Probiotic for preventing necrotising enterocolitis in preterm neonates- The past, present, and the future

Year 2010, Volume: 15 Issue: 4, 168 - 174, 17.01.2013

Girish Deshpande Sanjay Patole

Abstract

Abstract. Although survival of very preterm neonates has improved in the surfactant era necrotizing enterocolitis (NEC) continues to be major cause of mortality and morbidity. Despite decades of research the pathogenesis of NEC is poorly understood. Historically, apart from antenatal glucocorticoids and postnatal preference to early feeding with human milk, neonatologists have had not many options to minimize the risk of NEC in preterm neonates. Probiotics supplementation has given a fresh outlook for prevention of NEC in preterm neonates. Evidence from many recent randomized controlled trials have shown that probiotics can significantly reduce the risk of NEC, all cause mortality and time to full feeds in preterm VLBW neonates. Some important issues need to be addressed (e.g. optimal strains, dose, and duration, combination of probiotic organisms) before this therapy becomes a safe routine in high-risk preterm neonates. This brief review covers the current evidence, and future for probiotic supplementation in preterm neonates.

Key words: Neonates, necrotizing enterocolitis, preterm, probiotics, systematic review

Keywords

Neonates, necrotizing enterocolitis, preterm, probiotics, systematic review

References

• 1. Ng S. Necrotizing enterocolitis in the full-term neonate. J Paediatr Child Health 2001; 37: 1–4.
• 2. Rowe MI, Reblock KK, Kurkchubasche AG, Healey PJ. Necrotizing enterocolitis in the extremely low birth weight infant. J Pediatr Surg 1994; 29: 987– 990.
• 3. Lin PW, Stoll BJ. Necrotising enterocolitis. Lancet 2006; 368: 1271–1283.
• 4. Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcome of very low birth weight infants with necrotizing enterocolitis - A systematic review of observational studies. Arch Pediatr Adolesc Med 2007; 161: 583-590.
• 5. Bisquera JA, Cooper TR, Berseth CL. Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 2002; 109: 423–428.
• 6. Hsueh W, Caplan MS, Qu XW, et al. Neonatal necrotizing enterocolitis: clinical considerations and pathogenetic concepts. Pediatr Dev Pathol 2003; 6: 6–23.
• 7. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990; 336: 1519– 1523.
• 8. Caplan MS, Amer M, Jilling T. The role of human milk in necrotising enterocolitis. Adv Exp Med Biol 2002; 503: 83–90.
• 9. Hanson LA. Human milk and host defence: immediate and long-term effects. Acta Paediatr 1999; 88: 42–46.
• 10. Schanler RJ. The use of human milk for premature infants. Pediatr Clin North Am 2001; 48: 207–219.
• 11. Goldman AS. Modulation of the gastrointestinal tract of infants by human milk. Interfaces and interactions. An evolutionary perspective. J Nutr 2000; 130: 426S–431S.
• 12. Celano P, Jumawan J, Horowitz C, Lau H, Koldovsky O. Prenatal induction of sucrase activity in rat jejunum. Biochem J 1977; 162: 469–472.
• 13. Moog F. Developmental adaptations of alkaline phosphatises in the small intestine. Fed Proc 1962; 21: 51–56.
• 14. Neu J, Ozaki CK, Angelides KJ. Glucocorticoidmediated alteration of fluidity of brush border membrane in rat small intestine. Pediatr Res 1986; 20: 79–82.
• 15. Bauer CR, Morrison JC, Poole WK, et al. A decreased incidence of necrotizing enterocolitis after prenatal glucocorticoid therapy. Pediatrics 1984; 73: 682–688.
