• Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents

Effect of a Probiotic Infant Formula on Infections in Child Care Centers: Comparison of Two Probiotic Agents

doi 10.1542/peds.2004-1815

Zvi Weizman, MD; Ghaleb Asli, MD; and Ahmed Alsheikh, MD
Soroka Medical Center, BeerSheva, Israel
Translate. Original: Pediatrics 2005; 115; 59. doi 10.1542/peds.20041815.
The online version of this article, along with updated information and services, is located on the World Wide Web at: http: //www.pediatrics.org/cgi/content/full/115/1/5
PEDIATRICS (ISSN 0031 4005). Copyright© 2005 the American Academyof Pediatrics.

Objective. To investigate the effect of 2 different species of probiotics in preventing infections in infants attending child care centers.
Methods. A double-blind, placebo-controlled, randomized trial was conducted from December 1, 2000, to September 30, 2002, at 14 child care centers in the Beer-Sheva area of Israel in healthy term infants 4 to 10 months old. Infants were assigned randomly to formula supplemented with Bifidobacterium lactis (BB-12), Lactobacillus reuteri (American Type Culture Collection 55730 (DSM 17938)), or no probiotics. Duration of feeding, including follow-up, for each participant was 12 weeks. All infants were fed only the assigned formula and were not breastfed due to parental decision before recruitment to the study. Probiotic or prebiotic food products or supplements were not allowed. Main outcome measures were number of days and number of episodes with fever (>38°C) and number of days and number of episodes with diarrhea or respiratory illness.
Results. Participants (n=201) were similar regarding gestational age, birth weight, gender, and previous breastfeeding. The controls (n=60), compared with those fed B lactis (n=73) or L reuteri (n=68), had significantly more febrile episodes (mean [95% confidence interval]: 0.41 [0.28–0.54] vs 0.27 [0.17– 0.37] vs 0.11 [0.04–0.18], respectively). The controls also had more diarrhea episodes (0.31 [0.22–0.40] vs 0.13 [0.05–0.21] vs 0.02 [0.01–0.05], respectively) and episodes of longer duration (0.59 [0.34–0.84] vs 0.37 [0.08–0.66] vs 0.15 [0.12–0.18] days, respectively). The L reuteri group, compared with BB-12 or controls, had a significant decrease of number of days with fever, clinic visits, child care absences, and antibiotic prescriptions. Rate and duration of respiratory illnesses did not differ significantly between groups.
Conclusions. Child care infants fed a formula supplemented with L reuteri or B lactis had fewer and shorter episodes of diarrhea. These effects were more prominent with L reuteri, which was also the only supplement to improve additional morbidity parameters.
Key words: probiotics, infant formula, child care, infections.

REFERENCES

1. Isolauri E, Sutas Y, Kankaanpaa P, Arvilommi H, Salminen S. (2001). Probiotics: effects on immunity. Am J Clin Nutr. 73(2):444—450.

2. Lin DC. (2003). Probiotics as functional foods. Nutr Clin Pract.18:497—506.

3. Mackie RI, Sghir A, Gaskins HR. (1999). Developmental microbial ecology ofthe neonatal gastrointestinal tract. Am J Clin Nutr.69:1035—1045.

4. Lopez-Alarcon M, Villalpando S, Fajardo A. (1997). Breast-feeding lowers thefrequency and duration of acute respiratory infection and diarrhea ininfants under six months of age. J Nutr.127:436—443.

5. Martin R, Langa S, Reviriego C et al. (2003). Human milk is a source of lacticacid bacteria for the infant gut. J Pediatr.143:754—758.

6. Ghisolfi J, Roberfroid M, Rigo J, Moro G, Polanco I. (2002). Infant formula-supplemented with probiotics or prebiotics: never, now, or someday? J Pediatr Gastroenterol Nutr. 35:467—468.

7. Nafstad P, Hagen JA, Oie L, Magnus P, Jaakkola JJ. (1999). Day care centers andrespiratory health. Pediatrics.103:753—758.

