Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

Abstract

Necrotizing enterocolitis (NEC) is a devastating intestinal disease in preterm infants characterized by barrier disruption, intestinal microbial dysbiosis, and persistent inflammation of the colon, which results in high mortality rates. Current strategies used to manage this disease are not sufficient, although the use of human breast milk reduces the risk of NEC. Mother's milk is regarded as a fundamental nutritional source for neonates, but pasteurization of donor breast milk affects the composition of bioactive compounds. Current research is evaluating the benefits and potential pitfalls of adding probiotics and prebiotics to pasteurized milk so as to improve the functionality of the milk and thereby reduce the burden of illness caused by NEC. Probiotics (live micro-organisms that confer health to the host) and prebiotics (nondigestible oligosaccharides that stimulate the growth of healthy bacteria) are functional foods known to mediate immune responses and modulate microbial populations in the gut. Clinical research shows strain-and compoundspecific responses when probiotics or prebiotics are administered in conjunction with donor breast milk for the prevention of NEC. Despite ongoing controversy surrounding optimal treatment strategies, randomized controlled studies are now investigating the use of synbiotics to reduce the incidence and severity of NEC. Synbiotics, a combination of probiotics and prebiotics, have been proposed to enhance beneficial health effects in the intestinal tract more than either agent administered alone. This review considers the implications of using probiotic-, prebiotic-, and synbioticsupplemented breast milk as a strategy to prevent NEC and issues that could be encountered with the preparations. Adv Nutr 2016;7:928-37.

Immunonutrition for Preterm Infants

“…Evidence of their effectiveness in very preterm infants, however, is limited by concerns about the quality of the existing trial data [36]. There remains a need to conduct large, high-quality randomised controlled trials to assess the effect of prebiotic supplementation or of supplementation with prebiotic-probiotic combinations (“synbiotics”) on NEC, late-onset infection and other morbidity, and mortality amongst very preterm infants [37]. …”

Beyond Heat Stress: Intestinal Integrity Disruption and Mechanism-Based Intervention Strategies

“…Accumulating evidence indicates that provision of a combination of nutritional substances is more effective than treatment with a single dietary component. Synbiotics, a combination of probiotics and prebiotics, have been shown to exert synergistic effects in the intestinal tract [62,257]. Microbiota-stabilizing compounds in combination with other nutritional substances can also enhance beneficial health effects and can possibly be used in a broader range of clinical conditions.…”

“…The gut microbiota, which comprises a vast array of microorganisms, has a key effect on the regulation of host nutrition and metabolism, as well as on the stimulation of gut maturation, development, proliferation, and immune homeostasis [60,62]. A variety of host conditions, including diet, immune reactions, infections, and usage of antibiotics influences the gut microbiota.…”

Early‐Life Gut Microbiome—The Importance of Maternal and Infant Factors in Its Establishment

“…Probiotic supplements have been shown to be safe, as well as to significantly reduce the risk of necrotizing enterocolitis, decrease the time required for enteral feeding tolerance, and diminish the mortality risk in preterm infants 207‐214 . Moreover, probiotic supplementation in premature infants has been reported to improve the intestinal barrier, enhance the production of IgA and anti‐inflammatory cytokines, increase the diversity and functionality of the gut microbiota, and reduce pathological bacterial translocation 214 .…”