The Effects of Probiotics on Feeding Tolerance, Bowel Habits, and Gastrointestinal Motility in Preterm Newborns

Indrio, Flavia; Riezzo, Giuseppe; Raimondi, Francesco; Bellini, Massimo; Cavallo, Luciano; Francavilla, Ruggiero

doi:10.1016/j.jpeds.2007.11.005

Cited by 173 publications

(106 citation statements)

References 24 publications

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“…Studies in healthy infants indicated that formula supplementation with a single human breast milk– derived probiotic strain improved overall feeding tolerance by increasing gastric emptying rates and reducing fasting antral areas. 30 Colonization of the gut by commensal bacteria is essential for normal development of gastrointestinal-associated lymphoid tissue (GALT); this effect has been shown by the profound architectural and immunologic defects observed in germ-free rats. 31 Neonatology and pediatric gastroenterology are providing important information about the concurrent development of the gastrointestinal microbiota and the function of the mucosal immune system.…”

Section: The Metagenomics Era and Gastroenterologymentioning

confidence: 99%

“…In a randomized trial, the probiotic L. reuteri (strain ATCC 55730; 1 × 10 8 bacteria/d for 28 days) reduced crying times in breastfed colicky infants 132 ; the same probiotic strain (1 × 10 8 cfu/d for 30 days) reduced regurgitation and mean crying times while increasing gastric emptying rates in preterm neonates. 30 These studies highlight the potential effect of intentional manipulation of microbial communities on physiologic variables such as intestinal motility and pain perception. Animal studies have provided some evidence for mechanisms of action for the results from pediatric clinical trials.…”

Section: Irritable Bowel Syndrome and Related Disordersmentioning

confidence: 99%

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Targeting the Human Microbiome With Antibiotics, Probiotics, and Prebiotics: Gastroenterology Enters the Metagenomics Era

2009

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Studies of metagenomics and the human microbiome will tremendously expand our knowledge of the composition of microbial communities in the human body. As our understanding of microbial variation and corresponding genetic parameters is refined, this information can be applied to rational remodeling or “tailoring” of human-associated microbial communities and their associated functions. Physiologic features such as the development of innate and adaptive immunity, relative susceptibilities to infections, immune tolerance, bioavailability of nutrients, and intestinal barrier function may be modified by changing the composition and functions of the microbial communities. The specialty of gastroenterology will be affected profoundly by the ability to modify the gastrointestinal microbiota through the rational deployment of antibiotics, probiotics, and prebiotics. Antibiotics might be used to remove or suppress undesirable components of the human microbiome. Probiotics can introduce missing microbial components with known beneficial functions for the human host. Prebiotics can enhance the proliferation of beneficial microbes or probiotics, to maximize sustainable changes in the human microbiome. Combinations of these approaches might provide synergistic and effective therapies for specific disorders. The human microbiome could be manipulated by such “smart” strategies to prevent and treat acute gastroenteritis, antibiotic-associated diarrhea and colitis, inflammatory bowel disease, irritable bowel syndrome, necrotizing enterocolitis, and a variety of other disorders.

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Section: The Metagenomics Era and Gastroenterologymentioning

confidence: 99%

Section: Irritable Bowel Syndrome and Related Disordersmentioning

confidence: 99%

Targeting the Human Microbiome With Antibiotics, Probiotics, and Prebiotics: Gastroenterology Enters the Metagenomics Era

2009

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“…Pending the results of these studies, other strategies, such as probiotic or prebiotic supplementation to stimulate gastrointestinal maturity and function in preterm VLBW neonates, could also be evaluated [42,43,44,45,46,47]. Systematic reviews of RCTs have shown that prophylactic probiotic supplementation can significantly reduce the risk of NEC ≥ stage II and all-cause mortality while facilitating feed tolerance in preterm VLBW neonates [44,48,49].…”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews of RCTs have shown that prophylactic probiotic supplementation can significantly reduce the risk of NEC ≥ stage II and all-cause mortality while facilitating feed tolerance in preterm VLBW neonates [44,48,49]. Prebiotic oligosaccharides can modulate electrical activity and gastric emptying and may improve feed tolerance in preterm neonates [43,46]. They can also significantly reduce the stool viscosity and accelerate gastrointestinal transport in preterm neonates [47].…”

