The Role of Probiotics in the Prevention of Necrotizing Enterocolitis

Author(s): Ivana Trivić, Ana Savić Mlakar, Iva Hojsak*.

Journal Name: Current Pediatric Reviews

Volume 15 , Issue 2 , 2019

Become EABM
Become Reviewer

Abstract:

Necrotizing enterocolitis (NEC) is a frequent and severe life-threatening disease affecting the gastrointestinal tract of preterm infants. Given that NEC occurs in a well-defined population of patients, there might be a considerable benefit in identifying specific pharmacological and nutritional preventive strategies, that could reduce the incidence of NEC. Amongst nutritional strategies emphasis has been put on the use of probiotics. Therefore, the aim of this review is to summarize currently available evidence on the role of probiotics in general, as well as the role of specific probiotic strains or their combinations, in the prevention of NEC.

Keywords: Premature infant, microbiota, sepsis, neonate, NEC, patients, probiotics.

[1]
Nino DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: New insights into pathogenesis and mechanisms. Nat Rev Gastroenterol Hepatol 2016; 13: 590-600.
[2]
Stoll BJ, Hansen NI, Bell EF, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126: 443-56.
[3]
Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011; 364: 255-64.
[4]
Christensen RD, Lambert DK, Baer VL, Gordon PV. Necrotizing enterocolitis in term infants. Clin Perinatol 2013; 40: 69-78.
[5]
Tanner SM, Berryhill TF, Ellenburg JL, et al. Pathogenesis of necrotizing enterocolitis: Modeling the innate immune response. Am J Pathol 2015; 185: 4-16.
[6]
Vongbhavit K, Underwood MA. Prevention of necrotizing enterocolitis through manipulation of the intestinal microbiota of the premature infant. Clin Ther 2016; 38: 716-32.
[7]
Arboleya S, Ang L, Margolles A, et al. Deep 16S rRNA metagenomics and quantitative PCR analyses of the premature infant fecal microbiota. Anaerobe 2012; 18: 378-80.
[8]
La Rosa PS, Warner BB, Zhou Y, et al. Patterned progression of bacterial populations in the premature infant gut. Proc Natl Acad Sci USA 2014; 111: 12522-7.
[9]
Elfvin A, Dinsdale E, Wales PW, Moore AM. Low birthweight, gestational age, need for surgical intervention and gram-negative bacteraemia predict intestinal failure following necrotising enterocolitis. Acta Paediatr 2015; 104: 771-6.
[10]
Luig M, Lui K. Nsw, Group AN. Epidemiology of necrotizing enterocolitis--Part II: Risks and susceptibility of premature infants during the surfactant era: a regional study. J Paediatr Child Health 2005; 41: 174-9.
[11]
Claud EC, Walker WA. Bacterial colonization, probiotics, and necrotizing enterocolitis. J Clin Gastroenterol 2008; 42: S46-52.
[12]
Warner BB, Deych E, Zhou Y, et al. Gut bacteria dysbiosis and necrotising enterocolitis in very low birthweight infants: A prospective case-control study. Lancet 2016; 387: 1928-36.
[13]
Wang Y, Hoenig JD, Malin KJ, et al. 16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitis. ISME J 2009; 3: 944-54.
[14]
Underwood MA, Sohn K. The Microbiota of the Extremely Preterm Infant. Clin Perinatol 2017; 44: 407-27.
[15]
Mai V, Young CM, Ukhanova M, et al. Fecal microbiota in premature infants prior to necrotizing enterocolitis. PLoS One 2011; 6e20647
[16]
Hill C, Guarner F, Reid G, et al. Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014; 11: 506-14.
[17]
