Probiotics in pediatrics

The Use of Gut Microbial Modulation Strategies as Interventional Strategies for Ageing

Gut microbial composition codevelops with the host from birth and is influenced by several factors, including drug use, radiation, psychological stress, dietary changes and physical stress. Importantly, gut microbial dysbiosis has been clearly associated with several diseases, including cancer, rheumatoid arthritis and Clostridium difficile-associated diarrhoea, and is known to affect human health and performance. Herein, we discuss that a shift in the gut microbiota with age and reversal of age-related modulation of the gut microbiota could be a major contributor to the incidence of numerous age-related diseases or overall human performance. In addition, it is suggested that the gut microbiome of long-lived animals such as reptiles should be investigated for their unique properties and contribution to the potent defense system of these species could be extrapolated for the benefit of human health. A range of techniques can be used to modulate the gut microbiota to have higher abundance of “beneficial” microbes that have been linked with health and longevity.

Intestinal Rehabilitation: A Management Program for Short-Bowel Syndrome

Over the last 3 decades, there has been significant improvement in the survival and quality of life of patients who require home parenteral nutrition; however, parenteral nutrition remains costly, is associated with multiple complications, and does not promote the function of the remaining bowel. Intestinal rehabilitation refers to the process of restoring enteral autonomy and decreasing dependence on parenteral nutrition by utilizing dietary, pharmacological, and, occasionally, surgical interventions. A major focus of research has been to identify a trophic factor that will enhance adaptation of the remaining gastrointestinal tract following massive gut resection and allow enteral autonomy. Whether intestinal rehabilitation occurs as the result of increased intestinal adaptation or as the result of a comprehensive approach to care has yet to be determined. This article reviews intestinal failure as the result of short-bowel syndrome and the management strategy of an intestinal rehabilitation program in the care of these patients.

Effect of a synbiotic on infantile acute gastroenteritis

Acute gastroenteritis is still a common disease worldwide. Synbiotics are being used to alleviate the effects of acute gastroenteritis-related diarrhoea. The objective of this study was to determine the efficacy of a synbiotic in reducing the duration of diarrhoea in children with acute gastroenteritis. The study has been carried out on data gathered from children with acute gastroenteritis between the age of three months and 14 years seen in paediatric polyclinics between August 2009 and April 2010. While synbiotic group patients got a sachet containing Bifidobacterium lactis 2211 with a minimum of 5×10⁶ cfu active bacteria and 900 mg chicory inulin twice daily for five days together with an oral rehydration solution, the control group only received an oral rehydration solution. Therapy with synbiotic plus an oral rehydration solution shortened the duration of acute diarrhoea in children by approximately one day compared to oral rehydration solution only.

An update on management of severe acute infectious gastroenteritis in children

This article focuses on clinical and diagnostic aspects relevant to severe acute infectious gastroenteritis in children and will update treatment strategies focused on, although not limited to, anti-infective therapy. For the purposes of this article we will consider severe acute infectious gastroenteritis as follows: watery diarrhea accompanied by, or at high risk for, moderate to severe dehydration due to abrupt onset of vomiting that reduces oral intake, and/or frequent emission of liquid stools, or moderate to severe dysenteric/bloody diarrhea with moderate to high-grade fever. The article will not include food poisoning associated with bacterial toxins and will only briefly discuss oral rehydration strategies and intravenous solutions. The article will also briefly discuss current preventive measures against rotavirus gastroenteritis through vaccination, a topic that has been extensively discussed elsewhere.

Probiotics: preventing antibiotic-associated diarrhea

PURPOSE

Probiotics are live microorganisms that offer a health benefit to the host. Found typically in dietary supplements, probiotics can be safely used in the treatment of acute diarrheal disease, inflammatory bowel disease, and antibiotic-associated diarrhea. They can be found in milks, yogurt, powders, and pills.

CONCLUSIONS

Research has shown that several strains of probiotics are helpful in the prevention and treatment of antibiotic-associated diarrhea. The most commonly studied probiotics are Lactobacillus GG and Saccharomyces boulardii.

PRACTICE IMPLICATIONS

By understanding the uses, dosages, and safety of common probiotics, nurses can help educate patients and their families on the benefits of probiotics.

Applications of probiotics for neonatal enteric diseases

Probiotics are bacteria and yeast that have a beneficial effect on the maintenance of health. Probiotic microorganisms are inherently present in fermented food products. A renewed interest in probiotic therapy designed for both treatment and prevention of intestinal and extraintestinal disorders has resulted in studies in infants and children. This review focuses on the applications of probiotics in enteric conditions experienced by neonates and discusses future evaluations to develop recommendations for their use.

