Probiotics: Are We Ready for Routine Use?

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality among premature infants and affects 7% of very low birth weight infants.1 The cause of NEC is unclear, and its etiology is multifactorial; NEC seems to be the “single final pathway” created by a variety of injuries, including mucosal damage from gastrointestinal ischemia or hypoxia, increased osmolarity from enteral feedings, and the presence of potentially invasive pathogenic bacteria. Few treatments are available that have been proven to either prevent or ameliorate NEC. Feeding fresh human breast milk seems to be one of the more effective approaches to preventing NEC.2,3 The use of enteral antibiotics and other feeding practices may or may not affect NEC.4 Probiotics may be one of the most effective therapies for the prevention of NEC. At birth, an infant's gastrointestinal tract is sterile. Colonization of the gastrointestinal tract starts immediately after birth with the initiation of enteral feedings and is well established within the first few days of life.5 In breastfed infants, Bifidobacterium and lactobacillus predominate, with other enteric organisms being present less frequently.6,–,10 This is not the case for formula-fed infants. In these infants, coliforms, enterococci, and Bacteroides predominately colonize the intestinal tract. Preterm … Address correspondence to Roger F. Soll, MD, Division of Neonatal-Perinatal Medicine, University of Vermont, College of Medicine, Fletcher Allen Health Care, Smith 552A, 111 Colchester Ave, Burlington, VT 05401. E-mail: roger.soll{at}vtmednet.org