2P-S5-4

 

 

PROBIOTICS IN NEONATES: AN IDEA WHOSE TIME HAS COME

PANIGRAHI P

University of Maryland, Department of Pediatrics, Baltimore, MD, USA

 

Probiotics refer to live microbial supplements having beneficial effects on the host. Although, this is a century-old concept, their use in a multitude of conditions in different age groups has started appearing in the literature mostly during the last decade. Use of probiotics in neonates, is even a more recent trend that is developing at a very fast pace.

Due to the presence of large number of bacteria in the mammalian gut, often diverse in nature, and other in vivo conditions, the newly administered probiotics frequently fail to colonize or exert their effect optimally on the adult host. Depending on the environment and kinds of oral intake, the neonatal intestine takes several weeks for proper colonization.  During this period, with paucity of microorganisms in the gut, neonates, especially the premature infants are quite vulnerable to adverse effects of bacterial attachment and invasion in the GI tract.

Very recent evidence from basic research, animal experiments and limited number of clinical trials, now strongly suggest a potential role of these friendly bacteria in conditions such as necrotizing enterocolitis and neonatal sepsis.  While the mechanisms remain to be fully elucidated, blockage of bacterial adherence and translocation, induction of enzymes and gut maturity, modulation of local and systemic cytokines, improvement in gut permeability, and other host responses appear to be the key players in the pathogenesis of these conditions.  Going beyond the neonatal period, it has now been shown to prevent atopic disease in those infants who received probiotics during the first six months of their lives.  Among other conditions, childhood diarrhea, lactose intolerance, and Crohn¡¯s disease also appear to be potential targets that may benefit from probiotic therapy.  Careful selection of the probiotic strain, evaluation of its efficacy in  specific experimental models, and judicious clinical trials will be required before probiotics could be accepted as serious first line therapeutics.