Tolerance, Safety, and Effect on the Faecal Microbiota of an Enteral Formula Supplemented With Pre‐ and Probiotics in Critically Ill Children

Simakachorn, Nipat; Bibiloni, Rodrigo; Yimyaem, Phisek; Tongpenyai, Yothi; Varavithaya, Wandee; Grathwohl, Dominik; Reuteler, Gloria; Maire, J. C.; Blum, Stéphanie; Steenhout, Philippe; Benyacoub, Jalil; Schiffrin, Eduardo J.

doi:10.1097/mpg.0b013e318216f1ec

Cited by 44 publications

(47 citation statements)

References 45 publications

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“…GRV is one of the most routinely used parameters in the PICU despite a lack of evidence to support this parameter and current guidelines challenge the use of GRV as a marker for feeding intolerance . There is also no consensus for a standardised threshold for large GRV; however, the threshold of more than 50% of the feeding volume of the previous 4 h has been used in some studies and is the standard of care in our PICU . In the present study, gastric retention occurred in two infants receiving their feeding via a gastric route or a combined route and in one infant receiving EN via a post‐pyloric route.…”

Section: Discussionmentioning

confidence: 68%

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Eveleens

Dungen

Verbruggen

et al. 2018

J Human Nutrition Diet

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Background: Reaching an optimal nutritional intake is challenging in critically ill infants. One possible way to minimise nutritional deficits is the use of protein and energy-enriched (PE)-formulas. We aimed to describe weight achievement and gastrointestinal symptoms in infants admitted to the paediatric intensive care unit (PICU) while receiving PE-formula for a prolonged period. Methods: Records from infants admitted to a multidisciplinary PICU and using PE-formula were analysed retrospectively. Infants were eligible if they received PE-formula daily for at least 2 weeks. Weight achievement was determined as the difference between weight-for-age (WFA) Z-scores at the start and end of PE-formula use. Gastrointestinal symptoms, including gastric residual volume, constipation and vomiting, were evaluated as tolerance parameters. Results: Seventy infants with a median [interquartile range (IQR)] age of 76 (30-182) days were eligible. The PICU duration was 50 (35-83) days during which they received PE-formula for 30 (21-54) days. Predominant admission diagnoses were post-cardiac surgery, respiratory and cardiac diagnosis. A significant mean (SD) WFA Z-score increase of 0.48 (1.10) (P < 0.001) and a median (IQR) weight gain of 5.80 (3.28-9.04) g kg À1 day À1 was observed. Multivariate regression showed that a lower WFA Z-score at start was associated with a higher WFA Z-score increase during PE-formula use (b À0.35 (95% confidence interval = À0.50 to À0.19); P < 0.001). The maximum 24-h gastric residual volume was 8.1 mL (IQR = 2.2-14.3) for each 1 kg in bodyweight. Three (4%) infants were treated for diarrhoea and three infants were treated for vomiting. Conclusions: The majority of infants with a prolonged PICU stay showed weight improvement when using PE-formula. PE-formula was well tolerated because gastrointestinal symptoms only occurred in few infants.14% to 32% of critically ill infants already suffer from acute or chronic malnourishment upon admission to the PICU (1,2) . Development of malnutrition during PICU stay is associated with increased mortality, length of mechanical ventilation and length of stay (3,4) . Infants are 3

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Section: Discussionmentioning

confidence: 68%

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Eveleens

Dungen

Verbruggen

et al. 2018

J Human Nutrition Diet

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“…On the contrary, EEN (control formula) in critically ill children did not influence bacterial diversity in stool following 7 days of therapy (by DGGE), but induced a trend for increase in Lactobacillus and Enterococcus species (sp) and a decrease in Bifidobacterium sp. and Enterobacteriaceae by standard culture methods (51). Therefore, it is currently difficult to make convincing conclusions about the effects of EEN on human intestinal microbiota composition.…”

