Necrotizing Enterocolitis

Why More Than 40 Canadian Hospitals Are Using Probiotics for Intestinal Disease in Infants

New parents of preterm infants typically experience a wave of emotions and are often fearful that their newborn may develop an unpredictable health condition. A common disease primarily diagnosed in premature babies is necrotizing enterocolitis (NEC), which affects approximately five percent of infants born at <32 weeks gestation.¹ This devastating disease may lead to serious complications and mortality rates range between 20-30%.² Despite advancing research, diagnosis remains difficult and treatment options are limited.

Signs/Symptoms and Diagnosis

A distended abdomen, bloody stools after 8-10 days of age, and feeding intolerance may indicate NEC. This disease can also affect other organs in the body, including the brain, and place infants at risk of neurodevelopment delays.² Rapid progression (e.g. intestinal perforation or abdominal discoloration) requires surgery.

If gas in the wall of the intestines (pneumatosis intestinalis) is present on abdominal radiographs or computed tomography (CT) scans, NEC is the most likely diagnosis.

Multifactorial Cause

There are a number of predisposing factors in preterm infants who develop NEC, including genetic predisposition, the highly immunoreactive intestine, and the immature inflammatory response. Imbalanced microvascular tone and dysbiosis (unhealthy microbial composition) are other possible causes.²

Dysbiosis in the Infant Gut

Although broad-spectrum intravenous antibiotics may be necessary, prolonged antibiotic use in preterm infants can increase the risk of developing NEC by decreasing bacterial diversity.³ Not only are there fewer bacterial species, in many cases there is an overgrowth of pathogenic organisms. Establishing a healthy microbiome is necessary at the time of birth, and we know that decreased diversity is present in a number of gastrointestinal (GI) disorders.⁴

The colonization of ‘friendly’ bacteria in the intestinal tract is dependent upon early-life events such as mode of delivery (caesarean section vs. vaginal delivery) and type of feeding (breastfeeding vs. formula). Research shows that an unhealthy microbiome in infants predisposes them to develop intestinal disease and that infant probiotics (live microorganisms that confer health benefits on the host when administered in adequate amounts) may increase diversity of ‘beneficial’ microogranisms in the premature gut.

Infant Probiotics

A small number of bacterial subspecies including Bifidobacterium breve, Bifidobacterium infantis, Bifidobacterium longum and, to a lesser extent, Bifidobacterium bifidum colonize healthy term breastfed infants.⁵ Knowing that poor microbial colonization is a risk factor, prophylactic use of infant probiotics is on the rise. Today, more than 40 Canadian hospitals are using infant probiotics in Neonatal Intensive Care Units (NICU), with some infants born as young as 24 weeks gestation receiving probiotic mixtures. Scroll down for a list of these facilities.

FloraBABY by Renew Life is a Health Canada approved infant probiotic that was used in a cohort study on 294 infants in the NICU at Sainte Justine University Health Center in Montreal. It provided preterm infants with four Bifidobacterium species along with Lactobacillus rhamnosus GG (2 X 10⁹colony forming units per 0.5g). The results of this study are published in the Journal of Pediatrics and show that the probiotic mixture significantly reduced the frequency of NEC (9.8% – 5.4%).⁶

Conclusion

With the amount of scientific evidence supporting the safe use of probiotic supplementation in preterm infants (>22 randomized controlled trials),⁶ it is surprising that prophylactic probiotic use is not more common in neonatal medicine. Many parents assess the benefits and the risks before choosing to administer probiotics to their baby. Whether one agrees or disagrees with the routine administration of probiotic supplementation to preterm babies, most agree that new parents should have information from a credible source available to review.

Although Keith J. Barrington (neonatologist and one of the clinical researchers of the probiotic study at Sainte Justine University Health Center), did not give probiotics to his daughter (born 24 weeks gestation), his research following her birth might change the outcome for many other families.