Prebiotics and human milk oligosaccharides for infant health: perspectives of Indian experts

Introduction The first 1,000 days of life represent a critical window for establishing lifelong health, during which rapid immune, metabolic, and neurodevelopmental changes are closely linked to the maturation of the gut microbiota. Disruptions in early microbial colonisation may adversely affect these developmental processes, increasing susceptibility to infections, allergies, and other adverse health outcomes. Recent research highlights the potential of prebiotics and human milk oligosaccharides (HMOs) to modulate the gut microbiota, restore microbial balance, and support healthy early-life development. Therefore, this study aimed to gather expert insights on the role of prebiotic and HMO interventions in shaping early-life health outcomes. Methods A 12-member group of paediatric and neonatal experts from India reviewed the available evidence to assess the role of targeted prebiotic nutritional interventions in shaping early-life health outcomes. A modified Delphi-based approach was used to harness collective expertise through iterative feedback. Based on the available evidence and expert input, 24 preliminary statements were developed in three domains: (1) from gut to stool: indicators of infant health; (2) interplay between the gut microbiome and immune regulation; and (3) understanding the gut–brain crosstalk. Following consolidation of overlapping content, 21 scientific statements were finalised for voting. Consensus was predefined as ≥70% agreement (agree/strongly agree) with a median Likert score of ≥4. Results Experts reached high agreement (92%–100%) on the role of prebiotics and HMOs in supporting gut, immune, and brain development via gut modulation. The experts agreed that nutritional supplementation with targeted prebiotics such as short-chain galactooligosaccharides/long-chain fructooligosaccharides (9:1) may improve stool consistency, gastrointestinal tolerance, and digestive comfort while reducing infection risk. The experts opined that a 5-HMO blend may enhance gut barrier integrity, modulate immune responses, and lower inflammatory markers, and that sialylated HMOs, particularly 3′-sialyllactose and 6′-sialyllactose, may support neurodevelopment through improved cognitive and language outcomes and greater neuronal connectivity. Discussion Targeted nutritional interventions using prebiotics and HMOs may support healthy gut microbiota development, immune regulation, and neurocognitive growth in early life. These strategies hold promise for improving health outcomes, particularly for infants who are not exclusively breastfed.