Probiotic research in neonates with congenital gastrointestinal surgical conditions – Now is the time

Abstract

Summary Neonates with congenital gastrointestinal surgical conditions ( CGISC ) receive parenteral nutrition, get exposed to multiple courses of antibiotics, undergo invasive procedures, and are nursed in intensive care units. They do not receive early enteral feeding and have limited opportunities for skin to skin contact with their mothers. Many of these infants receive gastric acid suppression therapies. All these factors increase the risk of gut dysbiosis in these infants. Gut dysbiosis is known to be associated with increased risk of infections and other morbidities in ICU patients. Experimental studies have shown that probiotics inhibit gut colonization with pathogenic bacteria, enhance gut barrier function, facilitate colonization with healthy commensals, protect from enteropathogenic infection through production of acetate, reduce antimicrobial resistance, enhance innate immunity, and increase the maturation of the enteric nervous system and promote gut peristalsis. Through these mechanisms, probiotics have the potential to decrease the risk of sepsis and inflammation, improve feed tolerance and minimise cholestasis in neonates with CGISC . Among preterm non‐surgical infants, evidence from more than 35 RCT s and multiple observational studies have shown probiotics to be safe and beneficial. A RCT in neonates (N=24) with gastroschisis found that probiotic supplementation partially attenuated gut dysbiosis. Two ongoing RCT s (total N=168) in neonates with gastrointestinal surgical conditions are expected to provide feasibility data to enable the conduct of large RCT s. Rigorous quality assurance of the probiotic product, ongoing microbial surveillance and clinical vigilance are warranted while conducting such RCT s.

Gut microbiota in neonates with congenital gastrointestinal surgical conditions: a prospective study

“…Probiotics are known to inhibit gut colonization with pathogenic bacteria enhance gut barrier function, facilitate colonization with healthy commensals, protect from enteropathogenic infection through production of acetate, reduce antimicrobial resistance, enhance innate immunity and increase maturation of the enteric nervous system and promote gut peristalsis. 32 Through these mechanisms, probiotics have the potential to decrease the risk of sepsis, improve feed tolerance and minimize parenteral nutrition-associated cholestasis in infants with CGISCs. 32 Meta-analyses of RCTs in preterm infants (non-surgical) have shown probiotic supplementation to be beneficial in decreasing mortality, necrotizing enterocolitis (NEC), late-onset sepsis and improving feed tolerance.…”

“…32 Through these mechanisms, probiotics have the potential to decrease the risk of sepsis, improve feed tolerance and minimize parenteral nutrition-associated cholestasis in infants with CGISCs. 32 Meta-analyses of RCTs in preterm infants (non-surgical) have shown probiotic supplementation to be beneficial in decreasing mortality, necrotizing enterocolitis (NEC), late-onset sepsis and improving feed tolerance. 33 Majority of the RCTs included in those meta-analyses used Bifidobacteria as the sole or one of the components of probiotic supplements.…”

Probiotic supplementation in neonates with congenital gastrointestinal surgical conditions: a pilot randomised controlled trial

“…Experimental studies have shown that probiotic supplementation attenuates gut dysbiosis, strengthens the gut barrier, prevents enteropathogenic infections, reduces antimicrobial resistance, enhances immunity, and promotes gut peristalsis. 16 Through these mechanisms, probiotics have the potential to improve the outcomes of neonates with CGISC. 16 Many beneficial biological functions of probiotics are mediated via short-chain fatty acids (SCFAs).…”

“… 16 Through these mechanisms, probiotics have the potential to improve the outcomes of neonates with CGISC. 16 Many beneficial biological functions of probiotics are mediated via short-chain fatty acids (SCFAs). 17 The major SCFAs (80–95%) in the gut are acetate, propionate, and butyrate.…”