Long-term Colonization of a Lactobacillus plantarum Synbiotic Preparation in the Neonatal Gut

Department of Pediatrics, University of Maryland Medical School, Baltimore, MD 21201, USA.
Journal of pediatric gastroenterology and nutrition (Impact Factor: 2.63). 08/2008; 47(1):45-53. DOI: 10.1097/MPG.0b013e31815a5f2c
Source: PubMed


Probiotic, prebiotic, and synbiotic (a combination of pro- and prebiotic) supplements increasingly are being used to prevent and treat a variety of health conditions. Although colonization is considered a key element in the success of such treatments, few clinical studies have addressed colonizing ability. Studies are even more limited in neonates and infants, who may benefit most from such treatment. The present study was conducted to determine the colonizing ability, tolerance, and impact on the stool flora of 7 days of administration of a synbiotic supplement to a neonatal cohort, in preparation for a larger hospital-based trial.
In this randomized, double-masked, controlled trial, healthy inborn newborns >35 weeks of gestational age and >1800 g birth weight were randomized between 1 and 3 days after birth to receive an oral synbiotic preparation (Lactobacillus plantarum and fructooligosaccharides) or a dextrose saline placebo. Two babies were treated with the synbiotic preparation for every 1 baby treated with the placebo. Duration of therapy was 7 days. Comprehensive stool cultures were done at baseline and on days 3, 7, 14, 21, and 28.
Nineteen infants received the active study supplement and 12 infants received the placebo for 7 days. L plantarum was cultured from the stools of 84% of the treated infants after 3 days of treatment, and from 95% of infants on day 28 after birth. Of the infants, 100%, 94%, 88%, 56%, and 32% remained colonized at months 2, 3, 4, 5, and 6, respectively. In both groups, the total mean number of species and the mean log colony counts increased over time. The number of bacterial species was significantly higher on days 21 and 28 in the synbiotic preparation group compared with placebo (P = 0.002 and 0.03, respectively). There was a linear increase in the mean log gram-negative colony counts in the placebo group during the 4-week period that was significantly higher than that in the Lactobacillus group on days 14, 21, and 28 (P < 0.001 for each). In contrast, the supplement group had significantly higher gram-positive colony counts on days 14 (P = 0.002) and 28 (P = 0.04). Only 1 infant in the placebo group was colonized with L fermentum during the first 28 days of life. No difference was found in the percent increase in weight between baseline and day 7, but on day 28 and months 2, 3, and 6, the percent increase from baseline was higher in the probiotic-treated group (P </= 0.05). The supplement was tolerated well.
The synbiotic preparation colonized quickly after 3 days of administration and the infants stayed colonized for several months after therapy was stopped. There was an increase in bacterial diversity and gram-positive organisms and a reduction of gram-negative bacterial load in the treatment group. Because a combination preparation was used, it is difficult to specifically attribute the colonization to either the probiotic or prebiotic component in this study. Larger efficacy trials are warranted to examine the mechanism of action and precise effects of these supplements.

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    • "Tobin et al., 2013) or babies that were inoculated shortly after birth (e.g. Panigrahi et al., 2008). Since these hosts would not have an established intestinal microbiota at the time of application, it would be relatively easy for incoming bacteria to establish growth and persist. "
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    • "Lodinová-Žádníková et al., 2010 Luoto et al., 2010 Maldonado et al., 2010, 2012 Manzoni et al., 2009, 2011 Mihatsch et al., 2010 Mohan et al., 2008. Morisset et al., 2011 Nermes et al., 2011 Niers et al., 2009 Ou et al., 2012 Panigrahi et al., 2008 Rautava et al., 2009 Ritchie et al., 2010 Rojas et al., 2012 Romeo et al., 2011 Rose et al., 2010 Rougé et al., 2009 Rozé et al., 2012 Salmi et al., 2010 Samanta et al., 2008 Sari et al., 2012 Savino et al., 2010 Scalabrin et al., 2009 Soh et al., 2009, 2010 Szajewska et al., 2013 Taipale et al., 2011, 2012 Teran et al., 2009 Underwood et al., 2009 Van der Aa et al., 2010, 2011, 2012 Velaphi et al., 2008 Vlieger et al., 2009 West et al., 2009 Wickens et al., 2012 Yamasaki et al., 2012 Youngster et al., 2011 probiotic strains Bifidobacterium infantis (unspecified), "
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    • "In contrast to the gut microbiota of adult animals, the microbiota of neonates are more variable and less stable over time. The fragile ecological system is not only a disease risk to the newborn gut, but it can also have a long-term effect on it's later life health [15] [16] [17]. Comparing the gut bacterial communities of neonatal animals and humans which have been intensively studied, information on gut methanogenic communities of neonatal monogastric animals such as pigs is still limited. "
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