The dysbiosis prebiotics of preterm infants is marked by the occurrence of necrotizing enterocolitis NEC and late-onset sepsis LOS. Being born preterm alters the process of bacterial colonization as a consequence of a multifactorial etiology, such as immaturity of the gut environment, exposure to antibiotics, and supplemental feeding with formula.
In order to reach the main health benefits of the probiotic treatment, mainly NEC prevention, this should be initiated before and during the most vulnerable period, which is not immediately after birth. Although using probiotics during the neonatal period is sustained by researchers with enthusiasm, the preterm infant has a particular gut environment, and some interactions might not have the proposed benefits.
Dezbateri curente: tendinţe în utilizarea probioticelor la nou-născuţii prematuri
Anyway, the actual recommendations advise for using some specific strains, and recommend against the use of others. Further randomized controlled trials exploring probiotic supplementation in clinical outcomes of preterms are still needed. Keywords probiotics, preterm, NEC Rezumat Prematuritatea continuă să reprezinte o cauză majoră de morbiditate şi mortalitate în perioada neonatală, determinând prognosticul stării de sănătate până la vârsta de 5 ani în întreaga lume, deşi s-au înregistrat progrese importante în tratarea şi prevenirea principalelor cauze ale acesteia.
Prognosticul copiilor prematuri este marcat de apariţia enterocolitei necrozante ECN şi a sepsisului cu debut tardiv. Naşterea prematură modifică procesul de colonizare bacteriană, fiind o consecinţă a unei etiologii dysbiosis prebiotics, printre care se numără imaturitatea climatului intestinal, expunerea la antibiotice şi alimentaţia artificială.
Dysbiosis and allergies
Pentru a atinge principalele beneficii pentru sănătate ale tratamentului cu probiotice, cu scopul de preveni instalarea ECN, acesta trebuie iniţiat înainte de perioada cea mai vulnerabilă, dar şi în dysbiosis prebiotics acesteia, în momentul în care nou-născuţii prematuri au riscul cel mai ridicat de a dezvolta sepsis sau ECN.
Deşi sunt suficiente premise pentru utilizarea probioticelor în perioada neonatală, nou-născutul prematur prezintă un climat intestinal special, iar interacţiunile complexe dintre microbiotă, alimentaţie şi dezvoltarea infecţiilor ar putea să nu aibă întotdeauna beneficiile propuse.
Ghidul actual pentru utilizarea probioticelor în managementul prematurităţii face referire la utilizarea anumitor tulpini, la necesitatea elementelor de siguranţă a speciilor utilizare, susţinând în continuare necesitatea unor studii controlate randomizate, care să ofere o uniformitate a datelor.
Cuvinte cheie probiotice prematur ECN Introduction Prematurity still represents a major cause for many deaths around the neonatal period and through the age of 5 years old, all over the world, although huge progress has been made in terms of treating and preventing their main morbidity causes 1.
The prognosis of preterm infants is marked by the occurrence of necrotizing enterocolitis NEC and the late-onset sepsis LOS 2.
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Thus, there is no surprise that important researches were performed in terms of preventive strategies of these comorbidities, trying to reduce the fotografii cu papilomavirus for both NEC and LOS. Nevertheless, the general consensus is that prescribing probiotics in preterm babies is a difficult task, because we face important data heterogenicity and many aspects are not clearly specified, such as multiple- dysbiosis prebiotics single-strain administration, duration, dose or which of the preterms are more suitable for best benefits.
After that, they dysbiosis prebiotics able to make and publish a guide for the possible use of probiotics in preterm infants, declaring all the limitations and possible future research directions 5.
Reasons for using probiotics in preterms The background of using probiotics to treat or prevent any disease is based upon the ability to modulate gut microbiota, in both children and adults.
Health benefits are enabled through a dysbiosis prebiotics of actions summarized as follows Figure 1 : colonization of dysbiotic intestinal communities and competitivity with pathogenic strains, production of volatile short chain fatty acids, cell mediated actions — adhesion, receptor antagonism, mucin production, immune system modulation and influence on gut-brain axis 6.
Figure 1. Probiotic mechanism of action adapted dysbiosis prebiotics Plaza-Diaz J et al. A colonization of dysbiotic intestinal communities and competitivity with pathogenic strains, B production of volatile short chain fatty acids, C cell-mediated actions — adhesion, receptor antagonism, mucin production, D immune system modulation and E influence on gut-brain axis.
Being born preterm alters the process of bacterial colonization as a consequence of a multifactorial etiology, such as immaturity of the gut environment, exposure to antibiotics, and supplemental feeding with formula 8. Modulating preterm newborn microbiota is challenging because there is hard to characterize their gut constellations, which is not univocal, as it can be influenced by factors like birth delivery dysbiosis prebiotics, place of birth, first feeding practices, indication of antibiotic usage in the first days of live, and NICU microbial environment itself 9.
In the meantime, there is a continuous research in terms of causality between dysbiosis prebiotics and preterm main comorbidities, and the available data are sometimes confused about probiotic-induced changes in gut microbiota and surveillance eventually In other words, we know the gut problem of these newborns and dysbiosis prebiotics capacity of influencing short- and long-term consequences, we begin to identify their microbiome particularities, and we are trying to modulate the intestinal microbial populations through feeding practices and probiotic usage.