• 16. Crowley P, Chalmers I, Keirse MJ. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials. Br J Obstet Gynaecol 1990; 97: 11– 25.
• 17. Travadi J, Patole S, Charles A, et al. Pentoxifylline reduces the incidence and severity of necrotizing enterocolitis in a neonatal rat model. Pediatr Res 2006; 60: 185-189.
• 18. Sanders ME. Probiotics: considerations for human health. Nutr Rev 2003; 61: 91-99.
• 19. Health and Nutritional Properties of Probiotics in Food including Powder Milk and Live Lactic Acid Bacteria. In, Report of a Joint FAO/WHO Expert Consultation on Evaluation of Health and Nutritional Properties in Food Including Powder Milk with Live Lactic Acid Bacteria. American Cordoba Park Hotel, Cordoba, Argentina, 2001
• 20. Rautava S. Potential uses of probiotics in the neonate. Semin Fetal Neonatal Med 2007; 12: 45-53. 21. Goldmann DA, Leclair J, Macone A. Bacterial colonisation of neonates admitted to an intensive care environment. J Pediatr 1978; 93: 288–293.
• 22. Olivares M, Díaz-Ropero MP, Martín R, et al. Antimicrobial potential of four Lactobacillus strains isolated from breast milk. J Appl Microbiol 2006; 101: 72-79.
• 23. Martin R, Olivares M, Marin ML, et al. Probiotic potential of 3 Lactobacilli strains isolated from breast milk. J Hum Lact 2005; 21: 8-17.
• 24. Schwiertz A, Gruhl B, Lobnitz M, et al. Development of the intestinal bacterial composition in hospitalised preterm infants in comparison with breast-fed, full-term infants. Pediatr Res 2003; 54: 393–399.
• 25. Fanaro S, Chierici R, Guerrini P, et al. Intestinal microflora in early infancy: composition and development. Acta Paediatr Suppl 2003; 91: 48–55.
• 26. Gewolb IH, Schwalbe RS, Taciak VL, et al. Stool microflora in extremely low birth weight neonates. Arch Dis Child Fetal Neonatal Ed 1999; 80: F167– F173.
• 27. Stoll BJ. Epidemiology of necrotizing enterocolitis. Clin Perinatol 1994; 21: 205–218.
• 28. Schanler RJ. Probiotics and necrotising enterocolitis in premature neonates. Arch Dis Child Fetal Neonatal Ed 2006; 91: F395–F397.
• 29. Akira S, Yamamoto M, Takeda K. Role of adapters in Toll-like receptor signalling. Biochem Soc Trans 2003; 31: 637–642.
• 30. Jilling T, Simon D, Lu J, et al. The roles of bacteria and TLR4 in rat and murine models of necrotizing enterocolitis. J Immunol 2006; 177: 3273–3282.
• 31. Janssens S, Beyaert R. Role of toll-like receptors in pathogen recognition Clin Microbiol Rev 2003; 16: 637–646.
• 32. Caplan MS. Probiotic and prebiotic supplementation for the prevention of neonatal necrotizing enterocolitis. J Perinatol 2009; 2: S2-S6.
• 33. Caplan MS, Miller-Catchpole R, Kaup S, et al. Bifidobacterial supplementation reduces the incidence of necrotizing enterocolitis in a neonatal rat model. Gastroenterology 1999; 117: 577–583.
• 34. Hoyos AB. Reduced incidence of necrotising enterocolitis associated with enteral administration of Lactobacillus acidophilus and Bifidobacterium infantis to neonates in an intensive care unit. Int J Infect Dis 1999; 3: 197–202.
• 35. Deshpande G, Rao S, Patole S. Probiotics for prevention of necrotising enterocolitis in preterm neonates with very low birthweight: a systematic review of randomised controlled trials. Lancet 2007; 369: 1614-1620.
• 36. Barclay AR, Stenson B, Simpson JH, et al. Probiotics for necrotizing enterocolitis: a systematic review. J Pediatr Gastroenterol Nutr 2007; 45: 569- 576.
• 37. Alfaleh K, Bassler D. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 2008: CD005496.
