Fortifying breast milk with probiotics could prevent severe gut infections in premature babies, study says

06 Nov 2019 --- Administering probiotics to premature babies via breast milk may be the key to preventing severe gut infections and other intestinal problems, according to new research led by UK-based Norfolk and Norwich University Hospital (NNUH). Together with the Quadram Institute and the University of East Anglia, the NNUH researchers followed the outcomes of nearly a thousand very premature babies admitted to the Neonatal Intensive Care Unit over a decade. They found that introducing routine probiotics to these babies reduced the amount of cases of necrotizing enterocolitis (NEC). This is a life-threatening gut inflammation condition and a leading cause of mortality and morbidity in premature and very low birth weight infants (VLBW).

“Preterm babies represent a key group that do not have the same microbial communities as full-term vaginally delivered babies, with Bifidobacterium often ‘missing’ from their microbiota. This is why supplementing these infants with these missing microbes may prove so effective from a healthcare perspective,” Dr. Lindsay Hall, Microbiome Research Leader at Quadram Institute, tells NutritionInsight.

Premature babies are especially susceptible to diseases in the gut.Published in the ADC Fetal & Neonatal edition of the British Medical Journal (BMJ), the study conducted its research on newborns at <32 weeks’ gestation as well as 32-36 weeks’ VLBW infants. The selected newborns were reviewed in two consecutive five-year periods, a decade in total. The researchers administered the bacteria to expressed breast milk or donor breast milk, Dr. Hall explains. 

This is the first UK study to evaluate the potential impact of routine probiotics use on NEC rates, and the success of this research was multitude. It revealed that the numbers of cases of NEC dropped from 7.5 percent to 3 percent, and the number of sepsis cases, or blood poisoning, fell from 22.6 percent to 11.5 percent within the research timeframe. 

The administration of the multispecies Lactobacillus and Bifidobacterium was associated with a significantly decreased risk of NEC and late-onset sepsis in NNUH’s intensive care unit. Moreover, the researchers found that the routine daily dosing of the live bacteria was both cheap and simple, which increases its likelihood of being adopted in other medical facilities.

None of the infants suffered from sepsis episodes while receiving live bacteria. Moreover, the study indicated “no safety issues” whatsoever regarding the infants’ health during the research phase. The positive impact of administering the probiotics to the infants’ milk was particularly apparent in the first two weeks after birth, implying that achieving early probiotic bacterial gut colonization is crucial to the premature babies’ survival.

“Sepsis continues to be a leading cause of newborn deaths, with infants in developing countries being disproportionately impacted. The current body of research shows that a probiotic blend is associated with a significant reduction in sepsis in infants,” says Matthias Heinzel, President, DuPont Nutrition & Biosciences. 

Cumulative incidence of NEC from day of birth until final discharge home. What’s next?
Dr. Hall affirms that she and her research team have studies exploring how probiotics modulate the wider preterm infant microbiota over time and the mechanisms whereby they provide these key health benefits.

“This is another study that indicates how specific strains of beneficial microbes may positively influence preterm health. However, further carefully designed randomized controlled trials and mechanistic work is required to change health policies for routine supplementation in preterm infants in neonatal intensive care units,” she says.

She also asserts the role breast milk can play in infants’ crucial first weeks. “Breast milk is the gold standard for infant nutrition with plentiful studies highlighting the key health benefits for mum and babies. Indeed, we, and other researchers, have ongoing studies highlighting the importance of giving the right beneficial microbes with the right diet, in this case, breast milk. We know that certain microbes can digest components of breast milk, such as human milk oligosaccharides, that promote their growth in the infant gut.” 

In the future, Dr. Hall and her colleagues have numerous ongoing related projects. “The main point for us is to understand the ‘how’ [of our research]. This is so we can more rationally design intervention strategies, including for other infant populations, like full-term babies, or those babies with health issues such as allergies or inflammatory disorders,” she concludes. 

By Anni Schleicher