Issue link: https://viewer.e-digitaledition.com/i/712302
Additional Applications PROBIOTIC S H AV E PROV ED effective in treating and preventing diarrhea, especially in children. In a review of multiple trials and guidelines for the treatment of acute gastroenteritis, antibiotic-associated diarrhea (A AD) and necrotizing entero- colitis (NEC) published in the Journal of Clinical Gastroenterology, investigators discovered that different strains were more effective depending on the type of diarrhea. For example, Lactobacillus rhamnosus GG and Saccharomyces boulardii were found to be most effective in preventing A AD. "We are in a situation now with probiot- ics similar to where we were 60 or 70 years ago when the first antibiotics were created," says Stefano Guandalini, MD, Professor of Pediatrics and Section Chief of Pediatric Gastroenterology, Hepatology and Nutrition for The University of Chicago Medicine, and one of the inves- tigators on this research. "We seem to understand that all probiotics are not created equal. They are not the same, and we are honing our research and findings toward this concept." center's newborn ICU. There, preterm infants receive probiotic combination therapy until the corrected gestational age of 34 weeks. "The working theory is that the gut, the skin, everything is colonized by some [sort of bacteria] shortly after birth," Dr. Anderson Berry says. "Children in a normal nursery are colonized by bacteria from the mother, father and visitors. If a baby is born prematurely, he or she is immediately transitioned into the NICU environment and surrounded by medical staƒ and medical equipment. The types of bacteria those children are colonized with can be diƒerent." That environment well describes the experience of preterm infants with very low birth weights. Mortality rates are higher in this population, and the infants' ability to fight infection is compromised. Introducing bacteria that is closer to what would be found in the microbiome of healthy, full-term children is thought to encourage better immune system development as well as reduce the incidence of conditions such as late-onset sepsis in this population. The findings of Dr. Kanic and his associates' research lend credence to this theory. LOOKING AHEAD Though Dr. Kanic's research is an important step forward in the field of probiotic use in preterm infants, there is much yet to learn. He plans to research the long-term eƒects of probiotics on very low birth weight infants, as well as on infants in the extremely low birth weight category. Further study could yield broader applications, says Sonia Michail, MD, FA AP, CPE, AGAF, attending physician, Professor of Clinical Pediatrics with Children's Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, who has researched probiotics and the microbiome for 20 years. "Before widespread applicability of the use of probiotics is formalized as a standard practice, the appropriate studies should be conducted for specific probiotic products at specific doses for specific conditions," Dr. Michail says. "We hope to see more research addressing delivery of therapies and potentially vaccines through probiotic organisms." ■ 1 1 M D N E W S .C O M /// M D N E W S S A N A N T O N I O ■ 2 016