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Good evidence exists that probiotic treatment can help prevent distressing and potentially fatal illness in premature babies, say researchers

Probiotic-based treatment could prevent infection in premature babies

Natural Health News —Premature babies, whose immune systems are not fully functioning, are more vulnerable to a whole host of diseases including a distressing condition called necrotising enterocolitis.

Necroising enteroclitis (NEC) affects 8-13% of very low birthweight infants (those under 3lb, 4oz/1.5 kg), and up to half of the infants with this condition will die.

As babies develop the collection of gut bacteria that colonise healthy intestines, those with NEC have an extreme inflammatory reaction that leads to damage and death of these tissues that often requires surgery to correct. Steroids are one of the few currently available ways to prevent NEC, but their use can cause numerous complications.

Clinical trials of probiotics – ‘good’ bacteria often taken as dietary supplements to promote health – suggests that they have multiple benefits in adults, including improving symptoms of the common cold, aiding weight loss,  regulating moods, and repairing the damage caused by antibiotics, .

But recently several trials have also suggested that probiotic prophylaxis (i.e. using probiotics as a preventative strategy) may also significantly decrease the incidence and severity of NEC and should therefore be incorporated into the standard of care for preterm infants.

However, debate still remains because of what some scientists say are limitations of completed studies.

The weight of the evidence

Seeking clarity scientist in Brazil undertook a systematic review of randomised controlled trials that have investigated the benefits of using probiotics in the prevention of NEC and its complications in preterm newborns.

The review included 11 randomized trials involving 2,887 children.

Overall the evidence showed that  probitic treatment resulted in a reduction in the incidence of NEC and therefore the overall death, and in rates of neonatal sepsis when compared to the control group.

Babies that received probiotic supplementation were also able to transition more quickly to taking in food and spent less time in hospital compared to those not receiving probiotics.

There was, however, no difference in death rates in those infants who did contract NEC.

The authors, writing in Jornal de Pediatria (Rio) conclude “In premature newborns, the use of probiotics is effective as a prophylaxis for NEC and its complications”.

Not a recognised treatment

In spite of strong evidence of benefit the use of probiotics to treat premature babies is not widely embraced in mainstream care.

The US Food and Drug Administration (FDA), for example, does not sanction the use of whole bacteria in premature infants.

Nobody knows exactly how probiotics protect the gut. One theory is that it is the chemicals secreted by beneficial bacteria that typically live in the intestines of healthy babies that help reduce the frequency and severity of NEC.

How good bacteria help

Last year scientists at Massachusetts General Hospital for Children and Harvard Medical School tested this theory out using intestinal tissue from infants with NEC as well as fetal intestinal tissues.

They looked at the response of secretions from two probiotic strains of bacteria, L. acidophilus and B. infantus, and found that these secretions reduced inflammation in both immature intestinal tissue and tissue from infants with NEC.

Secretions from B. infantis alone showed a greater ability to reduce inflammation. While this does not rule out the possibility that the two strains could have a greater synergistic effect, it does suggest that B. infantis may be primarily responsible for the anti-inflammatory effect observed.

The study was published in the American Journal of Physiology – Gastrointestinal and Liver Physiology.

While NEC is a complex disease, and more research is needed, it seems clear that probiotic bacteria in some form can reduce the severity and incidence of NEC in very low birthweight infants, and could ultimately change the standard of care for these infants, potentially saving thousands of lives each year.