Prevention of Necrotizing Enterocolitis With Probiotics

Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease seen predominantly in very low birth weight (VLBW) infants during their hospitalization in a neonatal intensive care unit (NICU). NEC is probably a complex, multifactorial disease associated with immaturity of intestinal function as well as immature systemic and mucosal immune responses, enteric feeding, and microbiologic influences such as abnormal bacterial gas production that produces the pathognomonic radiographic finding of pneumatosis intestinalis.1,2 Currently, the precise contribution of each of these factors is unknown. Without this understanding, preventive measures have been theoretical and not consistently effective. In this issue of Pediatrics , Lin et al3 demonstrate that prophylactic administration of a probiotic mixture of Lactobacillus acidophilus and Bifidobacterium infantis given to VLBW infants reduces the incidence of all cases of NEC as well as severe stage III NEC.3 An important rationale for the use of probiotics in neonates at risk for NEC is the observation that the VLBW infant has aberrant fecal colonization when compared with term infants.1,4–6 VLBW infants often have a paucity (oligocolonization) of normal enteric bacterial species and a delayed onset of colonization compared with term infants. The aseptic NICU environment, which paradoxically has many resistant enteric organisms, may predispose VLBW infants to the development of an aberrant … Address correspondence to Robert M. Kliegman, MD, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226. E-mail: rkliegma{at}mail.mcw.edu