I. Lazar
Bolnišnica za ginekologijo in porodništvo Kranj, Kranj, Slovenija

M. Derganc
Klinični oddelek za otroško kirurgijo in intenzivno terapijo, Kirurška klinika, Univerzitetni klinični center Ljubljana, Ljubljana, Slovenija

Abstract

Late neonatal sepsis and necrotizing enterocolitis are important causes of morbidity and mortality in pre-mature infants, particularly in very- and extremely-low-birth weight infants. The breakdown of the normal bowel mucosal barrier, which is an important causative factor, is, to a large extent, the consequence of the absence of protective commensal flora and the overgrowth of pathogens. Thus, the bowel becomes an important source of pathogenic bacteria, which can lead to the development of necrotising enterocolitis and/or sepsis. Commensal flora inhibits the growth of pathogens, provides the protective mucus layer, improves tight junctions in epithelial cells and modulates the exaggerated neonatal bowel immune response. Exogenous pro- and prebiotics have been added with the aim of normalizing the bowel flora and decreasing the incidence of late neonatal sepsis and NEC. Numerous studies have shown the beneficial influence of different probiotics, particularly on the lower incidence of necrotising enterocolitis, but not of neonatal sepsis. Few data exist on the effect of prebiotics in preterm infants. In the paper, we reviewed the literature and open issues on the prophylactic use of pro- and prebiotics against necrotising enterocolitis and sepsis in very- and extremely-low-birth weight infants.

Key words: late neonatal sepsis, necrotizing enterocolitis, very-low-birth weight premature infants, probiotics, prebiotics.