Probiotics in critically ill children: An updated review

Abstract

Gut microbiome is a complex ecosystem where good microbes outnumber pathogenic bacteria. Gut microbiome plays important role in host biology, function, physiology, and immune response by performing nutritive and immune functions and by providing physical barriers against pathogenic microorganisms. Critical illness leads to disruption of the gut microbiome, colonization with and overgrowth of pathogenic microorganisms, translocation of pathogens and their toxins, systemic inflammatory response syndrome, and sepsis. Probiotics restore gut microbiome, improve the barrier function of gastrointestinal tract, and prevent bacterial translocation. Commonly used probiotics are Lactobacillus, Bifidobacterium, and Saccharomyces. Enteral administration of probiotics has been shown to reduce the rate of necrotizing enterocolitis, candida colonization, candidiasis, sepsis, feed intolerance, mortality, and duration of hospital stay among preterm infants; and ventilator-associated pneumonia and antibiotic-associated diarrhea in critically ill children. Few studies suggested that probiotics supplementation among critically ill children resulted in reduction in the rate of candida colonization and candidiasis; and modulation of inflammation. However, there are safety concerns with probiotics as there are few reports of bacteremia/sepsis and fungemia in immunocompromised cases. Further, well-designed multicentric studies are needed to give clear answers on the dose and duration of treatment, the effectiveness of a single or multiple strain of probiotics, risk-benefit potential, and cost-effectiveness in critically ill children.

Keywords

• gut
• pediatric intensive care unit
• probiotics