Probiotic Use for

Necrotizing
Enterocolitis in the
Newborn:
Is it Effective?

Nathan Smith
Shannon Cobb
Cyd Ward
Elizabeth Bobo
UAMS College of Nursing
December 2009 1
Importance to Childbearing Families
How will probiotics benefit newborns?
• Necrotizing enterocolitis (NEC) is one of the most common emergency diagnoses
for preterm infants and a major cause of death in neonatal care units.

• There is a mortality rate of 10%-50% in newborns which approaches

100% mortality with premature infants (Hunter, Podd, Ford, & Camerini,
2008).

• Newborns are at risk for NEC because of a lack of normal flora in the G.I. tract.

• Research indicates probiotics used as a prophylactic against necrotizing

enterocolitis might lessen incidences of NEC by suppressing colonization of
organisms.

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 Necrotizing Enterocolitis:
Inflammation and Necrosis of the Bowel
Signs and Symptoms:
• feeding intolerance
• abdominal distention
• vomiting
• bloody stools
• apnea
• bradycardia
• lethargy
• temperature instability
• absence of bowel sounds

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(Ladd & Ngo, 2009)
NEC
Diagnosis
• X-ray studies provide
evidence of
pneumatosis intestinalis
& portal venous gas
• Surgical confirmation
Red arrows point to linear bands of
radiolucency which parallel the wall of
the bowel indicating the presence of
pneumatosis intestinalis in necrotizing
enterocolitis. http://www.learningradiology.com/

(Hunter, Podd, Ford & Camerini, 2008) 4

Probiotics
Probiotics are nutritional
supplements that
contain live bacteria.
These microorganisms
assist in maintaining a
balance of bacteria in
the gastrointestinal
system.

(Ladd & Ngo, 2009) 5

 BELL’S STAGING CRITERIA FOR NECROTIZING ENTEROCOLITIS

Systemic Signs Intestinal Signs Radiologic Signs

Stage 1 Temperature Instability Poor Feeding Normal or
(Suspected Apnea Increased Residuals Intestinal Dilation
NEC) Bradycardia Abdominal Distention Mild ileus
Lethargy Emesis
Stool Guaiac (+)
Stage 2 As in Stage 1 Same as Stage 1 Intestinal dilation
(Proven + Absent bowel sounds Ileus
NEC) +/- Abdominal tenderness Pneumatosis Intestinalis
Portal vein gas
Possible ascites
Stage 3 Same as Stage 2 Same as Stage 2 Same as Stage 2
(Severe + Hypotension + Peritonitis + Definite ascites
NEC) Respiratory Acidosis Marked distention of
Neutropenia Abdomen

(Ladd & Ngo, 2009) 6

 The Research
Manzoni et. al. (2006) conducted a study on very low birth weight (i.e., < 1500 g)
neonates to determine the effectiveness of an orally supplemented probiotic
(Lactobacillus casei) in the prevention of gastrointestinal colonization by
Candida species.
 Subjects
 80 preterm neonates with a very low birth weight (< 1500 g)

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 The Research

 Method
 Over a 12-month period
 A prospective, randomized, double-blind trial in a large tertiary neonatal
intensive care unit in Turin, Italy
 Group A included neonates who received supplementation with an oral
probiotic; Group B neonates did not receive probiotic supplementation
 On a weekly basis, specimens were collected from various sites from all
patients for surveillance culture, to assess the occurrence and intensity of
fungal colonization in the gastrointestinal tract.
 Results
 The incidence of fungal enteric colonization was 23.1% (9 of 39 neonates)
in group A and 48.8% (20 of 41 neonates) in group B.
 No adverse effects occurred.

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 Research Conclusion
In summary, orally
administered
Lactobacillus casei
significantly reduces the
incidence and the
intensity of enteric
colonization by Candida
species among very low
birth weight neonates.

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Risks of Probiotic Use in Newborns

• Immediate or long-term toxicity

• Further research needed to determine specific
agents and doses

(as cited in Zupancic, 2009) 10

 Probiotic Benefits in Newborns
•Lower frequency of duration and diarrhea after antibiotic use
•Stimulation of the immune system
•Reduction of intestinal gas
•Improved absorption of essential nutrients
•Resistance to food-borne pathogens

(as cited in Zupancic, 2009) 11

Nursing Implications
• Establish breast feeding
• Assess for NEC’s clinical signs and
symptoms
• Feasible administration
• Refrigerate to 40F
• Appropriate spacing between
probiotic and antibiotic
administration
• Document results

(as cited in Zupancic, 2009) 12

13
 Conclusion

The incidence of necrotizing enterocolitis may be

significantly reduced with the use of probiotics.

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 References
• Hunter, C., Podd, B., Ford, H.,& Camerini, V. (2008). Evidence vs experience in neonatal
practices in necrotizing enterocolitis. Journal of Perinatology, 28S9-13. Retrieved from
CINAHL Plus with Full Text database.
• Ladd, N., & Ngo, T. (2009). Pharmacology notes. The use of probiotics in the prevention of
necrotizing enterocolitis in preterm infants. Baylor University Medical Center
Proceedings, 22(3), 287-291. Retrieved from CINAHL Plus with Full Text database.
• Manzoni, P., Mostert, M., Leonessa, M., Priolo, C., Farina, D., Monetti, C., Latino, M., &
Gomirato, G. (2006). Oral supplementation with Lactobacillus casei subspecies
rhamnosus prevents enteric colonization by Candida Species in preterm neonates: a
randomized study. Clinical Infectious Diseases, 42. Retrieved from CINAHL Plus
with Full Text database.
• Zupancic, J. (2009). Probiotic use in neonates. Women’s Health, vol. 13. Retrieved October
15, 2009 from http://dx.doi.org/10.1111/j.1751 486x.2009.01380.x

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