The effect of enteral supplementation of a prebiotic mixture of non-human milk galacto-, fructo- and acidic oligosaccharides on intestinal permeability in preterm infants
What this study found
The prebiotic mixture did not improve intestinal permeability in the first week of life. The lactulose-to-mannitol ratio decreased from t0 to t2 in both groups (P<0.001), but there was no additional effect of SC GOS/LC FOS/AOS on the decrease in L/M ratio (effect 0.34, 95% CI 0.22, 0.51; P<0.001). Baseline L/M ratios were 0.21 (0.03-2.16) in the prebiotic group and 0.34 (0.06-1.86) in the placebo group, and lactulose and mannitol concentrations did not differ between groups. Breast milk feeding during the first week was associated with lower intestinal permeability, suggesting any…
- Study & population
- Randomized placebo-controlled trial in preterm infants admitted to a level III NICU.
- Intervention
- The active regimen was an enteral prebiotic mixture consisting of 80% short-chain galacto-oligosaccharides and long-chain fructo-oligosaccharides plus 20% acidic oligosaccharides.
- Key limitation
- Follow-up was short, with intestinal permeability assessed only during the first week of life, so later effects were not evaluated.
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Open PDFOriginal 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-oligosaccharides (LCFOS)) and acidic oligosaccharides (AOS) on intestinal permeability of preterm infants as measured by the sugar absorption test in the first week of life. Furthermore, we determined host- and treatment-related factors associated with intestinal permeability. In a randomised controlled trial, preterm infants with a gestational age < 32 weeks and/or birth weight (BW) < 1500 g received enteral supplementation of SCGOS/LCFOS/AOS or placebo (maltodextrin) between days 3 and 30 of life. Intestinal permeability, reflected by the urinary lactulose/mannitol (L/M) ratio after oral ingestion of lactulose and mannitol, was assessed at three time points: before the start of the study (t = 0), at day 4 (t = 1) and at day 7 (t = 2) of life. Data were analysed by generalised estimating equations. In total, 113 infants were included. Baseline patient and nutritional characteristics were not different between the SCGOS/LCFOS/AOS (n 55) and the placebo groups (n 58). SCGOS/LCFOS/AOS had no effect on the L/M ratio between t = 0 and t = 2. In both the groups, the L/M ratio decreased from t = 0 to t = 2 (P < 0·001). Low BW increased the L/M ratio (P = 0·002). Exclusive breast milk feeding and mixed breast milk/formula feeding during the first week of life decreased the L/M ratio (P < 0·001 and P < 0·05, respectively). In conclusion, enteral supplementation of a prebiotic mixture does not enhance the postnatal decrease in intestinal permeability in preterm infants in the first week of life.