Journal of Pediatric Gastroenterology & Nutrition:
Letters to the Editor
van Goudoever, Johannes B; Koletzko, Berthold; Rigo, Jacques; Mihatsch, Walter; Szajewska, Hania; Shamir, Raanan; On behalf of the ESPGHAN Committee on Nutrition
To the Editor: We thank Professor Tarnow-Mordi for his letter on the important question of providing probiotics to preterm infants to reduce the risk of necrotizing enterocolitis (NEC) and mortality rates. Indeed, since the preparation of our manuscript, 9 additional studies have been published. Issues such as the number of infants studied per strain, dosage, timing of initiation, and long-term safety, however, necessitate more studies before a general conclusion on the use of various probiotics can be made, especially for European neonatal intensive care units, where the NEC incidence is frequently lower than in many of the reported studies. Furthermore, for any given probiotic microorganism there are rarely data from more than a single study. Feeding with milk from the infant's own mother, and especially when exclusively feeding with human milk, has been reported to reduce NEC and mortality rates in observational trials, and this seems to afford a greater degree of risk reduction than the addition of certain probiotics (1,2). Promoting the use of maternal milk, preferably fortified, should be a priority for all neonatologists.
The use of probiotics may be considered in units where the incidence of NEC is high. The choice of type of strain, dosage, timing of initiation, and duration of intervention should be based on data from the present literature. The most logical choice would be the strain that is most studied, with the highest effect size and with the best short- and long-term safety profile; however, the presently available evidence does not allow firm conclusions on these questions. Therefore, the steering committee of the comment on enteral nutrient supply to preterm infants (3) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Committee on Nutrition reemphasize their position that at this time the routine use of probiotics in preterm infants is not recommended. We intend to continually reassess our position in the light of any additional new evidence, as this becomes available.
1. Lucas A, Cole TJ. Breast milk and neonatal necrotising enterocolitis. Lancet 1990; 336:1519–1523.
2. Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr 2010;156:562–7.
3. Agostoni C, Buonocore G, Carnielli VP, et al. Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2010; 50:85–91.
© 2010 Lippincott Williams & Wilkins, Inc.