Researchers have shown that probiotic supplements not only save the lives of premature babies, they also ensure they develop a healthy microbiome. The development of the healthy microbiome, which helps fight infections and ensure proper development of the digestive system, depends on also feeding the babies breast milk.
A premature start to life – i.e. a birth before the 37th week of pregnancy – affects around 11% of all newborns in the world. If premature babies have a particularly low birth weight of less than 1500g, they are extremely susceptible to acute and long-term health complications. Particularly threatening is the development of necrotizing enterocolitis (NEC). This disease affects between seven and eleven percent of premature infants with a birth weight below 1500g and is associated with a mortality rate of 30%.
Scientists from the Quadram Institute, University of East Anglia, the Medical University of Graz and the Technical University of Munich have now published research results in the journal Nature Communications that show how the NEC rate can be kept below 3% through prophylactic measures. Breast milk and Bifidobacterium play a decisive role in this.
Premature babies with a very low birth weight (VLBW) face several challenges right from the start of life. NEC is one of those health threats. “Given the rapid onset of NEC, some neonatal intensive care units (NICUs) have developed special NEC prophylaxis programs that include the use of probiotics, enteral antibiotics, and differentiated feeding protocols, which have recently led to a significant decrease in NEC rates among preterm infants,” reports Bernhard Resch from the Medical University of Graz. Southern Austrian neonatal units have implemented various combinations of these prophylactic measures with great success, resulting in an exceptionally low average NEC rate of 2.9% in VLBW infants.
Probiotics support the early maturation of the digestive system
Bifidobacterium breve Image credits: Lindsay Hall and Kathryn Gotts with QIB Advanced Microscopy and JIC BioImaging.
The aim of these prophylaxis programs is to support the intestinal microbiome of preterm infants at an early stage. In the now published work, the scientists investigated the success mechanisms of the different therapy options on the intestinal microbiome and metabolism. A total of 55 VLBW infants were included in the study at three closely neighbouring hospitals in Graz, Klagenfurt and Leoben. At the three centres the following NEC prophylaxis options were applied: Antibiotic treatment, antimycotic treatment, use of probiotics (either Lactobacillus rhamnosus, a combination of Bifidobacterium longum subsp. infantis and Lactobacillus acidophilus, or no probiotics), and feeding with breast milk or formula milk for preterm infants.
“Using a multi-omics approach, we investigated the composition and function of the microbiome and its metabolites in the first weeks of life in order to understand the importance of the interactions between nutritional components, antibiotics and probiotics,” describes Christine Moissl-Eichinger from the Medical University of Graz.
The scientists were able to show that therapies involving the administration of the probiotic Bifidobacterium longum subsp. infantis substantially influence the development of the microbiome at an early stage, as it can metabolise the milk oligosaccharides contained in breast milk, that our bodies own enzymes can’t break down. This function is accompanied by an early maturation of the digestive system. The probiotic Lactobacillus rhamnosus also showed a positive but much smaller influence.
Crucially, the beneficial effects of Bifidobacterium longum subsp. infantis administration depend on concurrent feeding with natural breast milk. “We show that preventive interventions have the greatest impact on the development and maturation of the gastrointestinal microbiome and enable the establishment of a resilient microbial ecosystem that reduces pathogen threats in vulnerable preterm infants,” concluded first author Charlotte Neumann.
“We hope our findings will lead to the widespread adoption of these measures, so we can help these extremely vulnerable babies fight off these deadly infections, and also ensure that they get the best possible start to life” said Professor Lindsay Hall from the Quadram Institute, University of East Anglia and the Technical University of Munich.
Reference: Neumann, C.J., Mahnert, A., Kumpitsch, C. et al. Clinical NEC prevention practices drive different microbiome profiles and functional responses in the preterm intestine. Nature Communications 14, 1349 (2023). DOI: 10.1038/s41467-023-36825-1