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Probiotics for Preemies and Other Infants: Smart or Not?

Probiotics for Preemies and Other Infants: Smart or Not?

Probiotics appear to be the latest health trend for Americans, with annual sales of such products at a whopping $1.3 billion or so in 2016 (the most recent statistics available).

Many adults swear by probiotics (meaning a kind of live bacteria that can help balance the population of bacteria in the intestines). But are these products and supplements safe and effective for children?

Depends on who you ask. Much of the evidence appears anecdotal right now.

Lauren Manaker of Charleston, South Carolina, gives her three-year-old a daily probiotic. A registered dietitian and certified lactation counselor, Manaker has not only worked in NICUs (neonatal infant care units) where probiotics are increasingly prescribed, she has also sold infant probiotics for several years as a medical sales representative. So, yes — she’s biased.

“My daughter does not consistently take in enough live bacteria in her diet, and I do not see any downside in prophylactically keeping her gut colonized since she’s a generally healthy child with no past medical history,” Manaker told LifeZette.

“In the four years I worked in the NICU, I noticed a huge shift in the comfort level of doctors in [terms of] prescribing probiotics to infants and children," she said. "The research is emerging about how beneficial certain bacteria are to the health of the child or infant."

She said probiotics were used, with appropriate caution, even with premature babies.

Mark Underwood, chief of pediatric neonatology at UC Davis Children's Hospital, told NPR of preemies and probiotics, "If we give a probiotic, [a preemie's] chance of getting necrotizing enterocolitis [an illness affecting the intestines] goes down."

At his hospital, Davis said, all newborn preemies under a certain birth weight are now given probiotics.

Many parents and providers choose to use probiotics because they occur naturally in breast milk, said Manaker. If a baby's gut is not colonized with beneficial bacteria, she explained, it may get colonized by pathogens and non-beneficial bacteria (like E. coli), especially if the infant is receiving pasteurized breast milk or is on a formula without added probiotics.

“Providers are now recommending, ‘take a probiotic’ when an infant or child is on an antibiotic or having tummy issues,” she noted.

"She's seeing them increasingly used in the treatment of preemies."

Many probiotics are strain-specific and dose-specific, said Manaker, so the general advice to "take a probiotic" is not always the best approach. Some probiotics can help enhance the immune system, while others can reduce crying time in colicky infants, she said.

“Probiotics are generally considered safe, with little to no downside,” Wendy Dahl, an associate professor of food science and human nutrition at the University of Florida in Gainesville, told LifeZette. Dahl said she is seeing them increasingly used in the treatment of preemies.

Other medical professionals aren't so sure about the efficacy of probiotics in kids — and they’re asking for more research to back up claims probiotics help reduce gastrointestinal discomfort, improve immune health, and relieve constipation. The results of several recent studies may support their skepticism.

Two studies done on two commonly used probiotic products were presented earlier this month at the Pediatric Academic Societies (PAS) annual meeting in Toronto. Researchers said neither product had any effect on acute gastroenteritis in both infants and toddlers.

Mark Underwood of UC Davis decided to see if probiotics would help healthy, normal-weight babies. Enter the pediatric company Evolve BioSystems, which is working on solutions to restore and maintain a healthy newborn gut microbiome. Evolve BioSystems funded a clinical study evaluating the probiotic "B. infantis EVC001" in breast-fed infants.

In its December 2017 press release, the company said the study showed that providing dietary B. infantis EVC001 resulted in “rapid, substantial, and persistent remodeling of the gut microbiome in breast-fed infants,” and led to a reduction in potentially harmful bacteria.

"We found an increase in the number of good bacteria among the babies given the probiotic," Underwood told NPR. By measuring samples excreted by the babies, researchers documented a 79 percent increase in levels of bifidobacteria, a type of bacteria thought to be protective.

At the same time, Underwood and his team also measured a decrease in potentially harmful bacteria, such as Clostridium in the babies' guts.

With conflicting studies and a great deal of anecdotal evidence, it is up to parents and their pediatricians to decide if a probiotic is right for their children.

Dahl of UC Florida noted that if a parent believes a child with a health condition may benefit from a probiotic, it's best to consult the family's health care provider to ensure the best probiotic, in the correct dose, is chosen.


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