The DFW Hospital Council is posting blogs submitted by Associate Members. This post was provided by Gerber. For information, please contact Chris Wilson at chrisw@dfwhc.org.

The DFW Hospital Council and Gerber will be co-hosting the complimentary educational event “Leadership Conference: The Economic Burden of Allergies and Positive Patient Outcomes” tomorrow at Texas Scottish Rite Hospital for Children from 8:00 a.m. to 10:00 a.m. You can register here. Dr. Andrea Papamandjaris, making her first-ever Dallas appearance, will serve as keynote speaker. Dr. Papamandjaris is the head of the medical, scientific and regulatory unit for Nestlé Maternal and Infant Nutrition in Canada and director of medical affairs for Nestlé Infant Nutrition in the U.S. and is considered an international expert on pediatric nutrition.

Probiotics are live microorganisms that provide health benefits when ingested in adequate amounts. Bifidobacterium lactis strain Bb-12 (B. lactis) and Lactobacillus reuteri strain DSM- 17938 (L. reuteri) are two probiotic strains that have been clinically shown to provide health benefits in infants. Breastmilk contains beneficial bacteria, and exclusive breastfeeding promotes the development of a healthy microbiota. However, there are situations when even the breastfed baby may benefit from probiotics, such as after a C-section delivery or when common feeding problems develop.

The mode of delivery impacts the development of the infant gut microbiome. During a C-section delivery, the infant is not exposed to the vaginal canal where it would normally be exposed to maternal microbiota. Vaginally delivered infants tend to have a microbiome with earlier colonization and higher levels of bifidobacteria than their C-section delivered counterparts especially in the very early months of life.

These differences in microbiota may explain the correlation seen between C-section deliveries and the development of chronic immune diseases later in life. Supplementation with the probiotic, B. lactis, has been clinically shown to increase levels of bifidobacteria in C-section delivered infants and help support the developing immune system by increasing levels of secretory IgA, the key immunoglobulin of the gut-associated immune system.

Infant regurgitation is the most common gastrointestinal symptom among infants in the U.S. with a reported prevalence estimated at 30%. Although symptoms can be expected to self-resolve in the majority of cases, frequent spit-ups cause parental anxiety and is a common reason for pediatric office visits.

The intestinal microbiota has an influence on gastric motility via the gutbrain axis. The probiotic, L. reuteri, has been clinically shown to improve gastric emptying time and reduce the frequency of spit-ups in healthy breastfed infants and infants with uncomplicated regurgitation.

Another common issue during infancy is colic, which effects approximately 20% of infants. Although the exact causes of colic are unknown, abnormal gastrointestinal tract function may play an important role. Studies have shown that colicky infants have an immature mucosal barrier, altered gut motility, and an imbalanced gut microbiota compared to their non-colicky counterparts.

The probiotic, L. reuteri, may positively impact GI function and alleviate symptoms of colic in three ways; strengthening the mucosal barrier, increasing gastric motility and balancing the gut microbiota. Additionally, L. reuteri is the only probiotic repeatedly shown to reduce crying time in colicky infants in studies.

The American Academy of Pediatrics (AAP) recommends that all breastfed and partially breastfed infants consuming less than one liter of infant formula per day receive 400 IU of vitamin D daily via supplementation beginning in the first few days of life. Vitamin D supplements are now conveniently available with L. reuteri included in the formulation so that infants can receive the benefits of vitamin D and this probiotic in one convenient product.

In conclusion, the probiotics B. lactis and L. reuteri can benefit the breastfed baby by supporting the developing immune system and reducing symptoms of common feeding issues, such as frequent spit-ups and colic.

REFERENCES
1. Hill C, et al. Nat Rev Gastroenterol Hepatol. 2014;11(8): 506-514.
2. Holscher HD, et al. J Parenter Enteral Nutr. 2012;36(1 Suppl): 106S-117S.
3. Finn K, et al. J Pediatr Gastroenterol Nutr. 2017;107;65(Suppl2): S186-187.
4. Bird SA, et al. J Pharm Pract. 2017;30(3):366-374.
5. Soto A, et al. J Pediatr Gastroenterol Nutr. 2014;59(1):78-88.
6. Davis EC, et al. Gut Microbes. 2017;82(2):143-171.
7. Yuniaty T, et al. Paediatr Indonesiana. 2013;53(2): 89-99.
8. Rutayisire E, et al. BMC Gastroenterol. 2016;16(1):86.
9. Sevelsted A, et al. Pediatrics. 2015;135(1): e92-98.
10. Vandenplas Y, et al. J Pediatr Gastroenterol Nutr. 2015;61(5):531-538.
11. Smart J, Hiscock H. J Pediatr Child Health. 2007; 43:284-290.
12. Rouster AS, et al. J Pediatr Gastroenterol Nutr. 2016;62(6):847-51.
13. Carabotti M, et al. Ann Gastroenterol. 2015;28(2): 203-209.
14. Indrio F, et al. J Phys Pharm. 2009;60(Suppl 6):27-31.
15. Indrio F, et al. Eur J Clin Invest. 2011;41(4):417-422.
16. Lothe L, et al. Acta Paediatrica. 1990;79(4):410-416.
17. Savino F, et al. Acta Paediatrica. 2004;93(6):825-829.
18. Rosenfeldt V, et al. J Pediatr. 2004;145(5):612-616.
19. Savino, F, et al. Pediatrics. 2010;126(3): e526-e533.
20. Wagner CL, et al. Pediatrics. 2008; 122:1142-1152.