Probiotic for Infants
The gut microbiota plays an important role in human health by providing a barrier for colonization of pathogens, by exerting important metabolic functions (fermentation or nondigestible fiber, production of vitamin K), and by stimulating the development of the immune system. At birth, the intestines are sterile. The bacteria colonizing the infant gut during the first days of life originate mainly from the mother and the environment. Vaginally born infants are colonized at first by fecal and vaginal bacteria of the mother, whereas infants born through cesarean section are exposed initially to bacteria originating from the hospital environment and health care workers.
Breastfed infants are generally healthier than formula-fed infants, especially with respect to their ability to fend off infections. Some of the health benefits of human milk have been attributed partly to factors that modulate the development of a normal gut microbiota. A number of clinical studies in which infants were supplemented with probiotics suggest that some probiotics have beneficial effects in managing and preventing gastrointestinal infections and diarrhea, preventing the onset of allergy, reducing colic-associated crying, and may be useful in the treatment of atopic disease.
L. reuteri and L. rhamnosus are two naturally occurring strains that well-documented probiotics in terms of safety and capability to colonize the human intestine. [1] [2] [3] [4] At 108CFU/day, these probiotics are well-tolerated with no reported side effects.
In a double-blind, placebo-controlled, crossover study, two probiotic Lactobacillus strains (L. rhamnosus and L. reuteri) were given in combination for 6 weeks to 1- to 13-year-old children with atopic dermatitis.[5] After active treatment, 56% of the patients experienced improvement of the eczema, whereas only 15% believed their symptoms had improved after placebo.
Giving pregnant mothers L. rhamnosus and continuing the supplementation in the child until two years of age led to a 44% lower incidence of eczema in children up to the age of six, compared to placebo.[6]
In a randomized study administration of prophylactic L. rhamnosus, to children (mean age 4.7 years) receiving antimicrobial therapy for respiratory infection, reduced the incidence of antibiotic-associated diarrhea to one third.[7] Similarly, in a double-blind randomized trial of 188 children (median age 4 years) receiving oral antibiotic therapy, the number of children with antibiotic-associated diarrhea was reduced from 26% to 8% with the coadministration ofL. rhamnosus.[8]
Thirty preterm newborns were randomly assigned in a double-blind manner to receive L. reuteri (108 CFU/day) or placebo for 30 days. Newborns receiving probiotics showed a significant decrease in regurgitation and mean daily crying time and a larger number of stools compared with those given placebo.[9] Similarly, a placebo-controlled study of 42 infants with regurgitation were given either 108 CFU/day L. reuteri or placebo for 30 days.[10] The frequency of regurgitation was significantly reduced.
Infantile colic is one of the most common problems within the first 3 months of life, affecting as my as one out of four infants. Forty six infants diagnosed with infantile colic were given either 108 CFU/day L. reuteri or placebo for 21 days. Infants showing a 50% reduction in crying time from baseline were significantly higher in the L. reuteri group versus placebo group on days 7 (20 vs 8), 14 (24 vs 13), and 21 (24 vs 15).[11] [12]
In a double-blind, placebo-controlled, randomized trial conducted at 14 Israeli child care centers, with 201 healthy term infants 4 to 10 months old, infants were assigned randomly to formula supplemented with B. lactis, L. reuteri, or no probiotics. Those fed L. reuteri had significantly fewer episodes with fever (>38⁰C) and number of days and number of episodes with diarrhea or respiratory illness.[13]
L. reuteri converts glycerol into a potent broad-spectrum antimicrobial compound, reterin, which inhibits the growth of gram-positive and gram-negative bacteria. The ability of L. reuteri isolates to inhibit growth in vitro was determined for the following enteric pathogens: Escerichia coli, Salmonella enteric, Shigella sonnei and Vibrio cholera.[14]
Prebiotic Oligosaccharides
Human milk oligosaccharides (HMO), after lactose and lipids, represent the third largest component in human milk (20-23 g/L in colostrum and 12-14 g/L in mature milk). They are important components of the defense system of human milk, having both the prebiotic potential and the direct interaction with the immune cells. Although these oligosacchardies are not identical to HMO, studies in preterm and term infants have shown that a formula supplemented with this prebiotic mixture results in an intestinal microbiota similar to that found in breast-fed infants. Because a balanced intestinal microbiota is crucial for the expansion and education of the immune system early in life, a prebiotic mixture will help to modulate the immune system in bottle-fed infants.
A mixture of scGOS and lcFOS has been shown to reduce the incidence of atopic dermatitis and infectious episodes during the first 6 months of life.[15] The protective effects were lasting beyond the intervention period. Infants in the scGOS/lcFOS groups had significantly lower incidence of allergic manifestations. Infants in the scGOS/lcFOS group had fewer episodes of physician-diagnosed upper respiratory tract infections, fever episodes, and fewer antibiotic prescriptions.
A study on term infants with no particular risk shows that the episodes of intestinal and upper respiratory tract infections were significantly lower in the groups fed a formula supplemented with scGOS/lsFOS, when compared to a group fed a standard formula without prebiotics during the first year of age.[16]
Conclusion
There is a substantial and evolving body of positive evidence concerning the safety and efficacy of probiotics and prebiotics in infants. For infants, the aim of probiotic and prebiotic supplementation is to provide a safe yet sufficient microbial stimulus for the immature immune system, which contributes to the anti-inflammatory and anti- diarrheal effects. Also probiotics may suppress the proliferation and virulence of bacterial pathogens.
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Both probiotics and prebiotics are necessary for a child's proper and healthy development. Healthful bacteria and prebiotics are passed from mother to child through breast milk. In some instances – for example, if an infant is formula-fed or born through Caesarian section – it may be beneficial to supplement an infant with healthful, proper amounts of these beneficial components of breast milk
