Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups

Abstract

AimThe use of probiotics has been covered by many guidelines, position papers and evidence‐based recommendations, but few have referred to specific patient groups or clinical indications. This review summarises recommendations and scientifically credited guidelines on the use of probiotics for children with selected clinical conditions and provides practice points.MethodsAn expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric health care and review and summarise the guidelines, recommendations, position papers and high‐quality evidence.ResultsThe panel found that specific probiotic strains were effective in preventing antibiotic‐associated and nosocomial diarrhoea, treating acute gastroenteritis and treating infantile colic in breastfed infants. However, special caution is indicated for premature infants, immunocompromised and critically ill patients and those with central venous catheters, cardiac valvular disease and short‐gut syndrome. This review discusses the safety of using probiotics in selected groups of paediatric patients and the quality of the available products providing practice points based on proved findings.ConclusionEfficacy of probiotics is strain specific. Their benefits are currently scientifically proven for their use in selected clinical conditions in children and not recommended for certain patient groups.

Paediatricians play a key role in preventing early harmful events that could permanently influence the development of the gut microbiota in childhood

“…The gut microbiota can be modulated to achieve health‐promoting effects . The beneficial manipulation of the composition and metabolic footprint of the gut microbiota can be achieved by using probiotics.…”

“…The beneficial manipulation of the composition and metabolic footprint of the gut microbiota can be achieved by using probiotics. These can be defined as a preparation of, or a product containing, viable microorganisms in an adequate number to enable such dietary preparations to favourably modulate the gut microbiota . The ability to exert a beneficial modulation on the gut microbiota may be enhanced by combining probiotics with other ingredients (64), namely prebiotics, which are capable of favouring the growth and/or activity of microorganisms.…”

“…Probiotics have been defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host . The term probiotics is used widely, but not always properly, in the scientific literature and by the industry.…”

Probiotics do have a role to play in treating critically ill children

“…We read with interest the review by Hojsak et al on using probiotics for children with selected clinical conditions and from specific vulnerable groups. They suggested using specific strains of probiotics to prevent upper respiratory tract infections in children attending day care centres and prevent nosocomial and antibiotic‐associated diarrhoea, acute gastroenteritis and infantile colic in breastfed infants.…”

More research is needed on the use of probiotics for critically ill patients

“…We are grateful to Williams and Kumar Angurana for their comments on our paper in Acta Paediatrica and for providing the references to their own work on the use of probiotics for critically ill patients .…”