Role of Prebiotics, Probiotics, and Synbiotics in the Prevention of Necrotising Enterocolitis in Very Low Birth Weight Infants
The incidence of necrotising enterocolitis (NEC) in very low birth weight (VLBW) infants ranges from 2.6% to 28% and is a significant cause of mobidity and mortality in neonatal intensive care units (NICUs). Evidence suggests promising results with the use of probiotics and prebiotics in the prevention of NEC. The growth and metabolic activity of beneficial probiotic bacteria are enhanced by undigestible prebiotic sugars which may have direct immunologic effects. A study published in The Journal of Pediatrics evaluated the efficacy of prebiotics and probiotics (in combination with synbiotics or alone) in the prevention of NEC in VLBW infants.
In this prospective, randomised, controlled trial, 400 VLBW infants (birth weight <1500 g) with gestational age <32 weeks were assigned to 3 study groups and a control group (placebo). The infants in the study groups were administered probiotic (Bifidobacterium lactis, 5 × 109 colony-forming units), prebiotic (inulin 900 mg), or synbiotic (Bifidobacterium lactis, 5 × 109 colony-forming units, 30 mg plus inulin 900 mg) in formula or breast milk for a maximum duration of 8 weeks before discharge or death. The primary outcome was NEC. Time to reach full enteral feeding, length of NICU stay, late-onset sepsis, and death were also assessed.
Infants in the probiotic and synbiotic groups showed lower rates of NEC (2.0% and 4.0%, respectively) compared to infants in the prebiotic and control groups (12.0% and 18.0%, respectively). Infants in the 3 study groups showed faster time to reach full enteral feeding, reduced rates of mortality and clinical nosocomial sepsis, and shorter NICU stay compared to infants in the control group. Postnatal probiotic (with or without prebiotic) and antenatal steroid use resulted in reduced risk of NEC. However, maternal antibiotic exposure increased the risk of NEC.
Thus, based on the study results, it can be concluded that the use of probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) results in reduced incidence of NEC in VLBW infants. However, the use of prebiotic (inulin) alone has no effect on the incidence of NEC.
News Source: Dilli D, Aydin B, Fettah N, et al. The ProPre-Save Study: Effects of Probiotics and Prebiotics Alone or Combined on Necrotizing Enterocolitis in Very Low Birth Weight Infants. J Pediatr. 2015;166(3):545-551.e1.