Therapeutic use of prebiotics, probiotics, and postbiotics to prevent necrotizing enterocolitis: what is the current evidence?

Abstract

Necrotizing enterocolitis (NEC) is a leading cause of neonatal morbidity and mortality, and preventive therapies that are both effective and safe are urgently needed. Current evidence from therapeutic trials suggests that probiotics are effective in decreasing NEC in preterm infants, and probiotics are currently the most promising therapy for this devastating disease. However, concerns regarding safety and optimal dosing have limited the widespread adoption of routine clinical use of probiotics in preterm infants. This article summarizes the current evidence regarding the use of probiotics, prebiotics, and postbiotics in the preterm infant, including their therapeutic role in preventing NEC.

Copyright © 2013 Elsevier Inc. All rights reserved.

Figures

Figure 1

Factors influencing abnormal intestinal bacterial colonization in preterm infants.

Figure 2

Mechanisms of action of probiotics at the cellular level in intestinal epithelia.

Figure 3

Plots demonstrate the relative risk of necrotizing enterocolitis (NEC) (panel A) and mortality (panel B) in the probiotic treatment arm, compared to placebo, of therapeutic trials in preterm infants. Error bars reflect 95% confidence interval (CI) for relative risk estimates. Two studies had no NEC events in the probiotic treatment arm and estimates, without 95% CI, are indicated by black arrows. Data from individual studies referenced as well as from Deshpande et al.[66] and Wang et al.[63].

Figure 4

Plot demonstrates the relative risk of sepsis in the probiotic treatment arm, compared to placebo, of therapeutic trials in preterm infants. Error bars reflect 95% confidence interval for relative risk estimates. Data from individual studies referenced as well as from Deshpande et al.[66] and Wang et al.[63].