Therapeutic Use of Prebiotics, Probiotics, and Postbiotics to Prevent Necrotizing Enterocolitis

Abstract

Synopsis Necrotizing enterocolitis (NEC) is a leading cause of neonatal morbidity and mortality and preventative therapies that are both effective and safe are urgently needed. Current evidence from therapeutic trials suggests that probiotics are effective in decreasing NEC in preterm infants and probiotics are currently the most promising therapy on the horizon for this devastating disease. However, concerns regarding safety and optimal dosing have limited the widespread adoption of routine clinical use of probiotics in preterm infants. In addition, prebiotics and postbiotics may be potential alternatives or adjunctive therapies to the administration of live microorganisms, although studies demonstrating their clinical efficacy in preventing NEC are lacking. This review summarizes the current evidence regarding the use of probiotics, prebiotics and postbiotics in the preterm infant, including its therapeutic role in preventing NEC.

Necrotizing enterocolitis: current perspectives

“…Probiotics exert their beneficial effect in various ways, such as improving epithelial function, increasing secretory immunoglobulin A, and attenuation of proinflammatory pathways. 102 Numerous studies have evaluated the use of probiotics to supplement colonization of the preterm gut with commensal flora, and thereby reducing the incidence of NEC. [103][104][105][106][107] However, there has been wide variation in the timing, dose, and formulation of probiotics used in the various trials.…”

In vitro and in vivo defensive effect of probiotic LAB against Pseudomonas aeruginosa using Caenorhabditis elegans model

“…Hence our interpretation of the results was based on the breakpoint values suggested by FEDAP (EFSA Panel on Additives and Products or Substances used in Animal Feed – European Food Safety Authority, 2012) [41] for ampicillin, tetracycline, erythromycin, streptomycin, gentamicin and chloramphenicol. For kanamycin, vancomycin, clindamycin and penicillin we adopted the breakpoints of tetracycline and erythromycin, respectively.…”

Probiotics and growth in preterm infants: A randomized controlled trial, PREMAPRO study

“…The second study was conducted exclusively in VLBW infants who were fed breast milk that was or was not supplemented with a mixture of probiotics [12]. The third study used L sporogenes, a strain that does not appear to have any beneficial effects [9], which is in contrast to B. lactis [2,22,23].…”