NEC is a heterogeneous pathology characterized by the development of ulcers and necrosis of the intestinal wall with further perforation. Lethality, depending on the form, ranges from 25 to 55%. The development of this disease is facilitated by hypoxia and ischemia in the perinatal period, poor nutrition of the newborn and colonization of the intestine by abnormal microorganisms.
Numerous studies describe intestinal dysbiosis preceding the onset of NEC in preterm infants, most characterized by an increase in proteobacteria and a decrease in the relative abundance of Firmicutes and Bacteroidetes species.
In the treatment of NEC in newborns, the use of probiotic preparations during their stay in the intensive care unit is promising. Probiotic preparations may include a single bacterial strain or a combination of several strains.
The indispensable properties of probiotics are the prevention of intestinal dysbacteriosis and the activation of the metabolism of nutrients from which the world and macronutrients necessary for intestinal health are synthesized. For example, the subspecies Bifidobacterium longum infantis consumes human milk oligosaccharides to promote a healthy gut microbiota.
Studies have been conducted in the USA evaluating the effectiveness of oral probiotics for the prevention of NEC, including single bacterial strains and mixtures of probiotics, including Lactobacillus species, Bifidobacterium/Saccharomyces. Even though babies who receive breast milk containing Bifidobacterium breve and Bifidobacterium infantis species, not all probiotic preparations contain these bacteria. In addition, the duration of colonization of the gastrointestinal tract after discontinuation of probiotics may persist for only a few months.
There is evidence of the effectiveness of probiotics in the treatment of NEC. Children weighing less than 1000 g took part in studies of probiotic preparations.
Israel has evaluated a mixture of Bifidobacteria infantis, Streptococcus thermophilus and Bifidobacteria bifidus;
Italy assessed exposure to Lactobacillus rhamnosus GG;
Taiwan investigated the effect of strains of Lactobacillus acidophilus and Bifidobacteria infantis.
Each of these studies found a reduction in the incidence of necrotizing enterocolitis in infants receiving probiotics compared with controls.
The European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) has published guidance on the potential use of probiotics in preterm infants.