Section: Discussionmentioning

confidence: 99%

Monotonous Diets Protect Against Acute Colitis in Mice

Nagy‐Szakal

Mir

Ross³

et al. 2013

J. pediatr. gastroenterol. nutr.

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OBJECTIVES Multiple characteristics of industrialization have been proposed to contribute to the global emergence of inflammatory bowel diseases (IBDs: Crohn disease [CD] and ulcerative colitis [UC]). Major changes in eating habits during the past decades and the effectiveness of exclusive enteral nutrition (EEN) in the treatment of CD indicate the etiologic importance of dietary intake in IBDs. A uniform characteristic of nutrition in developing countries (where the incidence of IBD is low) and EEN is their consistent nature over prolonged periods. However, the potentially beneficial effect of dietary monotony in respect to mammalian intestinal inflammation has not been examined. METHODS The association between alternating (two different complete chows) and persistent regular diets, and dextran sulfate sodium (DSS) colitis susceptibility in C57BL/6J mice was studied. Colonic mucosal microbiota changes were investigated by high-throughput pyrosequencing of the 16S rRNA gene. RESULTS The severity of colitis increased upon dietary alternation compared to consistent control feeding. The microbiota of the alternating nutritional group clustered discretely from both control groups. CONCLUSIONS Our findings highlight that monotonous dietary intake may decrease mammalian vulnerability against colitis in association with microbiota separation. The epidemiologic and therapeutic implications of our results are also discussed.

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“…Simakachorn et al randomized 94 patients between 1 and 3 years old who were requiring mechanical ventilation to receive either a test formula containing a synbiotic blend (composed of 2 probiotic strains ( Lactobacillus paracasei NCC 2461 and Bifidobacterium longum NCC 3001), fructooligosaccharides, inulin, and Acacia gum, or a control formula. Infants in the test group tolerated well pre- and pro biotics [75]. Faecal bifidobacteria and total lactobacilli were higher in the test group, whereas enterobacteria levels diminished.…”

Section: Pre- and Pro Biotics In Critically Ill Children: Availablmentioning

confidence: 99%

Gut Microbial Translocation in Critically Ill Children and Effects of Supplementation with Pre- and Pro Biotics

Papoff

Ceccarelli

d’Ettorre

et al. 2012

International Journal of Microbiology

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Bacterial translocation as a direct cause of sepsis is an attractive hypothesis that presupposes that in specific situations bacteria cross the intestinal barrier, enter the systemic circulation, and cause a systemic inflammatory response syndrome. Critically ill children are at increased risk for bacterial translocation, particularly in the early postnatal age. Predisposing factors include intestinal obstruction, obstructive jaundice, intra-abdominal hypertension, intestinal ischemia/reperfusion injury and secondary ileus, and immaturity of the intestinal barrier per se. Despite good evidence from experimental studies to support the theory of bacterial translocation as a cause of sepsis, there is little evidence in human studies to confirm that translocation is directly correlated to bloodstream infections in critically ill children. This paper provides an overview of the gut microflora and its significance, a focus on the mechanisms employed by bacteria to gain access to the systemic circulation, and how critical illness creates a hostile environment in the gut and alters the microflora favoring the growth of pathogens that promote bacterial translocation. It also covers treatment with pre- and pro biotics during critical illness to restore the balance of microbial communities in a beneficial way with positive effects on intestinal permeability and bacterial translocation.

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Tolerance, Safety, and Effect on the Faecal Microbiota of an Enteral Formula Supplemented With Pre‐ and Probiotics in Critically Ill Children

Abstract: The enteral formula supplemented with synbiotics was well tolerated by children in intensive care units; it was safe and produced an increase in faecal bacterial groups of previously reported beneficial effects.

Cited by 44 publications

References 45 publications

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Weight improvement with the use of protein and energy enriched nutritional formula in infants with a prolonged PICU stay

Monotonous Diets Protect Against Acute Colitis in Mice

Gut Microbial Translocation in Critically Ill Children and Effects of Supplementation with Pre- and Pro Biotics

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