Probiotics and necrotizing enterocolitis

Necrotizing enterocolitis: new insights into pathogenesis and mechanisms

“…The finding that a degree of perturbation in the normal gut microbial flora exists in patients with NEC supports a rationale of using probiotics to treat and prevent this disease 105,115,116 . Considering the vulnerability of premature infants, routine administration of probiotic agents has elicited substantial controversy regarding the type of agent to be used, dosing and timing 128,129 . A systematic review, analysing 24 trials, evaluated the efficacy and safety of probiotics for preventing NEC 130 and suggested that oral administration of probiotics decreases all-cause mortality and incidence of severe NEC in preterm infants; however, the precise probiotic agent, timing and length of therapy still remains to be established 128,130 .…”

Necrotizing enterocolitis symposium: Epidemiology and early diagnosis

“…The presentation of a sick premature neonate who has been tolerating enteral feeds but has developed abdominal distension, increased aspirates and has pneumatosis intestinalis and pneumoperitoneum is all too familiar, as are the findings at laparotomynecrotic bowel requiring extensive resection, and the outcomesmortality, neurodevelopmental impairment and short bowel syndrome [1]. Probiotics have not eradicated the disease [2] and the surgical outcomes do not appear to have improved over twenty years [3,4], so research into the epidemiology and rapid diagnosis of the disease is urgently required.…”

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

“…Another series of compounds that have potential use in preventing NEC is a new class of TLR4 inhibitors which, by preventing TLR4 activation, may inhibit the inflammatory cascade in NEC [79,80]. Of course, probiotics have polarized the neonatal community regarding their ability (or not) to prevent NEC [81]. An extensive discussion is beyond the scope of this review and unfortunately we seem no closer to a definitive answer despite large-scale trials, such as ProPrems [82] and PIPS [83].…”

“…Probiotics have not eradicated the disease [2] and the surgical outcomes do not appear to have improved over 20 years [3]. The high mortality (around 30% for surgical NEC) [3] and long-term morbidity [4,5] of survivors mandates urgent research into the pathogenesis, diagnosis, prevention, and treatment of this devastating disease.…”