The effect of a bifidobacter supplemented bovine milk on intestinal permeability of preterm infants
Introduction
Gastrointestinal complications such as feeding intolerance, necrotizing enterocolitis (NEC) and gut associated sepsis pose a considerable problem in the care of preterm infants [1]. NEC is the most common surgical emergency and a major cause of death in this patient population [2]. These intestinal complications occur mostly in the first weeks of life, suggesting that immaturity of intestinal epithelial barrier function and absorptive capacity may play a role in the pathophysiology of intestinal complications in preterm neonates [3]. Indeed breakdown of the intestinal barrier is not only implicated in the pathogenesis of acute illnesses such as bacterial translocation leading to sepsis but is also implicated in several diseases having their origins during infancy that manifest in later life. These include atopic disease such as eczema, asthma and inflammatory bowel disease [4], [5], [6], [7], [8]. To reinforce the barrier effect in the gut it may be advantageous to alter the microflora by oral bacteriotherapy, as it was shown in animal studies [9], [10], [11], [12], [13], [14]. This investigation sought to ascertain the effect of Bifidobacterium lactis (BF) on gut mucosal barrier function of preterm infants, using the lactose to mannitol (L/M) urine concentration as a marker of intestinal permeability (IP) [15], [16]. Additional outcome variables included probiotic tolerance, somatic growth, incidence of sepsis and NEC.
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Patients
This controlled blind prospective study was conducted in the NICU of Alexandra regional Hospital from January 2004 to December 2005 and was approved by the local medical ethics committee. Parents of eligible neonates were informed in detail about the study, and informed consent was obtained before enrolment. Preterm infants admitted to the NICU were eligible for the study if they fulfilled the following inclusion criteria: gestational age between 27 and 37 weeks, stable state, formula fed and
Methods
Growth parameters, food acceptance and tolerance and stool characteristics were recorded throughout the study. Body weight was measured daily using electronic precision scale. Body length was measured weekly with a fixed headboard and a movable footboard. Head circumference was measured weekly with a nonstretchable tape.
IP by the sugar absorption test [15], [16] was first evaluated within two days of birth and before the first feeding was given (measurement day 1) and subsequently after 7 days
Statistical analysis
Based on data from a previous study [19], a sample size of at least 30 infants for each group was considered adequate to detect a significant difference in L/M ratio between groups. We assumed a possible loss of 10% of subjects and thus estimated 35 infants in each group. Data are presented as median (range). Statistical analysis was made with the use of statistical packet SPSS version 10.01. Comparison between groups was made by Mann–Whitney test while comparisons inside each group were made
Results
Of the initial 80 infants included in the study 5 were excluded after randomization because of NEC, severe infection, need for parenteral nutrition after the 14th day of life or inadequate urine collection (3 in the control group 2 in the study group). Thus 75 infants completed the study (41 in the BLSPF group and 34 in the control group). All infants tolerated the study formula well.
There was no significant difference in baseline L/M ratios between the two groups (p = 0.079). The L/M ratio
Discussion
BL used in this study has been shown to possess the characteristics of an effective probiotic and has been tested in a variety of situations in different age groups [20], [21], [22].
In the present study it was demonstrated that preterm infants fed a preterm formula supplemented with BL for 30 days had a significant reduction of IP as compared to infants receiving an unsupplemented formula. To our knowledge this the first study showing an effect of probiotics on the intestinal barrier of human
Acknowledgement
We would like to thank the Nestlé Company, Vevey for providing the B. lactis supplemented milk formula.
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