Hooper LV, Wong MH, Thelin A, et al. Molecular analysis of commensal host-microbial relationships in the intestine. Science 2001; 291: 881-4.
[18]
Lin PW, Myers LE, Ray L, et al. Lactobacillus rhamnosus blocks inflammatory signaling in vivo via reactive oxygen species generation. Free Radic Biol Med 2009; 47: 1205-11.
[19]
Wickramasinghe S, Pacheco AR, Lemay DG, Mills DA. Bifidobacteria grown on human milk oligosaccharides downregulate the expression of inflammation-related genes in Caco-2 cells. BMC Microbiol 2015; 15: 172.
[20]
Underwood MA, Arriola J, Gerber CW, et al. Bifidobacterium longum subsp. infantis in experimental necrotizing enterocolitis: Alterations in inflammation, innate immune response, and the microbiota. Pediatr Res 2014; 76: 326-33.
[21]
Kumar A, Wu H, Collier-Hyams LS, et al. The bacterial fermentation product butyrate influences epithelial signaling via reactive oxygen species-mediated changes in cullin-1 neddylation. J Immunol 2009; 182: 538-46.
[22]
Patel RM, Myers LS, Kurundkar AR, et al. Probiotic bacteria induce maturation of intestinal claudin 3 expression and barrier function. Am J Pathol 2012; 180: 626-35.
[23]
Bron PA, Kleerebezem M, Brummer RJ, et al. Can probiotics modulate human disease by impacting intestinal barrier function? Br J Nutr 2017; 117: 93-107.
[24]
Walker WA. Mechanisms of action of probiotics. Clin Infect Dis 2008; 46: S87-91.
[25]
Denning TL, Bhatia AM, Kane AF, Patel RM, Denning PW. Pathogenesis of NEC: Role of the innate and adaptive immune response. Semin Perinatol 2017; 41: 15-28.
[26]
Jilling T, Simon D, Lu J, et al. The roles of bacteria and TLR4 in rat and murine models of necrotizing enterocolitis. J Immunol 2006; 177: 3273-82.
[27]
Leaphart CL, Cavallo J, Gribar SC, et al. A critical role for TLR4 in the pathogenesis of necrotizing enterocolitis by modulating intestinal injury and repair. J Immunol 2007; 179: 4808-20.
[28]
Gomez-Llorente C, Munoz S, Gil A. Role of Toll-like receptors in the development of immunotolerance mediated by probiotics. Proc Nutr Soc 2010; 69: 381-9.
[29]
Patel RM, Underwood MA. Probiotics and necrotizing enterocolitis. Semin Pediatr Surg 2018; 27: 39-46.
[30]
van den Akker CHP, van Goudoever JB, Szajewska H, et al. Probiotics for Preterm Infants: A strain specific systematic review and network meta-analysis. J Pediatr Gastroenterol Nutr 2018; 67(1): 103-22.
[31]
Aceti A, Gori D, Barone G, et al. Probiotics for prevention of necrotizing enterocolitis in preterm infants: systematic review and meta-analysis. Ital J Pediatr 2015; 41: 89.
[32]
AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 2014.CD005496
[33]
Lau CS, Chamberlain RS. Probiotic administration can prevent necrotizing enterocolitis in preterm infants: A meta-analysis. J Pediatr Surg 2015; 50: 1405-12.
[34]
Yang Y, Guo Y, Kan Q, et al. A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Braz J Med Biol Res 2014; 47: 804-10.
[35]
Deshpande G, Rao S, Patole S, Bulsara M. Updated meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates. Pediatrics 2010; 125: 921-30.
[36]
Rao SC, Athalye-Jape GK, Deshpande GC, Simmer KN, Patole SK. Probiotic Supplementation and Late-Onset Sepsis in Preterm Infants: A Meta-analysis. Pediatrics 2016; 137e20153684
[37]
Aceti A, Gori D, Barone G, et al. Probiotics and Time to Achieve Full Enteral Feeding in Human Milk-Fed and Formula-Fed Preterm Infants: Systematic Review and Meta-Analysis. Nutrients 2016; 30(8)E471