8. Loubiala PJ, Jaakkola N, Ruotsalainen R, Jaakkola JK. (1997). Day care centersand diarrhea: a public health perspective. J Pediatr. 131:476—479.

9. Szajewska H, Mrukowicz JZ. (2001). Probiotics in the treatment and preventionof acute infectious diarrhea in infants and children: a systematic reviewof published randomized, double-blind, placebo-controlled trials. J PediatrGastroenterol Nutr. 33(2): 17—25.

10. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. (2002). Lactobacillustherapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 109: 678—684.

11. Guandalini S, Pensabene L, Zikri MA et al. (2000). Lactobacillus GG administeredin oral rehydration solution to children with acute diarrhea: amulticenter European trial. J Pediatr Gastroenterol Nutr. 30: 54—60.

12. Hatakka K, Savilahti E, Ponka A et al. (2001). Effect of long term consumption of probiotic milk on infections in children attending day care centres:double blind, randomised trial. BMJ. 322: 1327—1329.

13. Pedone CA, Arnaud CC, Postaire ER, Bouley CF, Reinert P. (2000). Multicentricstudy of the effect of milk fermented by Lactobacillus casei on the incidenceof diarrhea. Int J Clin Pract. 54: 568—571.

14. Collet JP, Ducruet T, Kraker NS et al. (1993). Stimulation of nonspecific immunityto reduce the risk of recurrent infections in children attending day care centers. Pediatr Infect Dis J. 12:648—652.

15. Alsheikh A, Weizman Z. (2003). Safety of infant formula supplemented withtwo strains of probiotics in early infancy. Abstract. Pediatr Res. 53: 174A.

16. Erickson KH, Hubbard NE. (2000). Probiotic immunomodulation in health anddisease. J Nutr. 130: 403—409.

17. Reuter G. (2001). The Lactobacillus and Bifidobacterium microflora of the humanintestine: composition and succession. Curr Issues Intest Microbiol. 2:43—53.

18. Casas IA, Dobrogosz WJ. (2000). Validation of the probiotic concept: Lactobacillusreuteri confers broad-spectrum protection against disease in humansand animals. Microb Ecol Health Dis. 12: 247—285.

19. Ouwehand AC, Lagstrom H, Suomalainen T, Salminen S. (2002). Effect ofprobiotics on constipation, fecal azoreductase activity and fecal mucincontent in the elderly. Ann Nutr Metab. 46: 159—162.

20. Connolly E, Valeur N, Engel P, Carbajal N, Ladefoged K. (2003). In situ colonizationand immunomodulation by the probiotic Lactobacillus reuteri (ATCC 55730) in the human gastrointestinal tract. Abstract. Clin Nutr. 22: 57.

21. Petschow B, Figueroa R, Harris C et al. (2003). Comparison of intestinal colonization and tolerance following oral administration of differentlevels of Lactobacillus rhamnosus strain GG (LGG) in healthy term infants. Abstract. J Pediatr Gastroenterol Nutr. 36: 566.

22. Matarese LE, Seidner DL, Steiger E. (2003). The role of probiotics in gastrointestinaldisease. Nutr Clin Pract. 18: 507—516.

23. Isolauri E, Ribeiro HC, Gibson G et al. (2002). Functional foods and probiotics: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 35: 106—109.

24. Kailam M, Isolauri E, Soppi E et al. (1992). Enhancement of the circulating antibody secreting cell response in human diarrhea by a human lactobacillusstrain. Pediatr Res. 32: 141—144.

25. Ishibashi N, Yamazaki S. (2001). Probiotics and safety. Am J Clin Nutr. 73(2): 465—470.

26. Saavedra J. (2001). Clinical applications of probiotic agents. Am J Clin Nutr. 73: 1147—1151.

27. Ouwehand AC, Kirjavainen PV, Gronlund MM, Isolauri E, Salminen SJ. (1999). Adhesion of probiotic microorganisms to intestinal mucus. Int Dairy J. 9: 623—630.

28. Dunne C, O'Mahony L, Murphy L et al. (2001). In vitro selection criteria forprobiotic bacteria of human origin: correlation with in vivo findings. Am J Clin Nutr. 73: 386—392.