Probiotics, prebiotics infant formula use in preterm or low birth weight infants: a systematic review

Abstract

BackgroundPrevious reviews (2005 to 2009) on preterm infants given probiotics or prebiotics with breast milk or mixed feeds focused on prevention of Necrotizing Enterocolitis, sepsis and diarrhea. This review assessed if probiotics, prebiotics led to improved growth and clinical outcomes in formula fed preterm infants.MethodsCochrane methodology was followed using randomized controlled trials (RCTs) which compared preterm formula containing probiotic(s) or prebiotic(s) to conventional preterm formula in preterm infants. The mean difference (MD) and corresponding 95% confidence intervals (CI) were reported for continuous outcomes, risk ratio (RR) and corresponding 95% CI for dichotomous outcomes. Heterogeneity was assessed by visual inspection of forest plots and a chi2 test. An I2 test assessed inconsistencies across studies. I2> 50% represented substantial heterogeneity.ResultsFour probiotics studies (N=212), 4 prebiotics studies (N=126) were included. Probiotics: There were no significant differences in weight gain (MD 1.96, 95% CI: -2.64 to 6.56, 2 studies, n=34) or in maximal enteral feed (MD 35.20, 95% CI: -7.61 to 78.02, 2 studies, n=34), number of stools per day increased significantly in probiotic group (MD 1.60, 95% CI: 1.20 to 2.00, 1 study, n=20). Prebiotics: Galacto-oligosaccharide / Fructo-oligosaccharide (GOS/FOS) yielded no significant difference in weight gain (MD 0.04, 95% CI: -2.65 to 2.73, 2 studies, n=50), GOS/FOS yielded no significant differences in length gain (MD 0.01, 95% CI: -0.03 to 0.04, 2 studies, n=50). There were no significant differences in head growth (MD −0.01, 95% CI: -0.02 to 0.00, 2 studies, n=76) or age at full enteral feed (MD −0.79, 95% CI: -2.20 to 0.61, 2 studies, n=86). Stool frequency increased significantly in prebiotic group (MD 0.80, 95% CI: 0.48 to 1.1, 2 studies, n=86). GOS/FOS and FOS yielded higher bifidobacteria counts in prebiotics group (MD 2.10, 95% CI: 0.96 to 3.24, n=27) and (MD 0.48, 95% CI: 0.28 to 0.68, n=56).ConclusionsThere is not enough evidence to state that supplementation with probiotics or prebiotics results in improved growth and clinical outcomes in exclusively formula fed preterm infants.

Necrotizing Enterocolitis

“…Prebiotics can be digested by these beneficial bacteria, thereby improving their growth and subsequently promoting the effects of these bacteria on gastrointestinal immunity [34]. In a study by Mihatsch and colleagues [35], 20 very low birth weight infants were randomized to receive 14 days of preterm formula supplemented with galacto-oligosaccharides (short chain) and fructo-oligosaccharides (long chain) or with placebo.…”

The Microbiome and Probiotics in Childhood

“…21 Mugambi et al likewise agree that weight gain is unaltered by use of probiotic-supplemented formula, but that the number of stools per day increased significantly with the use of supplemented formula. 22 In addition, probiotic-supplemented formula did not decrease the incidence of infant gastroesophageal reflux, crying, restlessness, vomiting, or diarrhea. 23 In premature infants, supplementation with Bifidobacterium lactis had no effect on the risk of necrotizing enterocolitis stage !…”

“…34 Ostensibly noninfectious pediatric gastrointestinal disorders, specifically abdominal pain, have also been explored as therapeutic targets of probiotics. One meta-analysis noted that L. rhamnosus GG supplementation was correlated with a significantly higher rate of treatment responses (e.g., decrease in pain intensity or no pain) in the overall population with abdominal pain-related functional enteric disorders (RR, 1.31; 95% CI, 1.08-1.59 and [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] and in the irritable bowel syndrome subgroup (RR, 1.70; 95% CI, 1.27-2.27 and 3-8). 35 Thus, Lactobacillus-based probiotics may have a beneficial role in these enteric diseases.…”

Role of probiotics in preterm infants: a randomized controlled trial

“…Even though the results of some studies done in the recent past, have proved that there is not much of a beneficial effect, the use of probiotics in preterm infants cannot be underestimated. 5,6 Few studies have analysed the hospitalisation days and have shown a positive association-reduction in the number of hospitalised days.But, in our study there was no significant reduction in the average duration of hospital stay.…”