Pre‑ & Probiotics: Evidence behind the microbiome in pediatric care

In this episode of Milestones in Pediatric Nutrition, Professor Andrew Prentice interviews Professor Hania Szajewska from the Medical University of Warsaw about probiotics and prebiotics in pediatric nutrition. Professor Szajewska emphasizes the importance of evidence-based definitions from the International Scientific Association for Probiotics and Prebiotics (ISAPP), requiring documented health benefits in randomized controlled trials before products can be classified as probiotics or prebiotics. The discussion highlights critical factors influencing infant gut microbiota development, including mode of delivery, feeding method, and antibiotic exposure, with breastfeeding providing human milk oligosaccharides (HMOs) that selectively promote bifidobacteria. Professor Szajewska reviews current evidence from ESPGHAN guidelines, noting that while biotic-supplemented formulas demonstrate safety and adequate growth support, clinical benefit evidence remains limited and strain-specific. She discusses targeted probiotic applications, including necrotizing enterocolitis prevention and acute gastroenteritis management, while acknowledging the need for identifying populations most likely to benefit from these interventions.