, asthma, atopic disease, gastrointestinal disease, diabetes, malnutrition, mood/anxiety disorders, and autism spectrum disorders. Treatment studies suggest that probiotics are potentially protective against the development of some of these diseases. Timing and duration of treatment, the optimal probiotic strain(s), and factors that may alter the composition and function of the microbiome are still in need of further research. Other treatments such as prebiotics, fecal microbial transplantation, and antibiotics have limited evidence. Future translational work, in vitro models, long-term and follow-up studies, and guidelines for the composition and viability of probiotic and microbial therapies need to be developed. Overall, there is promising evidence that manipulating the microbiome with probiotics early in life can help prevent or reduce the severity of some childhood diseases, but further research is needed to elucidate biological mechanisms and determine optimal treatments.
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Affiliation(s)
- John Slattery
- Arkansas Children’s Research Institute, Little Rock, AR, USA
- Division of Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Derrick F. MacFabe
- The Kilee Patchell-Evans Autism Research Group, Departments of Psychology (Neuroscience) and Psychiatry, Division of Developmental Disabilities, University of Western Ontario, London, ON, Canada
| | - Richard E. Frye
- Arkansas Children’s Research Institute, Little Rock, AR, USA
- Division of Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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85
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Meyer S, Gortner L, Lindner U, Dahmen K, Butte M. Fast food versus slow food in very and extremely low-birthweight infants: speed of feeds is a little more than a gut feeling. Acta Paediatr 2016; 105:1129-31. [PMID: 27119204 DOI: 10.1111/apa.13451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/15/2016] [Accepted: 04/25/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Sascha Meyer
- Neonatal Intensive Care Unit; University Children's Hospital of Saarland; Homburg Germany
| | - Ludwig Gortner
- Neonatal Intensive Care Unit; University Children's Hospital of Saarland; Homburg Germany
| | - Ulrike Lindner
- Neonatal Intensive Care Unit; University Children's Hospital of Saarland; Homburg Germany
| | - Kristina Dahmen
- Medical School; University Hospital of Saarland; Homburg Germany
| | - Mona Butte
- Neonatal Intensive Care Unit; University Children's Hospital of Saarland; Homburg Germany
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86
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Zhang SF, Tang ZS, Tong L, Tao XX, Suo QF, Xu XM. Effects of clostridium butyricum and bifidobacterium on BTLA expression on CD4 + T cells and lymphocyte differentiation in late preterm infants. Microb Pathog 2016; 100:112-118. [PMID: 27622346 DOI: 10.1016/j.micpath.2016.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Probiotics is recognized to promote growth performance and immune function via balancing the intestinal microflora. Live clostridium butyricum and bifidobacterium combined powder (LCBBCP) has been widely to treat intestinal dysbacteriosis in newborns in China. This study was undertaken to investigate the effects of the combined probiotics on the expression of B and T lymphocyte attenuator (BTLA) on CD4+ T cells and the differentiation of lymphocyte subsets in late preterm infants. METHODS Eighty eligible late preterm infants were equally randomized into LCBBCP therapy group (oral LCBBCP dissolved in formula milk before intake) and control group (treated with simple formula milk for preterm infants) by random digit table. Flow cytometry was used to determine the expression level of BTLA on CD4+ T cells and the percentage of individual subpopulation of lymphocytes in peripheral-blood mononuclear cells (PBMCs) obtained from the late preterm infants in both groups. RESULTS BTLA protein expression on CD4+ T cells showed no significant change in LCBBCP therapy group before and after intervention, yet was rapidly and significantly down-regulated in the controls. The percentage of increased CD4+ T cells, decreased CD8+ T cells and increased ratio of CD4+/CD8+ T cell proportion were seen in both groups after treatment, yet the increasing or decreasing extent in LCBBCP therapy group was more obvious than in control group. The proportion of NK cells and B lymphocytes remained no significant difference between the two groups before and after therapy. CONCLUSIONS LCBBCP appears capable of facilitating the activation, proliferation and differentiation of T lymphocytes, which is beneficial to improving immunity in late preterm infants. The continuous high expression of BTLA on CD4+ T cells in LCBBCP therapy group may be involved in the inhibiting of excessive activation of T lymphocytes. Our findings may lay a basis for further clinical evaluation of the efficacies and wider clinical recommendation of probiotics containing live clostridium butyricum and bifidobacterium for late preterm infants.
