REVIEW   

Minerva Pediatrica 2019 June;71(3):253-62

DOI: 10.23736/S0026-4946.19.05526-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Should we treat every infant with a probiotic?

Mark A. UNDERWOOD ✉

Division of Neonatology, University of California Davis, Sacramento, CA, USA

Intestinal dysbiosis is associated with a long list of both acute and chronic inflammatory diseases and appears to be increasing in developed countries over the last century with the introduction of antibiotics, changes in sanitation, formula feeding and cesarean sections. The evidence supporting prophylactic administration of probiotic microbes to very preterm infants for the prevention of necrotizing enterocolitis, late onset sepsis and death is strong. The evidence for benefit of probiotics in infantile colic is strong but limited to the L. reuteri DSM 17938 strain and to breast-fed infants. The evidence for prevention of atopic dermatitis is mixed with the strongest benefit seen with initiation of probiotic treatment during pregnancy and continued after birth. The more provocative question of whether routine administration of probiotics to all infants can reverse trends in intestinal dysbiosis and dysbiosis-associated diseases remains unanswered. A large cohort study or randomized controlled trial of probiotics in infancy with sufficient follow-up to assess changes in dysbiosis-associated diseases is warranted and could be paradigm shifting.

KEY WORDS: Enterocolitis, necrotizing; Sepsis Dermatitis, atopic; Colic; Probiotics