Lactobacillus Acidophilus/Bifidobacterium Infantis Probiotics Are Beneficial to Extremely Low Gestational Age Infants Fed Human Milk

Abstract

Objective: To evaluate the nutrition-related effects of prophylactic Lactobacillus acidophilus/Bifidobacterium infantis probiotics on the outcomes of preterm infants <29 weeks of gestation that receive human milk and/or formula nutrition. We hypothesize that human-milk-fed infants benefit from probiotics in terms of sepsis prevention and growth. Methods: We performed an observational study of the German Neonatal Network (GNN) over a period of six years, between 1 January, 2013 and 31 December, 2018. Prophylactic probiotic use of L. acidophilus/B. infantis was evaluated in preterm infants <29 weeks of gestation (n = 7516) in subgroups stratified to feeding type: (I) Exclusively human milk (HM) of own mother and/or donors (HM group, n = 1568), (II) HM of own mother and/or donor and formula (Mix group, n = 5221), and (III) exclusive exposure to formula (F group, n = 727). The effect of probiotics on general outcomes and growth was tested in univariate models and adjusted in linear/logistic regression models. Results: 5954 (76.5%) infants received L. acidophilus/B. infantis prophylactically for the prevention of necrotizing enterocolitis (NEC). Probiotic use was associated with improved growth measures in the HM group (e.g., weight gain velocity in g/day: effect size B = 0.224; 95% CI: 2.82–4.35; p < 0.001) but not in the F group (effect size B = −0.06; 95% CI: −3.05–0.28; p = 0.103). The HM group had the lowest incidence of clinical sepsis (34.0%) as compared to the Mix group (35.5%) and the F group (40.0%). Only in the Mix group, probiotic supplementation proved to be protective against clinical sepsis (OR 0.69; 95% CI: 0.59–0.79; p < 0.001). Conclusion: Our observational data indicate that the exposure to L. acidophilus/B. infantis probiotics may promote growth in exclusively HM-fed infants as compared to formula-fed infants. To exert a sepsis-preventive effect, probiotics seem to require human milk.

Current and future methods of probiotic therapy for necrotizing enterocolitis

“…There are several factors, regardless of whether single or multistrain probiotics are used, that complicate analysis and comparison of the RCTs discussed here, including the use of different probiotic formulations and dosing, differences in gestational age of the study groups (degree of prematurity), whether VLBW or ELBW infants were included, and differences in the incidence of NEC. In addition, the use of human breast milk vs. formula to feed the neonate while they are on probiotics may alter the effect of probiotics on NEC (70). For example, probiotic supplementation of B. breve and L. casei (Yakult LB, São Paulo, Brazil) to human milk in VLBW preterm infants during the first month of life was associated with a reduction in the incidence of NEC (Bell's stage ≥2).…”

Treatment of preterm brain injury via gut‐microbiota–metabolite–brain axis

“…Prophylactic probiotics usage is recommended to support the development of healthy GM, suppress the colonization of potentially pathogenic bacteria, and inhibit opportunistic pathogen overgrowth without altering the overall longitudinal bacterial profile in the neonatal period 87,88 . Recent studies suggest that the early microbial colonization affects brain development in preterm infants and microbiome optimization improves neurodevelopmental outcomes 89,90 . This anticipates probiotic interventions for improving neurodevelopment, although their safety remains controversial.…”

Probióticos y Prebióticos. Rol en la Terapéutica de la Enfermedad Diarreica Aguda Infantil

“…En un estudio observacional de la Red Neonatal Alemana,que incluyó 7516 lactantes prematuros menores de 29 semanas de gestación, estratificados según tipo de alimentación (lactancia materna exclusiva, lactancia materna y fórmulas; y sólo fórmulas); se verificó que la exposición del subgrupo de lactancia materna exclusiva a probióticos Lactobacillus acidophilus/ Bifido bacterium infantis, permitió una mejora de las medidas de crecimiento. Nivel de evidencia 3b para estudios de tratamiento, grado de recomendación B (Manterola et al;Fortmann et al 2020). Hallazgos similares a los obtenidos en un estudio observacional multicéntrico anterior, en el se que estudió el efecto de Lactobacillus acidophilus/Bifido bacterium infantis en 5351 infantes; que permitió verificar una reducción del riesgo de morbilidad gastrointestinal en recién nacidos de muy bajo peso al nacer.…”