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Affiliation(s)
- Shi-Fa Zhang
- Department of Pediatrics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Zong-Sheng Tang
- Department of Central Laboratory, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China.
| | - Ling Tong
- Department of Pediatrics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Xiang-Xiang Tao
- Office of Educational Administration, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Qi-Feng Suo
- Department of Central Laboratory, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
| | - Xue-Mei Xu
- Department of Pediatrics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China
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87
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Johnson-Henry KC, Abrahamsson TR, Wu RY, Sherman PM. Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis. Adv Nutr 2016; 7:928-37. [PMID: 27633108 PMCID: PMC5015037 DOI: 10.3945/an.116.012237] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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.
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Affiliation(s)
- Kathene C Johnson-Henry
- Cell Biology Program, Research Institute, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children
| | - Thomas R Abrahamsson
- Department of Clinical and Experimental Medicine, Division of Pediatrics, Linköping University, Linköping, Sweden
| | - Richard You Wu
- Cell Biology Program, Research Institute, Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children;,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine
| | - Philip M Sherman
- 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
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88
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Denkel LA, Schwab F, Garten L, Geffers C, Gastmeier P, Piening B. Protective Effect of Dual-Strain Probiotics in Preterm Infants: A Multi-Center Time Series Analysis. PLoS One 2016; 11:e0158136. [PMID: 27332554 PMCID: PMC4917100 DOI: 10.1371/journal.pone.0158136] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 06/10/2016] [Indexed: 12/27/2022] Open
Abstract
Objective To determine the effect of dual-strain probiotics on the development of necrotizing enterocolitis (NEC), mortality and nosocomial bloodstream infections (BSI) in preterm infants in German neonatal intensive care units (NICUs). Design A multi-center interrupted time series analysis. Setting 44 German NICUs with routine use of dual-strain probiotics on neonatal ward level. Patients Preterm infants documented by NEO-KISS, the German surveillance system for nosocomial infections in preterm infants with birth weights below 1,500 g, between 2004 and 2014. Intervention Routine use of dual-strain probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. (Infloran) on the neonatal ward level. Main outcome measures Incidences of NEC, overall mortality, mortality following NEC and nosocomial BSI. Results Data from 10,890 preterm infants in 44 neonatal wards was included in this study. Incidences of NEC and BSI were 2.5% (n = 274) and 15.0%, (n = 1631), respectively. Mortality rate was 6.1% (n = 665). The use of dual-strain probiotics significantly reduced the risk of NEC (HR = 0.48; 95% CI = 0.38–0.62), overall mortality (HR = 0.60, 95% CI = 0.44–0.83), mortality after NEC (HR = 0.51, 95% CI = 0.26–0.999) and nosocomial BSI (HR = 0.89, 95% CI = 0.81–0.98). These effects were even more pronounced in the subgroup analysis of preterm infants with birth weights below 1,000 g. Conclusion In order to reduce NEC and mortality in preterm infants, it is advisable to add routine prophylaxis with dual-strain probiotics to clinical practice in neonatal wards.
