Prebiotic Use Beneficial in Formula-Fed Newborns

From Reuters Health Information

NEW YORK (Reuters Health) Aug 05 - Supplementation with prebiotic oligosaccharides is well tolerated and produces short-term beneficial effects in full-term, formula-fed neonates, according to a new study.

"Prebiotic oligosaccharides are short-chain carbohydrates with a degree of polymerization between 2 and 60 and are nondigestible by human or animal digestive systems," Dr. Shripada Rao, of the University of Western Australia, Perth, and colleagues explain in the August issue of the Archives of Pediatric and Adolescent Medicine. The carbohydrates' key feature is their ability to selectively promote the growth of bifidobacteria and lactobacilli in the colon.

Human milk contains prebiotics and, therefore, breastfed infants typically receive adequate amounts to stimulate gut flora. Formula-fed infants, by contrast, may be deficient in prebiotics and might benefit from supplementation.

The researchers searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL databases and proceedings of relevant conferences. Trials comparing formula milk supplementation, with or without prebiotics, that commenced no later than age 28 days and continued for at least 2 weeks were eligible for inclusion.

Main outcome measures included stool colony counts of bifidobacteria, lactobacilli, and pathogens; pH; consistency; frequency; anthropometry; and symptoms of intolerance.

Of 24 identified trials, 11 were eligible for inclusion (n = 1459). Six trials showed significant increases in bifidobacteria after prebiotic supplementation. Two studies demonstrated a trend toward increases in bifidobacteria counts.

Meta-analysis results show a significant reduction in stool pH in the prebiotic-supplemented group. Infants who received the prebiotic supplementation also had softer and more frequent stools, similar to those of breastfed infants. Lastly, the supplementation group had slightly better weight gain than controls.

Of eight trials that reported on tolerance, all but one reported that prebiotic supplementation was well tolerated. One study found that infants who received prebiotic supplementation had more frequent diarrhea (18% vs. 4%), irritability (16% vs. 4%), and eczema (18% vs. 7%) compared to control subjects.

"Colonization of intestines with healthy bacteria early in the newborn period has the theoretical potential to confer long-term health benefits; but it is too early to recommend their supplementation routinely for formula fed infants," Dr. Rao told Reuters Health by email. "Rigorously conducted randomized controlled trials focusing on long-term outcome are necessary to find out if this improved colonization results in long-term health benefits."

Arch Pediatr Adolesc Med 2009;163:755-764.