Probiotics: role in pathophysiology and prevention in necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is an inflammatory bowel disease largely affecting low birth weight, premature infants. Once acquired, NEC is accompanied by significant mortality and morbid sequelae. Our understanding of the pathophysiology of NEC continues to evolve, and the development of NEC is likely multifactorial with resultant bowel injury mediated through a final, common inflammatory pathway. The predisposition for NEC appears to involve the interplay between intestinal integrity and function, enteral feeding and bacterial colonization, and regulation of the gastrointestinal and systemic inflammatory response. Commensal organisms or probiotics have been shown to be crucial in the development and modulation of each of these factors within the intestinal epithelium. As a result, probiotic supplementation has been proposed as a promising new intervention for the prevention of NEC. To understand the potential utility of probiotics in NEC, we will discuss: the components of gut defense; the role of the intestinal ecosystem in modulating immunity and inflammation; bacterial colonization patterns in the preterm infant compared with patterns seen in the healthy, full-term infant; the evidence for probiotic use in other populations and diseases; and finally, the evidence of probiotic use specific to the preterm infant and NEC.

Probiotic bacteria change Escherichia coli-induced gene expression in cultured colonocytes: Implications in intestinal pathophysiology

AIM: To investigate the change in eukaryotic gene expression profile in Caco-2 cells after infection with strains of Escherichia coli and commensal probiotic bacteria.

METHODS: A 19200 gene/expressed sequence tag gene chip was used to examine expression of genes after infection of Caco-2 cells with strains of normal flora E. coli, Lactobacillus plantarum, and a combination of the two.

RESULTS: The cDNA microarray revealed up-regulation of 155 and down-regulation of 177 genes by E. coli. L. plantarum up-regulated 45 and down-regulated 36 genes. During mixed infection, 27 genes were up-regulated and 59 were down-regulated, with nullification of stimulatory/inhibitory effects on most of the genes. Expression of several new genes was noted in this group.

CONCLUSION: The commensal bacterial strains used in this study induced the expression of a large number of genes in colonocyte-like cultured cells and changed the expression of several genes involved in important cellular processes such as regulation of transcription, protein biosynthesis, metabolism, cell adhesion, ubiquitination, and apoptosis. Such changes induced by the presence of probiotic bacteria may shape the physiologic and pathologic responses they trigger in the host.

Colonization and impact of disease and other factors on intestinal microbiota

The aim of this study was to review the process of microbial colonization and the environmental and host factors that influence colonization and microbial succession. The impact of some diseases on intestinal microbiota composition is also described. Microbial colonization of the gut by maternal vaginal and fecal bacteria begins during and after birth. During the first 2 years of life, specific microbes become established in a process designated microbial succession. Microbial succession in the gastrointestinal tract is influenced by numerous external and internal host-related factors, and by the second year of life, the intestinal microbiota composition is considered identical to that of adults. Nevertheless, intestinal microbiota in both infants and adults remain incompletely characterized and their diversity poorly defined. The main explanation is that many intestinal bacteria that live in an anaerobic environment are difficult or impossible to culture outside the intestine. However, recent advances in molecular biology techniques have initiated the description of new bacteria species. The composition of gut microbiota can be modulated by host, environmental, and bacterial factors, and strong evidence has emerged of substantial modifications during illness or exposure to threatening experiences. It has been postulated that improvements in hygienic measures have led to an increase in allergic diseases ("hygiene hypothesis"). Alterations in gut microbiota and their functions have been widely associated with many chronic and degenerative diseases, including inflammatory bowel disease, colon cancer, and rheumatoid arthritis.

Probiotics in primary care pediatrics

Probiotics are live microorganisms that help stabilize and balance intestinal microflora. Although these organisms are ubiquitous and have been used in the production of foods, probiotics have been used more frequently for therapeutic purposes, including the treatment and prevention of pediatric diseases. This article reviews the proposed mechanisms of the beneficial effects of probiotics, potential uses of these organisms in pediatric care, and promising future directions for their application.

Clinical safety of Lactobacillus casei shirota as a probiotic in critically ill children

OBJECTIVE

Diarrhea is frequently observed among critically ill children (CIC) admitted for intensive care. There is increasing evidence that probiotics decrease the incidence of acute infectious and nosocomial and antibiotic induced diarrhea amongst children hospitalized in nonintensive care settings. Despite theoretic advantages for the use of probiotics in CIC, safety has remained a concern in this vulnerable group. The objective of this study was to establish clinical safety (invasive infection/colonization) of Lactobacillus casei shirota (LCS) used as a probiotic in CIC.

METHODS

Prospective, descriptive pilot study on children admitted to a pediatric intensive care unit. Data regarding safety were collected on the initial recruits to a randomized controlled trial aimed to study the effects of LCS on stool frequency and consistency in CIC. Safety was assessed by bacteriologic surveillance for LCS in surface swabs and endotracheal aspirates (colonization) as well as blood, urine, and sterile body fluid cultures (invasive infection/bacteremia).

