Necrotizing enterocolitis is a condition that
completely damages the intestines often resulting in death of the infant. This
condition is seen more often in preterm infants being cared for in an intensive
Though the exact reason
for the necrotizing enterocolitis is not known, lack of blood supply to the
intestines may be responsible.
Bacterial infection may also play a role.
What are the
recent guidelines for the use of probiotics in preterm infants?
indicate that probiotics play a role in the prevention of the development of
necrotizing enterocolitis in premature babies, thus reducing the number of
deaths in this population.
Recent guidelines for the use of probiotics in
preterm infants (infants born before 37 weeks) were published in the BMC
Medicine journal. Some salient features
of the guidelines are listed below:
• Based on
various published studies, the guidelines suggest that probiotics containing
bifidobacteria and lactobacilli are the best choice in preterm infants.
This combination has been found to promote the growth of
lactic-acid bacteria within the infant's digestive tract. It is however, not entirely clear whether
the use of multiple strains may be more beneficial than single strains. Combinations may be used only if they have
been well tested before. Studies also
indicate that Lactobacillus GG and Bifidobacterium animalis (subspecies lactis)
may not be useful in preventing necrotizing enterocolitis; the use of these
probiotic strains alone should be avoided in preterm infants pending further studies.
The dose of probiotics in preterm infants is not
yet clearly defined and should be extrapolated from studies that have
demonstrated an effect of the probiotic.
should be administered as early as possible in preterm infants
. This is to ensure bacterial colonization with the desired
bacteria before the gut is invaded by pathogenic bacteria.
probiotic supplementation may be stopped once the infant has reached a
corrected gestational age of 36 to 37 weeks
this age, the chances of digestive tract complications due to prematurity tend
probiotic supplementation should also be stopped during an acute illness like
severe infection or sepsis
. This is due to lack of
evidence whether the probiotic would be safe in this condition.
The infant should be monitored for adverse effects
like abdominal distension, flatulence, diarrhea, vomiting, and probiotic sepsis
(severe infection caused by the probiotic).
1. Despande GC, Rao SC, Keil AD, Patole SK. Evidence based guidelines
for use of probiotics in preterm neonates. BMC Medicine 2011; 9:92.