益生菌与婴幼儿健康

肠道是机体最大的免疫器官和微生态体系,肠道菌群通过调整免疫应答影响机体健康。小儿在不同生长时期存在肠道菌群结构的个体差异,并受许多因素影响,如饮食、生活环境、用药和特定疾病状况等。益生菌是由食物供给,通过改善机体微生态环境,对宿主产生有益作用的活的微生物,在预防急性腹泻、抗生素相关性腹泻、过敏性疾病、炎症性肠病和坏死性小肠结肠炎方面发挥重要作用,大量研究证实益生菌应用是安全有效的。     

Probiotics in primary care pediatrics

Probiotics are live microorganisms that help stabilize and balance intestinal microflora. Although these organisms are ubiquitous and have been used in the production of foods, probiotics have been used more frequently for therapeutic purposes, including the treatment and prevention of pediatric diseases. This article reviews the proposed mechanisms of the beneficial effects of probiotics, potential uses of these organisms in pediatric care, and promising future directions for their application.     

Probiotics in allergy management

The gut contains a diverse bacterial flora that is acquired at birth and has a number of physiological functions. Administration of prebiotics or probiotics may favourably alter this gut microflora. Prebiotics are poorly digested oligosaccharides that promote the growth of desirable bacteria and may have other beneficial gastrointestinal and systemic effects. Probiotics are "helpful" human bacteria that provide a variety of health benefits when administered exogenously. Probiotics produce beneficial effects in the prevention and treatment of traveller's diarrhoea, viral diarrhoea, and diarrhoea in day care centres. Moreover, probiotics have been shown to reduce relapses associated with Clostridium difficile, and Lactobacilli are effective in the prevention of antibiotic-associated diarrhoea. Probiotics may also be efficacious in the treatment of gastroenteritis. Clinical studies of probiotics in inflammatory bowel disease have proved disappointing, but beneficial effects in adults with irritable bowel syndrome have been reported with Bifidobacterium infantis 35624. Lactobacilli GG reduces the incidence of gastrointestinal symptoms and gut permeability in patients with atopic dermatitis, and administration of probiotics reduces the frequency and severity of atopic eczema when administered to pregnant women and then to newborn infants. In conclusion, probiotics are effective in the treatment and/or prevention of a number of conditions, including diarrhoea, irritable bowel syndrome and atopic dermatitis, and the product used should be selected based on the particular indication.     

Probiotics for the prevention of necrotizing enterocolitis

Necrotizing enterocolitis (NEC) remains a significant cause of morbidity and mortality for low birth weight premature infants. Prematurity, ischemia, formula feeding, and bacterial colonization are risk factors for the self-perpetuating cycle of damaged intestinal epithelia, inflammation, bacterial entry, sepsis, and shock that characterizes NEC. Probiotics are food supplements containing live bacteria that benefit the recipient by improving the microflora balance within the intestine. Several studies suggest that the administration of probiotics may have a prophylactic effect for NEC and may reduce morbidity and mortality rates for low birth weight infants.     

Probiotics and the mechanism of necrotizing enterocolitis

Necrotizing enterocolitis (NEC) is a severe intestinal inflammatory disorder in newborns. Although the pathogenesis of NEC is not completely understood, we reviewed the literature and our previous studies to explore the mechanism of NEC and to evaluate the role for probiotics in this disease. NEC may be associated with an inappropriate innate immune and excessive inflammatory response of the immature intestine. Probiotics are widely used in promoting human health and adjunctive therapy of human disease. There are growing clinical trials and research studies that support a beneficial role for probiotics for NEC. We have reviewed the literature associated with the use of probiotics in NEC.     

Clinical efficacy of probiotics: review of the evidence with focus on children

Probiotics are marketed in several countries and widely used by pediatric health care providers. Although probiotics can be helpful for specific disorders, they have been broadly prescribed for disorders without clear evidence to support their use. Furthermore, in certain specific conditions, probiotics cause clinical deterioration. This report is a review and evaluation of the evidence or lack thereof to support a beneficial effect of probiotic agents in a variety of pediatric conditions and to review the safety and potential adverse events that may be encountered when using probiotics. It is also important to emphasize that probiotics are highly heterogeneous with differences in composition, biological activity, and dose among the different probiotic preparations.     