• 38. Deshpande G, Rao S, Patole S, Bulsara M. Updated meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Pediatrics 2010; 125: 921-930.
• 39. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996; 17: 1– 12.
• 40. Kitajima H, Sumida Y, Tanaka R, et al. Early administration of Bifidobacterium breve to preterm neonates: randomised control trial. Arch Dis Child 1997; 76: F101–F107.
• 41. Dani C, Biadaioli R, Bertini G, et al. Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm neonates. A prospective double-blind study. Biol Neonate 2002; 82: 103–108.
• 42. Costalos C, Skouteri V, Gounaris A, et al. Enteral feeding of premature neonates with Saccharomyces boulardii. Early Hum Dev 2003; 74: 89–96.
• 43. Bin-Nun A, Bromiker R, Wilschanski M, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr 2005; 147: 192– 196.
• 44. Lin HC, Su BH, Chen AC, et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight neonates. Pediatrics 2005; 115: 1–4.
• 45. Manzoni P, Mostert M, Leonessa ML, et al. Oral supplementation with Lacibacillus casei subspecies rhamnosus prevents enteric colonisation by Candida species in preterm neonates: A randomised study. Clin Infect Dis 2006; 42: 1735–1742.
• 46. Mohan R, Koebnick C, Schildt J, et al. Effects of Bifidobacterium lactis Bb12 supplementation on intestinal microbiota of preterm neonates: A double placebo controlled, randomised study. J Clin Microbiol 2006 ; 44: 4025–4031.
• 47. Stratiki Z, Costalos C, Sevastiadou S, et al. The effect of a Bifidobacter supplemented bovine milk on intestinal permeability of preterm infants. Early Hum Dev 2007; 83: 575-579.
• 48. Lin HC, Hsu CH, Chen HL, et al. Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter, randomized, controlled trial. Pediatrics 2008; 122: 693-700.
• 49. Samanta M, Sarkar M, Ghosh P, et al. Prophylactic probiotics for prevention of necrotizing enterocolitis in very low birth weight newborns. J Trop Pediatr 2009; 55: 128-131.
• 50. Rougé C, Piloquet H, Butel MJ, et al. Oral supplementation with probiotics in very-low-birthweight preterm infants: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2009; 89: 1828-1835.
• 51. Satoh Y, Shinohara K, Umezaki H, et al. Bifidobacteria prevents necrotising enterocolitis and infection. Int J Probiot Prebiot 2007; 2: 149-154.
• 52. Stockman JA. III. Year book of Pediatrics 2009 Elsevier Mosby; Chapter 14 Newborn: Deshpande G, Rao S, Patole S. Probiotics for prevention of necrotising enterocolitis in preterm neonates with very low birthweight: a systematic review of randomised controlled trials. 441-443
• 53. Agrawal R, Sharma N, Chaudry R, et al. Effects of oral Lactobacillus GG on enteric microflora in low birth weight neonates. J Pediatr Gastroenterol Nutr 2003; 36: 397–402.
• 54. Reuman PD, Duckworth DH, Smith KL, et al. Lack of effect of Lactobacillus on gastrointestinal bacterial colonisation in premature neonates. Ped Infect Dis 1986; 5: 663–668.
• 55. Thompson C, McCarter YS, Krause PJ, et al. Lactobacillus acidophilus sepsis in a neonate. J Perinatol 2001; 21: 258–260.
• 56. Broughton RA, Gruber WC, Haffar AA, Baker CJ. Neonatal meningitis due to Lactobacillus. Pediatr Infect Dis 1983; 2: 382–384.
• 57. Martin CR, Walker WA. Probiotics: role in pathophysiology and prevention in necrotizing enterocolitis. Semin Perinatol 2008; 32: 127-137.
• 58. Vankerckhoven V, Huys G, Vancanneyt M, et al. Biosafety assessment of probiotics used for human consumption: recommendations from the EUPROSAFE project. Trends Food Sci Technol 2008; 19: 102-114.