Section: Discussionmentioning

confidence: 99%

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

2016

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Background: A delayed passage of meconium is considered as a risk factor for feed intolerance in preterm neonates. Objectives: The aim of this study was to review the effects of different therapeutic agents for meconium evacuation on feed tolerance in preterm neonates. Methods: A systematic review of randomised controlled trials (RCTs) of different therapeutic agents for meconium evacuation in preterm neonates (gestation <32 weeks and/or birth weight <1,500 g) using the Cochrane systematic review methodology was undertaken. Databases including Google Scholar were searched in January 2016. The primary outcome was the time to reach full feeds (TFF; ≥120 ml/kg feeds with stoppage of parenteral nutrition >24 h). Secondary outcomes included necrotising enterocolitis (NEC), weight at discharge and adverse effects. The results were summarised as per the GRADE guidelines. Results: Six RCTs (2 each of glycerine suppository and enema, 1 normal saline enema and 1 oral osmotic contrast agent; n = 442) with a low or unclear risk of bias were included. The pooled estimate (random effects model) showed no reduction in TFF [mean difference (MD) -0.03, 95% CI -2.47, 2.41, p = 0.98; level of evidence: low]. No differences in NEC [risk ratio (RR) 1.71, 95% CI 0.63, 4.65, p = 0.30; level of evidence: low] and weight at discharge (MD -0.08, 95% CI -0.30, 0.15, p = 0.50; level of evidence: low) were found. The trial assessing oral osmotic contrast agents reported a trend towards a higher incidence of NEC ≥ stage II. There were no other adverse effects. Conclusion: Limited low-quality evidence indicates that prophylactic glycerine suppository, small volume glycerine/normal saline enema or oral osmotic contrast agents to evacuate meconium did not reduce TFF in preterm neonates. Large, well-designed trials are essential to study this clinically significant issue.

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“…Another study showed that supplementation with Lactobacillus GG has the potential to significantly reduce the incidence and intensity of enteric colonization by Candida species in preterm infants [54]. Other probiotics studied include Bifidobacterium longum BB536 and Lactobacillus GG (no effect on gastrointestinal tolerance of enteral feeding in very-low-birth-weight infants but may improve gastrointestinal tolerance in infants weighing >1,000 g) [55] and Lactobacillus reuteri ATCC55730 (may stimulate gastric emptying) [56,57]. …”

Section: Probiotics Prebiotics and Synbioticsmentioning

confidence: 99%

Is Early Nutrition Related to Short-Term Health and Long-Term Outcome

Szajewska

Makrides

2011

Ann Nutr Metab

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This paper summarizes the literature concerning the effects of administering (1) long-chain polyunsaturated fatty acids (LCPUFA), (2) probiotics and/or (3) prebiotics to preterm infants. Clinically relevant, short- and long-term efficacy outcomes, such as those related to a reduced risk of disease, as well as outcomes related to safety, were sought. MEDLINE and the Cochrane Library literature searches performed in September 2010 were limited to randomized controlled trials, their systematic reviews or meta-analyses. LCPUFA supplementation, particularly docosahexaenoic acid (DHA), of infant formula for preterm infants has consistently demonstrated better visual development of preterm infants compared with unsupplemented formulas. There is increasing evidence to suggest that LCPUFA supplementation for preterm infants is also related to improvements in more global measures of development, without any adverse effects. It is, however, important to note that the DHA doses tested in the infant formula interventions for preterm infants have been rather conservative. Newer studies comparing dietary DHA concentrations that match in utero accumulation rates with dietary DHA concentrations typical in the milk of women consuming little fish or in supplemented infant formulas demonstrate that these higher DHA doses are related to improvements in domains of cognitive development. Although further work is needed to better understand the optimal DHA requirements of preterm infants, it is clear that a dietary source of DHA is important to support neurodevelopment. To date, the most promising application of probiotics in preterm infants is the prevention of necrotizing enterocolitis by the administration of certain probiotics. Many other benefits of administering probiotics and/or prebiotics to preterm infants are, however, largely unproven. Efficacy and safety should be established for each probiotic and/or prebiotic product. Further research should specify strain-specific outcomes and determine optimal dosing schedules. Safety and long-term follow-up studies are of particular interest.

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The Effects of Probiotics on Feeding Tolerance, Bowel Habits, and Gastrointestinal Motility in Preterm Newborns

Cited by 173 publications

References 24 publications

Targeting the Human Microbiome With Antibiotics, Probiotics, and Prebiotics: Gastroenterology Enters the Metagenomics Era

Targeting the Human Microbiome With Antibiotics, Probiotics, and Prebiotics: Gastroenterology Enters the Metagenomics Era

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

Is Early Nutrition Related to Short-Term Health and Long-Term Outcome

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