This toolkit is intended as a resource for clinicians in neonatal intensive care units seeking to gain a better understanding of probiotics use in the NICU. It is not a recommendation for or against the routine use of probiotics in the NICU or for or against the use of any product or preparation. The information provided may inform a decision-making process and foster discussion amongst key stakeholders specific to your unit.
The decision to initiate routine probiotic administration for preterm infants remains complex. As new evidence becomes available, including data from ongoing clinical trials, we recommend establishing a frequent re-evaluation of literature. The most current evidence available as of the date of publication was used in the development of this toolkit. There is a PDF version of this toolkit available for download.
The information provided in this toolkit is for educational purposes only and is not a substitute for professional medical advice. If you have a question as to how the information in this toolkit may apply to you or your situation, please consult professional medical advice.
About Us
The NEC Society is a 501(c)(3) nonprofit organization dedicated to building a world without necrotizing enterocolitis (NEC) by advancing research, advocacy, and education. We bring together patient-families, clinicians, and other diverse stakeholders to better understand, treat, and prevent this devastating disease. We are grateful to our Scientific Advisory Council and Key Opinion Leaders for their time and dedication to furthering our mission.
All NEC Society Board, Council, and staff have completed the organization’s conflict of interest disclosure. Some members reported financial conflicts, which can be reviewed by contacting jennifer@necsociety.org. All NEC Society statements, actions, and materials are the sole position of the NEC Society and do not necessarily reflect any member’s individual institution or place of employment.
Introduction
The Gut Microbiome
The gut microbiome is a collection of all microbes that live in the intestines and provide protection against pathogens, help develop the immune system, and aid in digestion and energy production.1 The disruption of the gut microbiome, referred to as intestinal dysbiosis, defines an imbalance of the structure and function of this community of microbes. In neonates, several factors may influence the gut microbiome including gestational age (GA), type of feeding, antibiotic exposure, and the maternal microbiome.2
References
- National Institutes of Health/National Institutes of Environmental Health Sciences
- Sarkar A, Yoo JY, Valeria Ozorio Dutra S, Morgan KH, Groer M. The Association between Early-Life Gut Microbiota and Long-Term Health and Diseases. J Clin Med. 2021;10(3):459. doi:10.3390/jcm10030459
- Cuna A, Morowitz MJ, Ahmed I, Umar S, Sampath V. Dynamics of the preterm gut microbiome in health and disease. Am J Physiol Gastrointest Liver Physiol. 2021;320(4):G411-G419. doi:10.1152/ajpgi.00399.2020 4. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187(1):1-7. doi:10.1097/00000658-197801000-00001 doi:10.1097/00000658- 197801000-00001 5. Gordon PV, Swanson JR, Attridge JT, Clark R. Emerging trends in acquired neonatal intestinal disease: is it time to abandon Bell’s criteria? J Perinatol. 2007;27(11):661-671. doi:10.1038/sj.jp.7211782 6. Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res. 2020;88(Suppl 1):10-15. doi:10.1016/j.clp.2018.05.014 7. Adams-Chapman I. Necrotizing Enterocolitis and Neurodevelopmental Outcomes. Clin. Perinatol. 2018;45(3):453-466. doi:10.1016/j.clp.2018.05.014 8. Han SM, Knell J, Henry O, et al. Long-term outcomes of severe surgical necrotizing enterocolitis. J Pediatr Surg. 2020;55(5):848-851. doi:10.1016/j.jpedsurg.2020.01.019 9. Patel RM, Ferguson J, McElroy SJ, Khashu M, Caplan MS. Defining necrotizing enterocolitis: current difficulties and future opportunities. Pediatr Res. 2020;88(Suppl 1):10-15.doi:10.1038/s41390-020-1074-4 10. Hackam D, Caplan M. Necrotizing enterocolitis: Pathophysiology from a historical context. Semin Pediatr Surg. 2018;27(1):11-18. doi:10.1053/j.sempedsurg.2017.11.003 11. Patel RM, Underwood MA. Probiotics and necrotizing enterocolitis. Semin Pediatr Surg. 2018;27(1):39-46. doi:10.1053/j.sempedsurg.2017.11.008 12. Rose AT, Patel RM. A critical analysis of risk factors for necrotizing enterocolitis. Semin Fetal Neonatal Med. 2018;23(6):374-379. doi:10.1016/j.siny.2018.07.005
