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Probiotika bei Frühgeborenen

Probiotics in preterm infants

  • Leitthema
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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Bei Frühgeborenen erfolgt die intestinale bakterielle Kolonisation verzögert, die Diversität der Darmflora ist reduziert, das Risiko, antibiotikaresistente Keime zu erwerben, sowie das Risiko einer intestinalen bakteriellen Translokation sind erhöht. Nosokomiale Infektionen, Infektionen durch antibiotikaresistente Keime, systemische Inflammationsreaktionen sowie die nekrotisierende Enterokolitis (NEK) treten häufiger als bei Reifgeborenen auf. Die vorhandenen Daten stützen die Hypothese, dass Probiotika den Nahrungsaufbau beschleunigen und sowohl die Morbidität als auch die Mortalität reduzieren. Diese Ergebnisse sind viel versprechend, bedürfen aber der Bestätigung in großen Studien. Unklar ist, welches Probiotikum besonders gut geeignet ist, welche Dosis optimal ist, wann und wie am besten mit der Verabreichung begonnen wird und ob ein einzelner Keim oder eine Kombination gegeben werden sollen. Die Sicherheit und Effizienz eines jeden Präparats müssen separat nachgewiesen werden. Zusammenfassend gibt es derzeit nicht genug Studiendaten, um Probiotika bei sehr kleinen Frühgeborenen in der klinischen Routine zu empfehlen.

Abstract

Preterm infants are prone to delayed gastrointestinal colonization, reduced microbial diversity in the bowel, acquisition of antibiotic-resistant strains, loss of strains associated with antibiotic treatment, and increased intestinal bacterial translocation. These effects make the preterm infant more susceptible to antibiotic-resistant infections, systemic inflammatory response syndrome, and necrotizing enterocolitis (NEC). Meta-analysis of the available double-blinded controlled randomized trials supports the hypothesis that probiotics accelerate early enteral feeding advancement and reduce morbidity and mortality. Although these results are promising, large trials are required in the future to prove these effects. Currently, the most effective probiotic or combination of probiotics, dosage and timing are unknown. Efficacy and safety need to be established for each product. There is currently insufficient data available to recommend the routine use of probiotics in preterm infants.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: In den letzten Jahren Tätigkeiten als Referent oder Berater für diverse Firmen (u. a. Milupa, Humana, Nestlé, Danone, Hipp), die Ernährungskommission der Deutschen Gesellschaft für Kinder- und Jugendmedizin und die nationale Stillkommission.

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  1. Klinik für Kinder- und Jugendmedizin, Diakonieklinikum, Schwäbisch-Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland

    W.A. Mihatsch

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Correspondence to W.A. Mihatsch.

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Mihatsch, W. Probiotika bei Frühgeborenen. Monatsschr Kinderheilkd 156, 1070–1075 (2008). https://doi.org/10.1007/s00112-008-1830-8

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