Department of Neonatology, Nepean Hospital, Kingswood, NSW 2747, Australia.
Sydney Medical School Nepean, University of Sydney, Kingswood, NSW 2747, Australia.
Nutrients. 2018 Jul 5;10(7):871. doi: 10.3390/nu10070871.
Current evidence supports the use of probiotics in preterm neonates for prevention of necrotizing enterocolitis, mortality and late onset sepsis. Despite the strong evidence, the uptake of this intervention has not been universal due to concerns including probiotic sepsis, pro-inflammatory response and transmission of antibiotic resistance. Critically ill extremely preterm neonates with potentially compromised gut integrity are at higher risk of probiotic sepsis due to translocation. In most countries, probiotics are sold as food supplements with poor quality control. The traditional definition of probiotics as “live microorganisms” has been challenged as many experts have questioned the importance of viability in the context of the beneficial effects of probiotics. Paraprobiotics (ghost probiotics), are defined as non-viable microbial cells (intact or broken) or crude cell extracts (i.e., with complex chemical composition), which, when administered (orally or topically) in adequate amounts, confer a benefit on the human or animal consumer. Current evidence indicates that paraprobiotics could be safe alternatives to probiotics in preterm neonates. High-quality pre-clinical and clinical studies including adequately powered randomised controlled trials (RCTs) are warranted in preterm neonates to explore this new frontier.
目前的证据支持在早产儿中使用益生菌预防坏死性小肠结肠炎、死亡率和晚发性败血症。尽管有强有力的证据，但由于对益生菌败血症、促炎反应和抗生素耐药性传播的担忧，这种干预措施的采用并未普及。由于易位，潜在肠道完整性受损的危重症早产儿发生益生菌败血症的风险更高。在大多数国家，益生菌作为食品补充剂出售，质量控制较差。益生菌作为“活微生物”的传统定义受到了挑战，因为许多专家质疑在益生菌有益作用的背景下，生存能力的重要性。拟益生菌（幽灵益生菌）被定义为非存活微生物细胞（完整或破碎）或粗细胞提取物（即具有复杂化学成分），当以足够的量（口服或局部）给予时，对人类或动物消费者有益。目前的证据表明，拟益生菌可能是早产儿中益生菌的安全替代品。早产儿需要进行高质量的临床前和临床研究，包括足够大的随机对照试验（RCT），以探索这一新领域。