[38]
Athalye-Jape G, Deshpande G, Rao S, Patole S. Benefits of probiotics on enteral nutrition in preterm neonates: A systematic review. Am J Clin Nutr 2014; 100: 1508-19.
[39]
Olsen R, Greisen G, Schroder M, Brok J. Prophylactic Probiotics for Preterm Infants: A Systematic Review and Meta-Analysis of Observational Studies. Neonatology 2016; 109: 105-12.
[40]
Denkel LA, Schwab F, Garten L, et al. Protective effect of dual-strain probiotics in preterm infants: A multi-center time series analysis. PLoS One 2016; 11e0158136
[41]
Costeloe K, Bowler U, Brocklehurst P, et al. A randomised controlled trial of the probiotic Bifidobacterium breve BBG-001 in preterm babies to prevent sepsis, necrotising enterocolitis and death: The Probiotics in Preterm infantS (PiPS) trial. Health Technol Assess 2016; 20: 1-194.
[42]
Modi N. Probiotics and Necrotising Enterocolitis: the devil (as always) is in the detail. Commentary on N. Ofek Shlomai et al.: Probiotics for preterm neonates: what will it take to change clinical practice? Neonatology 2014; 105: 64-70.
[43]
Athalye-Jape G, Rao S, Patole S. Lactobacillus reuteri DSM 17938 as a Probiotic for Preterm Neonates: A Strain-Specific Systematic Review. JPEN J Parenter Enteral Nutr 2016; 40: 783-94.
[44]
Athalye-Jape G, Rao S, Simmer K, Patole S. Bifidobacterium breve M-16V as a Probiotic for Preterm Infants: A Strain-Specific Systematic Review. JPEN J Parenter Enteral Nutr 2017; 42(4): 677-88.
[45]
Kolacek S, Hojsak I, Berni Canani R, et al. Commercial Probiotic Products: A Call for Improved Quality Control. A Position Paper by the ESPGHAN Working Group for Probiotics and Prebiotics. J Pediatr Gastroenterol Nutr 2017; 65: 117-24.
[46]
Lewis ZT, Shani G, Masarweh CF, et al. Validating bifidobacterial species and subspecies identity in commercial probiotic products. Pediatr Res 2016; 79: 445-52.
[47]
Sanders ME, Shane AL, Merenstein DJ. Advancing probiotic research in humans in the United States: Challenges and strategies. Gut Microbes 2016; 7: 97-100.
[48]
Imperial IC, Ibana JA. Addressing the Antibiotic Resistance Problem with Probiotics: Reducing the Risk of Its Double- Edged Sword Effect. Front Microbiol 2016; 7: 1983.
[49]
Kunz AN, Noel JM, Fairchok MP. Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome. J Pediatr Gastroenterol Nutr 2004; 38: 457-8.
[50]
Bertelli C, Pillonel T, Torregrossa A, et al. Bifidobacterium longum bacteremia in preterm infants receiving probiotics. Clin Infect Dis 2015; 60: 924-7.
[51]
Zbinden A, Zbinden R, Berger C, Arlettaz R. Case series of Bifidobacterium longum bacteremia in three preterm infants on probiotic therapy. Neonatology 2015; 107: 56-9.
[52]
Vallabhaneni S, Walker TA, Lockhart SR, et al. Notes from the field: Fatal gastrointestinal mucormycosis in a premature infant associated with a contaminated dietary supplement-Connecticut, 2014. MMWR Morb Mortal Wkly Rep 2015; 64: 155-6.
[53]
Manzoni P, Lista G, Gallo E, et al. Routine Lactobacillus rhamnosus GG administration in VLBW infants: A retrospective, 6-year cohort study. Early Hum Dev 2011; 87(Suppl. 1): S35-8.
[54]
Boyle RJ, Robins-Browne RM, Tang ML. Probiotic use in clinical practice: what are the risks? Am J Clin Nutr 2006; 83: 1446-7.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 2
Year: 2019
Page: [88 - 91]
Pages: 4
DOI: 10.2174/1573396315666181224123223

Article Metrics

PDF: 22
HTML: 3
PRC: 1