Probiotics and prebiotics in pediatrics

This clinical report reviews the currently known health benefits of probiotic and prebiotic products, including those added to commercially available infant formula and other food products for use in children. Probiotics are supplements or foods that contain viable microorganisms that cause alterations of the microflora of the host. Use of probiotics has been shown to be modestly effective in randomized clinical trials (RCTs) in (1) treating acute viral gastroenteritis in healthy children; and (2) preventing antibiotic-associated diarrhea in healthy children. There is some evidence that probiotics prevent necrotizing enterocolitis in very low birth weight infants (birth weight between 1000 and 1500 g), but more studies are needed. The results of RCTs in which probiotics were used to treat childhood Helicobacter pylori gastritis, irritable bowel syndrome, chronic ulcerative colitis, and infantile colic, as well as in preventing childhood atopy, although encouraging, are preliminary and require further confirmation. Probiotics have not been proven to be beneficial in treating or preventing human cancers or in treating children with Crohn disease. There are also safety concerns with the use of probiotics in infants and children who are immunocompromised, chronically debilitated, or seriously ill with indwelling medical devices. Prebiotics are supplements or foods that contain a nondigestible food ingredient that selectively stimulates the favorable growth and/or activity of indigenous probiotic bacteria. Human milk contains substantial quantities of prebiotics. There is a paucity of RCTs examining prebiotics in children, although there may be some long-term benefit of prebiotics for the prevention of atopic eczema and common infections in healthy infants. Confirmatory well-designed clinical research studies are necessary.     

益生菌在儿童变态反应性疾病中的防治作用

变态反应性疾病逐年升高的发病率已引起全球的关注,严重危害儿童健康,其共同发病机制是机体对常见的吸入性或食物性过敏原产生以特异性IgE介导的或者细胞介导的免疫反应。流行病学调查、粪便菌群分析和临床研究均提示,变态反应性疾病的发生、发展与早期肠道菌群的紊乱密切相关。益生菌可调节肠道免疫反应、增加上皮细胞屏障功能和抑制病原菌的粘附定植,恢复或重建肠道正常微生物群。随着人们对变态反应性疾病认识的加深,益生菌对其防治作用将越来越受到人们的重视。     

肠道微生态和新生儿坏死性小肠结肠炎

肠道微生态是由体内有益菌及有害菌共同构成的生态环境,是人体最大、最复杂的微生态系统.研究表明,适当的肠道微生物定植过程有助于肠道结构和功能发育以及免疫系统成熟,它决定了之后肠道发生疾病的风险.肠道微生态或益生菌与新生儿坏死性小肠结肠炎（neonatal necrotizing enterocolitis,NEC）的关系已越来越受到关注.该文就新生儿肠道微生态的构成及作用、肠道微生态在NEC发生中的作用及机制、益生菌对NEC的防治作用等研究进展作一综述.     

Probiotics in neonatology

Probiotics are micro-organisms that confer health benefits on the host. Postulated mechanisms include: increasing resistance of the mucosal barrier to migration of bacteria and their toxins by strengthening intestinal cell junctions, modification of host response to microbial products, augmentation of immunoglobulin A mucosal responses, enhancement of enteral nutrition to inhibit the growth of pathogens; production of antimicrobial proteins; and competitive exclusion of potential pathogens. Published meta-analyses and systematic reviews report the effects of probiotics on important clinical outcomes in neonates. This paper will review the evidence for probiotic supplementation in neonatology, with a focus on preterm infants.     

肠道菌群的演进及与儿童哮喘的关系

哮喘是儿童常见的慢性疾病,危害儿童的健康,同时给社会和家庭带来很大的经济负担.肠道菌群与哮喘之间的关系是近几年研究的热点,微生态制剂对哮喘的预防和治疗作用也越来越受到重视.哮喘发病机制中"卫生假说"、Th1/Th2失衡学说、调节性T细胞(Treg)等机制推动了肠道菌群与哮喘关系之间的研究进展.该文就肠道菌群及对哮喘的预防和治疗相关研究进展作一综述.     

