The probiotic use in neonatology

Neonatal age represents a key moment for the establishment of resident intestinal microflora and for the development of a beneficial relationship between microbiota and the host, which is essential for maintaining health. Manipulation of neonatal microbiota through the use of probiotics has been studied for treatment of neonatal diseases and for early prevention of pediatric diseases. The objective of the present review is to consider potential benefits of probiotic supplementation in prevention and treatment of some neonatal and infantile disorders. Necrotizing enterocolitis (NEC) is a fearful disease of preterm infants, in which the intestinal dysbiosis of the premature intestinal tract has a potential pathogenic role. Administration of a probiotic supplementation to premature neonates for preventing NEC has been extensively studied with encouraging results, suggesting potential benefits of this kind of intervention. Hospitalized children (or neonates) are exposed to different pharmacological treatments, including antibiotics, and are at risk of developing nosocomial infections. In literature, several studies have tried to clarify the role of probiotic supplementation in the prevention of neonatal nosocomial infections such as, Clostridium difficile-associated diarrhea, nosocomial and ventilator-associated pneumonia, urinary and respiratory tractinfections. Infantile colic, known as excessive crying during the first few months of life, is a common problem in healthy infants affecting up to 20% of cases, and the composition of intestinal microbiota has been addressed as a risk factor. Studies have shown thatinadequate lactobacilli in the first few months of life may affect intestinal fatty acid profile favoring the development of infantile colic. Some studies have evaluated the safety and efficacy of probiotics as a therapeutic strategy for infantile colic but the available data is still too limited to draw definitive conclusions. Nevertheless, the clinical trials performed so far have given promising results on the reduction of the average crying time in healthy infants treated with a dose of 108 CFU of Lactobacillus reuteri for 3-4 weeks. Administration of probiotics in prenatal and neonatal age has also been studied for prevention of pediatric diseases, especially for allergies, whose incidence is continuously increasing in infants and children. The multifactorial pathogenesis of allergy includes disturbances in early colonization patterns and dysbiosis preceding the development of allergic disease. Moreover, it is well-known that the microbiota plays a pivotal role in shaping immune development and modulation. Consequently, several interventional studies have evaluated the benefits of supplementing at-risk neonates and infants, and even their expecting mothers, for preventing subsequent development of atopic diseases. Currently available results are still contrasting, preventing firm conclusions.