Infant nutrition part 2: Probiotics ‘safe for most newborns’
Benefits vs. risk
"In pre-term neonates the benefits of specific strains outweigh the potential adverse effect. But according to available data it makes sense to be cautious in very low birth weight infants and in those who are critically ill or with indwelling catheters.
In these populations, further studies, selecting specific strains to assess clinically relevant outcomes are needed,” Dr Jean-Pierre Chouraqui, Gastroentérologie, Hépatologie et Nutrition Pédiatriques Clinique Universitaire de Pédiatrie Grenoble, France, told a recent meeting.
He was speaking at one of two satellite events organised by the Nestlé Nutrition Institute to run alongside a meeting of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) in Sorrento, Italy.
He told delegates that two of the most widely used probiotics, Lactobacillus and Bifidobacterium have not shown any pathogenicity traits in healthy or mildly ill infants, with several controlled studies demonstrating that infant formulas containing different strains had no negative effect on stool habit, tolerance or infant growth.
However, a presentation at the parallel symposium organised by Nestlé stressed that the claims being made for probiotics to treat disease should be tested for quality, efficacy and safety as rigorously in trials as any conventional drug.
Safety and efficacy in older children
Professor Yvan Vandenplas from the Universitair Kinderziekenhuis,Vrije Universiteit, Brussels, Belgium, focused on a different set of studies, which were carried out mainly in older children.
“This presentation covers the use of probiotics in disease states, and mainly for older children after the period of breast feeding,” explained Annette Jarvi, healthcare nutrition, medical affairs manager for Nestlé.
“The studies cited cover a mix of products with added probiotics, as well as probiotics added separately. This does not include probiotics used in infant formulas for healthy children.”
Vandenplas found that interactions between different strains of probiotic bacteria have been reported, so any combination of products should be studied in addition to individual strains.
He added that dose-response studies examining probiotics and immunity are urgently needed, because there are indications that certain in-vitro effects are seen only at low bacterial doses and that high doses may even produce effects opposite to those obtained at low doses.
While he acknowledged that probiotics have been shown to be effective in children with acute infectious gastro-enteritis and in the prevention and treatment of antibiotic associated diarrhoea, Vandenplas added that the evidence for the efficacy of probiotics for treating atopic disease is largely negative, apart from positive studies for dermatitis.