The effect of enteral supplementation of a prebiotic mixture of non-human milk galacto-, fructo- and acidic oligosaccharides on intestinal permeability in preterm infants

British Journal of Nutrition
Q1
Sep 2010
Citations:60
Influential Citations:1
Interventional (Human) Studies
84
S2 IconPDF Icon

Enhanced Details

Methods
Randomized, double-blind, placebo-controlled trial in preterm infants with gestational age <32 weeks and/or birth weight <1500 g; n=113; supplementation started between days 3 and 30 of life; intestinal permeability assessed by SAT using urinary lactulose/mannitol ratio at three time points (t0 birth, t1 day 4, t2 day 7); generalized estimating equations for analysis; intention-to-treat.
Intervention
Enteral prebiotic mixture SC GOS/LC FOS/AOS (80% SC GOS/LC FOS, 20% AOS) given with feeds from day 3 to day 30 of life; maximum dose 1.5 g/kg/day; per-feed dosing: add 1 g per 60 mL feed if daily enteral intake ≤100 mL/kg, or 1 g per 100 mL feed if daily intake >100 mL/kg; administered with breast milk or preterm formula.
Results
Prebiotic SC GOS/LC FOS/AOS did not reduce intestinal permeability versus placebo in the first week of life (no significant difference in L/M ratio change from birth to day 7). L/M ratio decreased in both groups over the week (P<0.001). Lower birth weight associated with higher permeability (P=0.002). Exclusive breast milk feeding and mixed breast milk/formula feeding during the first week reduced L/M ratio vs exclusive formula feeding (P<0.001 and P<0.05, respectively). By day 7, 20% had a serious infection; L/M ratio did not differ by infection status; 16 infants developed necrotising enterocolitis with no difference in L/M ratio. Authors conclude that the prebiotic mixture does not enhance the postnatal decrease in permeability in the first week; beneficial effects may involve other aspects of gut barrier function (e.g., microbiota modulation, inflammatory response); higher/different dosing or longer duration might be needed.
Limitations
First-week permeability measured only; mean first-week dose was 0.73 g/kg/day (below max 1.5 g/kg/day); high antibiotic exposure (~75%) may mask prebiotic effects; not all infants reached full-dose by day 7; variation in feeding regimens; SAT may not capture other gut barrier improvements.

Abstract

Preterm infants have an impaired gut barrier function. We aimed to determine the effects of enteral supplementation of a prebiotic mixture consisting of neutral oligosaccharides (short-chain galacto-oligosaccharides (SCGOS)/long-chain fructo-oligosac...