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Is Probiotics Good for My Baby?

Michelle Lam Sze Hei

Introduction Probiotics are "Live microorganisms which when administered in adequate amounts confer a health benefit on the host. (Definition by WHO) Not to be confused, prebiotics are non-digestible food ingredients that stimulate growth and activity of probiotic bacteria in the gut, which may occur naturally in breast milk, but can also be added as dietary supplements to foods, beverages, and infant formula. Since the discovery of probiotics, many studies have been carried out to prove their efficacy in a wide range of diseases, which can be classified into gastrointestinal and non-gastrointestinal disorders. Lactic acid bacteria and bifidobacteria are examples of probiotics commonly used in adult food like yogurt, and also in many infant formulas. This article will review the evidence of health benets of probiotic and prebiotic products in children, and the safety of using them in infants. Benefits of probiotics in gastrointestinal disorder Lippincott Williams & Wilkins (2006) reviewed the quality of evidence in clinical trials for the use of probiotics. Most of the studies showed benefit of probiotics for a variety of digestive and non-digestive disorders. Amongst the various gastrointestinal disorders (inflammatory bowel disease, necrotizing enterocolities, acute gastroenteritis, antibiotics-associated diarrhoea), strong evidence of benefit is only found in acute viral gastrointestinal tract infections and antibiotics-associated diarrhoea (ADD). Meta-analysis and randomized controlled trials (RCT) showed that using certain probiotics (mainly Lactobacillus GG) can shorten the duration of acute viral gastrointestinal infections with mild to moderate severity for one day. Lactobacillus GG and S. boulardii in children are shown to be effective in preventing AAD in children treated with antibiotics. Dan W. Thomas, Frank R. Greer (2010) drew a similar conclusion. Administration of Lactobacillus GG significantly shortens the duration of acute rotavirus diarrhoea in children, but such therapeutic effect was not demonstrated in diarrhoea of any other etiology. Probiotics also seem to be more effective when given early in the course of diarrhoea. It is most helpful for otherwise healthy infants and young children with watery diarrhea secondary to viral gastroenteritis but not invasive bacterial infections. Meta-analysis of probiotic use indicates a beneficial effect in the prevention of antibiotic-associated diarrhoea in children, but no evidence for the same effect in its treatment. Benefits of probiotics in non- gastrointestinal disorder Lippincott Williams & Wilkins (2006) reviewed minimal or unclear evidence in treating hepatic encephalopathy, H. pylori infection, cancer, urogenital disorder and respiratory tract infection. The only non-digestive benefit of probiotics was shown in allergic disorders, such as eczema, allergic rhinitis and food allergies. Giving Lactobacillus GG to pregnant mothers with a strong family history of atopy and to their infants for the first 6 months after delivery, reduced the frequency of developing atopic dermatitis in

the infants significantly. Infants with atopic eczema and cows milk allergy showed improvements when Lactobacillus GG was added to hydrolyzed whey formula. On the contrary, Dan W. Thomas, Frank R. Greer (2010) quoted a different result. It concluded there was insufficient evidence for using probiotics in pregnant women or infants in the prevention of allergic disorders in infants. A 2007 large RCT in Finland treated pregnant women with atopic disease with a combination of probiotics and prebiotics during pregnancy that was continued in their infants after delivery. Despite a lower incidence of IgE-mediated allergic disease, the cumulative incidence of allergic disease in these infants was not reduced. It suggested the need of more studies to confirm the non-digestive benefits of probiotics in infants. Safety of Probiotics in infants Both Lippincott Williams & Wilkins (2006) and Dan W. Thomas, Frank R. Greer (2010) suggested probiotics products to be both safe and well tolerated in healthy infants. Most reports of serious infection with use of these products occurred in ill, pre-term infants and immunocompromised children or those with indwelling medical devices. Conclusion In general, probiotics have not been demonstrated to be harmful to healthy term infants, but should not be given to children with chronic illness or prematurity. On the other hand, evidence of clinical efficacy for their addition is insufficient to recommend routine use in infant formula or as supplements for pregnant women. As discussed above, the benefits of probiotics vary a lot with the formulation, the effective dose and the type of disease targeted. In view of the uncertainties of the cost and benefit of probiotics-added formulas, human milk remains the best food for young infants.
Reference 1. Lippincott Williams & Wilkins, Philadelphia (2006) Clinical Practice Guideline Clinical Efficacy of Probiotics: Review of the Evidence With Focus on Children In Journal of Pediatric Gastroenterology and Nutrition 43:550Y557 2. Dan W. Thomas, Frank R. Greer and COMMITTEE ON NUTRITION (2010) Clinical ReportProbiotics and Prebiotics in Pediatrics In SECTION ON GASTROENTEROLOGY, HEPATOLOGY, AND NUTRITION, Paediatrics