Enteral feeding of premature infants with Saccharomyces boulardii
Introduction
Saccharomyces boulardii (SB) is a thermophylic, non-toxic yeast used therapeutically for the treatment of a number of gastrointestinal disorders related to abnormal bacterial growth [1], [2]. Its beneficial effects are based both on its probiotic effect [3], [4] and also on its ability to produce polyamines [5].
Probiotics can be defined as a “live microbial feed supplement which beneficially affects the host animals by improving intestinal microbial balance” [6]. Bacterial colonization of the bowel in preterm infants in neonatal intensive care units may differ from that of healthy term infants. It may be delayed or deficient [7]. This can favor the overgrowth of pathologic microorganisms that can lead to necrotizing enterocolitis (NEC) [8], [9], [10], [11], bacterial translocation and sepsis [12], [13], [14], [15]. It has therefore been suggested that overgrowth of pathogens might be prevented by encouraging colonization of the bowel with non-pathogenic bacteria—e.g., bifidobacteria, lactobacilli, SB—which compete with pathogens for binding sites and substrates in the bowel and produce a wide range of antimicrobial substances [16], [17].
Polyamines on the other hand are ubiquitous substances essential for cell growth and differentiation. They enhance intestinal maturation, reflected in increased levels of enzyme expression [18], [19]. Therefore, it was hypothesised that SB administration in preterm babies could have a useful role in the gut by suppressing the growth of enterobacteria and by enhancing gastrointestinal function.
The objectives of the present study were: (a) To determine whether or not SB supplementation is well tolerated by preterm infants and can result in a reduction of the size of the bowel reservoir of nosocomial pathogens such as enterobacteria. (b) To assess the possible role of SB on gastrointestinal function as assessed by d-xylose and lipid absorption.
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Subjects and methods
A randomized prospective study on preterm babies admitted to our units was carried out. All consecutive admissions were considered for the study if they fulfilled the following entry criteria: They had a gestational age between 28 and 32 weeks; they did not have major gastrointestinal abnormalities; they were not receiving antibiotics or antifungals; they were not receiving breast milk. Of the 110 admitted babies who fulfilled these criteria, 23 were excluded from the study for various
Results
The outcome of the babies studied is described in Table 2. Of the 51 babies who were initially enrolled in the SB group, 11 were temporarily withdrawn from the study (5 developed NEC, 3 developed sepsis, 3 had vomiting). Of the 36 babies in the MD group, 11 were temporarily withdrawn from the study (6 developed NEC, 3 developed sepsis, 2 had vomiting). In none of the babies with NEC or sepsis was SB isolated from blood or stool. There was no significant difference between the two groups in age
Discussion
Probiotics have been proposed or studied for efficacy in the prevention and treatment of a large and diverse spectrum of gastrointestinal disorders. In the neonatal period, probiotics have been used by several investigators in order to decrease the number of pathogenic enterobacteria in the gut, to improve the general well being of infants [22], [24], [25], [26], [27] and to reduce the incidence of NEC [28], [29]. The rationale for using probiotics in acute infectious diarrhoea is based on the
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