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Affiliation(s)
- Luisa A. Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Garten
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Geffers
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Brar Piening
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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89
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Patole SK, Rao SC, Keil AD, Nathan EA, Doherty DA, Simmer KN. Benefits of Bifidobacterium breve M-16V Supplementation in Preterm Neonates - A Retrospective Cohort Study. PLoS One 2016; 11:e0150775. [PMID: 26953798 PMCID: PMC4783036 DOI: 10.1371/journal.pone.0150775] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/18/2016] [Indexed: 01/08/2023] Open
Abstract
Background Systematic reviews of randomised controlled trials report that probiotics reduce the risk of necrotising enterocolitis (NEC) in preterm neonates. Aim To determine whether routine probiotic supplementation (RPS) to preterm neonates would reduce the incidence of NEC. Methods The incidence of NEC ≥ Stage II and all-cause mortality was compared for an equal period of 24 months ‘before’ (Epoch 1) and ‘after’ (Epoch 2) RPS with Bifidobacterium breve M-16V in neonates <34 weeks. Multivariate logistic regression analysis was conducted to adjust for relevant confounders. Results A total of 1755 neonates (Epoch I vs. II: 835 vs. 920) with comparable gestation and birth weights were admitted. There was a significant reduction in NEC ≥ Stage II: 3% vs. 1%, adjusted odds ratio (aOR) = 0.43 (95%CI: 0.21–0.87); ‘NEC ≥ Stage II or all-cause mortality’: 9% vs. 5%, aOR = 0.53 (95%CI: 0.32–0.88); but not all-cause mortality alone: 7% vs. 4%, aOR = 0.58 (95% CI: 0.31–1.06) in Epoch II. The benefits in neonates <28 weeks did not reach statistical significance: NEC ≥ Stage II: 6% vs. 3%, aOR 0.51 (95%CI: 0.20–1.27), ‘NEC ≥ Stage II or all-cause mortality’, 21% vs. 14%, aOR = 0.59 (95%CI: 0.29–1.18); all-cause mortality: 17% vs. 11%, aOR = 0.63 (95%CI: 0.28–1.41). There was no probiotic sepsis. Conclusion RPS with Bifidobacterium breve M-16V was associated with decreased NEC≥ Stage II and ‘NEC≥ Stage II or all-cause mortality’ in neonates <34 weeks. Large sample size is required to assess the potential benefits of RPS in neonates <28 weeks.
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Affiliation(s)
- Sanjay K. Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia
- * E-mail:
| | - Shripada C. Rao
- Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Australia
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia
| | - Anthony D. Keil
- PathWest Laboratory Medicine Western Australia, Perth, Australia
| | - Elizabeth A. Nathan
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia
- School of Women's and Infants' Health, University of Western Australia, Perth, Australia
| | - Dorota A. Doherty
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia
- School of Women's and Infants' Health, University of Western Australia, Perth, Australia
| | - Karen N. Simmer
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia
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90
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Patole SK, Keil AD, Nathan E, Doherty D, Esvaran M, Simmer KN, Conway P. Effect of Bifidobacterium breve M-16V supplementation on faecal bifidobacteria in growth restricted very preterm infants – analysis from a randomised trial. J Matern Fetal Neonatal Med 2016; 29:3751-5. [DOI: 10.3109/14767058.2016.1147554] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Sanjay K. Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia,
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia,
| | - Anthony D. Keil
- PathWest Laboratory Medicine Western Australia, Perth, Australia,
| | - Elizabeth Nathan
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia,
- School of Women’s and Infants’ Health, University of Western Australia, Perth, Australia, and
| | - Dorota Doherty
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, Australia,
- School of Women’s and Infants’ Health, University of Western Australia, Perth, Australia, and
| | - Meera Esvaran
- Centre for Marine Bio-Innovation (CMB), University of New South Wales, Sydney, Australia
| | - Karen N. Simmer
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Australia,
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Australia,
| | - Patricia Conway
- Centre for Marine Bio-Innovation (CMB), University of New South Wales, Sydney, Australia
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Vongbhavit K, Underwood MA. Prevention of Necrotizing Enterocolitis Through Manipulation of the Intestinal Microbiota of the Premature Infant. Clin Ther 2016; 38:716-32. [PMID: 26872618 DOI: 10.1016/j.clinthera.2016.01.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/30/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE In spite of four decades of research, necrotizing enterocolitis (NEC) remains the most common gastrointestinal complication in premature infants with high mortality and long-term morbidity. The composition of the intestinal microbiota of the premature infant differs dramatically from that of the healthy term infant and appears to be an important risk factor for NEC. METHODS We review the evidence of an association between intestinal dysbiosis and NEC and summarize published English language clinical trials and cohort studies involving attempts to manipulate the intestinal microbiota in premature infants. FINDINGS Promising NEC prevention strategies that alter the intestinal microbiota include probiotics, prebiotics, synbiotics, lacteroferrin, and human milk feeding. IMPLICATIONS Shaping the intestinal microbiota of the premature infant through human milk feeding and dietary supplements decreases the risk of NEC. Further studies to identify the ideal microbial composition and the most effective combination of supplements are indicated.
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Affiliation(s)
- Kannikar Vongbhavit
- Department of Pediatrics, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakornayok, Thailand; Department of Pediatrics, University of California Davis, Sacramento, California
| | - Mark A Underwood
- Department of Pediatrics, University of California Davis, Sacramento, California.
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