Hammerman Cathy, Kaplan Michael
Department of Neonatology, Shaare Zedek Medical Center, Jerusalem.
Curr Opin Infect Dis. 2006 Jun;19(3):277-82. doi: 10.1097/01.qco.0000224823.73223.29.
Necrotizing enterocolitis remains an enigmatic and potentially devastating condition with high morbidity and mortality. This review explores ways in which bacterial pathogens, together with gut microflora, influence the pathophysiology of necrotizing enterocolitis. Specifically, it examines the role of gut microbial colonization and its 'normalization' with probiotics vis a vis its contribution to intestinal bacterial invasion.
Recent studies have demonstrated that prophylactic administration of probiotics to preterm neonates decreases both the incidence and severity of subsequent necrotizing enterocolitis.
Probiotics represent a therapeutic effort to bolster natural host defenses via the 'normalization' of abnormal gut microflora of the premature infant at risk, thereby reducing the subsequent threat of necrotizing enterocolitis. The appeal of probiotics in neonatology is threefold. First, their safety record renders them an attractive alternative to many of the more aggressive therapeutic options; second, they represent a simple, noninvasive attempt to recreate a natural or normal flora rather than a disruption of nature. Third, probiotics are used mainly for disease prevention and are naturally occurring. As such, they are not considered to be drugs, but rather food supplements. To date, very few other strategies have been proven definitively to be efficacious in decreasing the incidence of necrotizing enterocolitis.
坏死性小肠结肠炎仍然是一种神秘且可能具有毁灭性的疾病，发病率和死亡率都很高。本综述探讨了细菌病原体与肠道微生物群共同影响坏死性小肠结肠炎病理生理学的方式。具体而言，研究了肠道微生物定植的作用以及使用益生菌使其“正常化”对肠道细菌入侵的影响。
最近的研究表明，对早产儿预防性使用益生菌可降低随后发生坏死性小肠结肠炎的发病率和严重程度。
益生菌是一种治疗手段，通过使有风险的早产儿异常肠道微生物群“正常化”来增强天然宿主防御能力，从而降低随后坏死性小肠结肠炎的威胁。益生菌在新生儿学中的吸引力体现在三个方面。第一，它们的安全记录使其成为许多更激进治疗选择的有吸引力的替代方案；第二，它们是一种简单、无创的尝试，旨在重建自然或正常菌群，而非破坏自然。第三，益生菌主要用于疾病预防，且是天然存在的。因此，它们不被视为药物，而是食品补充剂。迄今为止，几乎没有其他策略被明确证明在降低坏死性小肠结肠炎发病率方面有效。
