Significant increases in arterial oxygen saturation (SaO2) levels and the SaO2/Fraction of inspired oxygen (FiO2) ratio were reported in the treated infants, whilst no changes were observed in the placebo group.
Further in vitro analysis noted significantly increased factor-erythroid 2-related factor (Nrf2) activation in intestinal epithelial cells following probiotic supplementation, suggesting increased antioxidant responses.
The Italian researchers summarise: “In preterm infants, we confirmed the previously observed SLAB51’s 'oxygen-sparing effect', permitting an improvement in SaO2 levels. We also provided evidence of SLAB51’s potential to enhance antioxidant responses, thus counteracting the detrimental effects of hyperoxia.”
They conclude that the multi-strain probiotic “represents a promising approach to managing preterm infants requiring oxygen supplementation”.
The occurrence of premature births has been increasingly over the years, with 5-18% of all deliveries currently estimated to occur before the 37th week of gestation. Thus, there has been a strong focus on the improvement of perinatal care to avoid associated health complications.
It is known that preterm babies struggle to adapt to their external environment due to immaturely developed lungs and thoracic cage. The resultant focus of ensuring sufficient oxygen to the babies is essential to prevent hypoxia.
Yet, there are risks associated with oxygen supplementation with regards to supplying excessive amounts resulting in oxygen toxicity via the development of reactive oxygen species (ROS) and reactive nitrogen species (RNS).
Recent studies have highlighted that a multi-strain probiotic SLAB51 resulted in significantly higher blood levels of the partial pressure of oxygen (pO2) and arterial saturation (SaO2) within adults. Thus, the researchers in the current study sought to investigate the effects of the probiotic within preterm neonates.
The double-blinded placebo-controlled study involved the recruitment of 30 neonates with oxygen demand after RDS or (early) bronchopulmonary dysplasia. The subjects were assigned randomly to receive the SLAB51 multi-strain probiotic or a placebo.
The probiotic group received the formulation orally, at 1 billion total bacteria per kg of weight. SLAB51 contains Streptococcus thermophilus, Bifidobacterium lactis, Bifidobacterium lactis, Lactobacillus acidophilus, Lactobacillus helveticus, Lactobacillus paracasei, Lactobacillus plantarum, and Lactobacillus brevis.
Resultant levels of SaO2, FiO2, and the SaO2/FiO2 ratio were measured two-hours before administration, just before product administration (0 h), and 2, 4, and 6 h after administration.
It was reported that after two hours, the probiotic group showed a significant increase in SaO2 levels and the SaO2/FiO2 ratio, when compared to the control group which showed no change.
Furthermore, SLAB51 was assessed in vitro in terms of its activation of Nrf2, which is responsible for antioxidant responses. A significant increase in Nrf2 was observed in the IECs that were exposed to the probiotic’s lysates.
The researchers emphasise the significance of the findings, which suggest that SLAB51 may present a possible alternative therapy within preterm infants with RDS that require oxygen supplementation.
Hypothesising the mechanism of action, they add: “The rapid onset of the “oxygen-sparing effect” of SLAB51 could result from a direct interaction between the bacterial strains in the formulation and the host cells in the proximal part of the intestine and not at more distal intestinal regions such as the colon.”
They urge the need for further research using a greater sample size to replicate the findings to confirm the association.
“SLAB51 Multi-Strain Probiotic Formula Increases Oxygenation in Oxygen-Treated Preterm Infants”
by Maria Elisabetta Baldassarre, Massimiliano Marazzato, Marta Pensa, Maria Teresa Loverro, Michele Quercia, Francesca Lombardi, Federico Schettini, and Nicola Laforgia