RESULTS

Safety data were available on 28 patients. LCS was cultured from the feces of five of the six study subjects who opened bowels during their stay on the pediatric intensive care unit. There was no evidence of either colonization or bacteremia with LCS in bacteriologic cultures obtained from study subjects. The preparation was well tolerated with no apparent side effects.

CONCLUSIONS

Our pilot safety study suggests that the use of LCS as a probiotic in enterally fed CIC is safe.

Lactobacillus sepsis associated with probiotic therapy

Probiotic strains of lactobacilli are increasingly being used in clinical practice because of their many health benefits. Infections associated with probiotic strains of lactobacilli are extremely rare. We describe 2 patients who received probiotic lactobacilli and subsequently developed bacteremia and sepsis attributable to Lactobacillus species. Molecular DNA fingerprinting analysis showed that the Lactobacillus strain isolated from blood samples was indistinguishable from the probiotic strain ingested by the patients. This report indicates, for the first time, that invasive disease can be associated with probiotic lactobacilli. This report should not discourage the appropriate use of Lactobacillus or other probiotic agents but should serve as a reminder that these agents can cause invasive disease in certain populations.

Current and potential uses of probiotics

OBJECTIVE

To present data that support the current and potential use of probiotics in treating or preventing allergic disorders of the gastrointestinal tract and other disorders.

DATA SOURCES

Case reports, double-blind studies, and animal studies were reviewed.

STUDY SELECTION

Studies were selected based on the expert opinion of the authors.

CONCLUSIONS

Well-designed research studies suggest that supplementary consumption of certain probiotic strains may temporarily alter the intestinal microflora of infants and children to produce a beneficial effect. However, generalization of probiotic effects must not be made and critical scientific evaluation must be used in directing patients to select the appropriate probiotic.

The pragmatics of feeding the pediatric patient with acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) represents the ultimate pulmonary response to a wide range of injuries, from septicemia to trauma. Optimal nutrition is vital to enhancing oxygen delivery, supporting adequate cardiac contractility and respiratory musculature, eliminating fluid and electrolyte imbalances, and supporting the proinflammatory response. Research is providing a better understanding of nutrients that specifically address the complex physiologic changes in ARDS. This article highlights the pathophysiology of ARDS as it relates to nutrition, relevant nutritional assessment, and important enteral and parenteral considerations for the pediatric patient who has ARDS.

Irreversible intestinal failure

Intestinal failure (IF) can be defined as the reduction of functional gut mass below the minimal amount necessary for digestion and absorption adequate to satisfy the nutrient and fluid requirements for maintenance in adults or growth in children. In developed countries, IF mainly includes individuals with the congenital or early onset of conditions requiring protracted or indefinite parenteral nutrition (PN). Short bowel syndrome was the first commonly recognized cause of protracted IF. The normal physiologic process of intestinal adaptation after extensive resection usually allows for recovery of sufficient intestinal function within weeks to months. During this time, patients can be sustained on parenteral nutrition. Only a few children have permanent intestinal insufficiency and life-long dependency on PN. Non-transplant surgery including small bowel tapering and lengthening may allow weaning from PN in some cases. Hormonal therapy with recombinant human growth hormone has produced poor results while therapy with glucagon-like peptide-2 holds promise. Congenital diseases of enterocyte development such as microvillus inclusion disease or intestinal epithelial dysplasia cause permanent IF for which no curative medical treatment is currently available. Severe and extensive motility disorders such as total or subtotal intestinal aganglionosis (long segment Hirschsprung disease) or chronic intestinal pseudo-obstruction syndrome may also cause permanent IF. PN and home-PN remain are the mainstays of therapy regardless of the cause of IF. Some patients develop complications while receiving long-term PN for IF especially catheter related complications (thrombosis, sepsis) and liver disease. These patients may be candidates for intestinal transplantation. This review discusses the causes of irreversible IF and emphasizes the specific medico-surgical strategies for prevention and treatment of these conditions at several stages of IF.

Probiotic use in children

Interest in nutritional supplements and functional foods has risen significantly in recent years. Many of the products that are marketed to consumers tout the benefits of probiotics for general good health and for a wide variety of conditions and situations. Although most of these products have been used safely for years, careful analysis of scientific research should be conducted before routinely recommending these products, especially for children. A basic understanding of intestinal flora, properties of probiotics, and clinical research findings is necessary for clinicians to delineate the role of probiotic agents in the pediatric population.

New perspectives on nutrition enhance outcomes for premature infants

Significant advances have occurred during the past 20 years in the understanding of the complex relationships of the environment, the developing gut-associated immune system, the bacterial flora, the barrier functions of the gut, and the effects of nutrient intake. These advances have produced a profoundly different way of interpreting the nutritional requirements for normal growth and development of premature infants throughout their entire life.