Gurien L A, Stallings-Archer K, Smith S D
Department of Pediatric Surgery, Arkansas Children's Hospital, AR, USA.
Department of Pathology, Arkansas Children's Hospital, AR, USA.
J Neonatal Perinatal Med. 2018;11(1):65-69. doi: 10.3233/NPM-181740.
Necrotizing enterocolitis (NEC) persists as the most common and serious gastrointestinal disorder among premature infants. Lactococcus lactis (LL), a lactic acid producing bacteria commonly found in buttermilk and cheese products, has several unique properties making it an ideal probiotic for neonates. We evaluated if the probiotic LL prevents development of NEC in a preterm rabbit model with Cronobacter sakazakii (CS).
Two-day preterm New Zealand white rabbit pups were randomly assigned to three diets: control (no additives), CS, and CS+LL. Pups were gavage fed and given daily oral ranitidine and indomethacin. Anal blockage was performed using tissue adhesive. Subjects were sacrificed on day four, with tissue from distal ileum and proximal colon graded for NEC by a pediatric pathologist blinded to group assignments. Outcomes were compared using Fisher's exact test.
All pups in the control group survived to sacrifice and none developed NEC. Survival was 26% higher (p = 0.03) and incidence of NEC 51% less (P < 0.001) in CS+LL group compared to CS group. Of the pups that developed NEC, all pups in the CS+LL group had Grade 1 NEC, while one-third of pups in the CS group developed Grades 2-4 NEC.
In the presence of CS, LL is protective against development of NEC in a preterm rabbit model. Future studies are needed that evaluate utilization of prophylactic probiotics in the neonatal intensive care unit to determine if this intervention can successfully decrease rates of NEC in preterm infants.
坏死性小肠结肠炎（NEC）仍然是早产儿中最常见且最严重的胃肠道疾病。乳酸乳球菌（LL）是一种常见于酪乳和奶酪制品中的产乳酸菌，具有多种独特特性，使其成为新生儿理想的益生菌。我们评估了益生菌LL在患有阪崎克罗诺杆菌（CS）的早产兔模型中是否能预防NEC的发生。
将出生两天的早产新西兰白兔幼崽随机分为三种饮食组：对照组（无添加剂）、CS组和CS + LL组。幼崽通过灌胃喂养，并每日口服雷尼替丁和吲哚美辛。使用组织粘合剂进行肛门堵塞。在第四天处死实验对象，由对分组不知情的儿科病理学家对回肠末端和结肠近端的组织进行NEC分级。使用Fisher精确检验比较结果。
对照组所有幼崽均存活至处死，且无一发生NEC。与CS组相比，CS + LL组的存活率高26%（p = 0.03），NEC发病率低51%（P < 0.001）。在发生NEC的幼崽中，CS + LL组所有幼崽均为1级NEC，而CS组三分之一的幼崽发展为2 - 4级NEC。
在存在CS的情况下，LL对早产兔模型中NEC的发生具有保护作用。需要进一步开展研究，评估新生儿重症监护病房中预防性益生菌的应用情况，以确定这种干预措施是否能成功降低早产儿的NEC发生率。