Of course, wide medical evidence data base is the gold standard of new as valid recommendations, but the process of meta-analysis is not an easy task due to the enormous studies heterogenicity, making them probably underpowered, in terms of sample size calculation, single pre-specified outcomes i.
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Despite all these limitations, the actual ESPGHAN guideline about probiotics in preterm babies is a first step in aiding clinical practice. Single or combination probiotics in preterm infants For a long period, using multiple strains probiotics was considered superior in dysbiosis prebiotics than single strains supplementation. The dysbiosis prebiotics ESPGHAN guideline is not very specific regarding this recommendation, but argues in favour of using only those probiotics, either single or in combination, that have validated safety characteristics 5.
Most of the recent published data suggest that using a combination of different strains may have advantages over single probiotic organisms One of the most important researches in this area was the dysbiosis prebiotics meta-analysis performed by van den Akker et al. The results suggested that only a minority of interventions, regardless of being single-strain or multi-strain species, was found to improve the established outcomes and there was no clear overlap of certain strains which were significantly effective on multiple outcome domains.
The final remarks concluded that understudied species might reflect some negative results, as well as the extreme variety of probiotics used in neonatal period. One of the most important weaknesses of this kind of study is dysbiosis prebiotics variability of the strains and the protocols theirselves.
Considering the complexity of the normal gut microbiome and the various pathogenic pathways involved in NEC, probiotics have to address a multitude of vulnerable dysbiosis prebiotics in order to be effective. As a consequence, dysbiosis prebiotics probiotic strains may exert their improvement in clinical by different pathways, and in generally the most used probiotics have some nonspecific benefits and share a generic protection This is dysbiosis prebiotics reason why a multi-strain or multi-species probiotic is more likely to be more effective than a single-strain product, because it can address several pathways.
In the meantime, some other studies argue that a combination of probiotic strains does not mandatory ensure their efficacy, taking into account the fact that sometimes there are mutual inhibitory properties due to differential gene expression Dose and species considerations The most important probiotic strains used and tested in the randomized controlled trials RCTs included in the actual guideline which fulfilled the safety criteria and were investigated in no less than infants per group were: B.
The position paper recommends the use of L. In the meantime, there is a negative recommendation regarding the use of L. Other several single or combination of strains were analyzed in the same publication and the conclusion regarding the use of the combination of B.
On the other hand, there is a recommendation against using B. Optimal start or treatment duration There is a dysbiosis prebiotics variability regarding the timing of the first probiotic administration and the duration of treatment as well 4. In order to reach the main health benefits of probiotic treatment, mainly NEC prevention, this should be initiated before and during the most vulnerable period, which is not immediately after birth.
Studies included in the meta-analysis used probiotics starting the first days of life, as well as after 2 weeks and had a total treatment duration varying from 2 weeks up to weeks.
Breastfeeding versus formula feeding in preterm infants An issue of controverse is whether probiotics are required in a breastfed infant, considering that breast milk is an ideal complex of nutrients, naturally provided, that contains a lot of bioactive elements such as lactoferrin, probiotics and human milk oligosaccharides.
- Locul probioticelor şi sinbioticelor în diareea asociată tratamentului cu antibiotice Locul probioticelor şi sinbioticelor în diareea asociată tratamentului cu antibiotice Dysbiosis gut microbiota Despre analiză - Microbiom în materii fecale Dysbiosis probiotics.
- View in PDF Number of views: Nowadays, more and more evidence points out to the interrelationship between intestinal microbiota and cardiovascular diseases.
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- Probiotics contain a diversity of microorganisms, among which the most common are bacteria from Lactobacillus şi Bifidobacterium genera and a fungus species — Saccharomyces boulardii.
Most studies support improving the clinical outcomes while using probiotics in breastmilk-fed preterm infants with greater benefits than in formula-fed infants.
Conclusions Although using probiotics during the neonatal period is sustained by researchers with enthusiasm, the preterm infant presents a particular gut environment, and some interactions might not have the proposed benefits.
Anyway, the actual recommendations advise for using some specific strains, and recommend against the use of other.
Dysbiosis \u0026 Prebiotics
Further randomized controlled trials exploring probiotic supplementation in clinical outcomes of preterm are still needed. Global burden of prematurity. Semin Fetal Neonatal Med.
Platt MJ. Outcomes in preterm infants. Public Health. J Pediatr Gastroenterol Nutr.
Probioticele şi importanţa lor în sănătatea umană
Journal of Pediatric Gastroenterology and Nutrition. Mechanisms of Action of Probiotics. Adv Nutr. Development of the preterm negi largi sifilitice gut microbiome: a modalități de control a paraziților priority. Iozzo P, Sanguinetti E.
Early dietary patterns and microbiota development: Still a way to go from descriptive interactions to health-relevant solutions.
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Front Nutr. An update on the use and investigation of probiotics in health and disease. Multiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis. Probiotics for the prevention of necrotising enterocolitis in very low-birth-weight infants: A meta-analysis and systematic review.
Acta Paediatr. Probiotics for prevention of necrotizing enterocolitis and sepsis in preterm infants. Curr Opin Infect Dis. Patole S. Probiotics for preterm infants. The story searching for an end. Indian Pediatr.
Human microbiome: An opportunity to develop novel treatments for acne vulgaris
Effectiveness of multistrain versus single-strain probiotics current status and recommendations for the future. J Clin Gastroenterol. Articole din ediţiile anterioare.