Probiotika und Allergien

For years there has been an increasing interest in the potential use of probiotics in allergy prevention and treatment, as they seem to influence the pathomechanisms leading to allergic disease at various levels: Probiotics stimulate the physiological intestinal flora necessary for maturation of the intestinal immune system and they help stabilise the intestinal barrier. They also induce specific and unspecific defense mechanisms in the gut, i.e. antigen specific humoral immune responses, and seem to counteract the dominance of the atopy-associated Th2-type cytokine profile. Therefore they could be of particular importance for newborns and infants in our part of the world, whose intestinal flora – due to environmental factors – has changed in composition and maturation, thus affecting the development of intestinal immune functions. Some smaller controlled studies have shown a clear clinical benefit of probiotics for infants with atopic dermatitis – both in terms of prevention and treatment. However, further experimental work is needed to explain the exact underlying mechanisms and clinical studies should demonstrate the various clinical effects of probiotics on a broader level, before they can be generally recommended in the context of allergy.     

Probiotika in der Kindergastroenterologie

Probiotics might help to prevent and treat gastrointestinal disorders by altering intestinal microflora and stabilizing the mucosal barrier function. The benefits of modifying the intestinal flora composition in prevention of necrotizing enterocolitis, infectious gastroenteritis, inflammatory bowel diseases and functional gastrointestinal disorders in children were shown in several studies during the last decade. However, the effects of every single probiotic strain needs to be assessed in randomized controlled clinical trials (RCT).     

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??There is strong evidence implicating the intestinal flora disturbance in developing allergicdisease including allergic rhinoconjunctivitis??asthma??eczema and food allergy. Experimental studies with animal model of allergy have shown that probiotics can improve allergic manifestations by induceing immune regulation Treg cell??inhibiting the secretion of allergen-induced IgE and Th2 cytokines??attenuating eosinophils infiltration and allergic inflammation in target organs. Probiotics have been proved effective in treatment of IgE-mediated eczema;however??because of the conflicting results??probiotics are recommended for prevention of allergy only in populations at high risk of allergy.     

Probiotika in der Prävention und Behandlung der akuten Gastroenteritis bei Kindern

Probiotics are live microbial food supplements (bacteria, yeast) with a beneficial effect on health. They have been studied mainly for the prevention and treatment of acute infectious diarrhea in children. In recent years there have been preliminary reports that probiotic bacteria may also play a role in the prevention and treatment of inflammatory bowel diseases as well as allergic conditions. Most randomized controlled clinical studies as well as a recently published meta-analysis and a systematic review confirm a modest but significant effect of probiotics, in particular of Lactobacillus GG, in the treatment of acute infectious diarrhea in children. However, it is premature to give practical recommendations for the use of probiotics for several reasons such as limited numbers of controlled studies as well as heterogeneity concerning study design und probiotic strains.     

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??The human microbiota and microbiome have been focus in medicine. It has been recognized that the microbiota has an important effects on human growth and development??immune function??nutrition and metabolism??and the microbiota has close association with infectious disease??chronic inflammatory bowel diseases??allergic diseases??autoimmune diseases??and metabolic disease such as obesity and diabetes. The knowledge of microbiota and probiotics have been changing. Probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host??and it has been widely used for preventing and treating medical conditions. The concept??mechanisms??pharmacological properties and the safety of probiotics are being updated.     

Empfehlungen zu Prä- und Probiotika in Säuglingsanfangsnahrungen

For some time infant formulas have been enriched with pre- and probiotics. Prebiotics are nondigestible food components that beneficially affect host health by selectively stimulating the growth or activity of a number of bacteria in the gut. Probiotics are live microorganisms capable of benefitting human health when supplied in effective doses. In healthy infants, a clinically relevant advantage of infant formulas enriched with pre- and probiotics, as compared to non-supplemented formulas, has not yet been unequivocally demonstrated. In cases where mother’s milk is unavailable or insufficient, infants with heart disease, a compromised immune system or on immunosuppressive treatment should currently not be given infant formulas with probiotics due to remaining questions on safety in these risk situations. Preterm infants who cannot receive fortified human milk should receive a preterm formula without probiotics. The Committees on Nutrition support carrying out further controlled randomised trials of high scientific standards with adequate sample sizes to further evaluate the safety and efficacy of infant formulas and preterm formulas with pre- and probiotics, which should address longer term effects as far as possible.     

Pro- und Präbiotika bei Nahrungsmittelallergien

Several studies over the last decade have shown the benefits of modifying the intestinal flora composition in gastroenteritis, inflammatory bowel diseases, and irritable bowel syndrome. The so-called hygiene hypothesis suggests that a lack of exposure to infections in early life predisposes to atopic diseases. For this reason, probiotics have been used recently for both prevention and therapy of atopic eczema and cow’s milk allergy in pregnant women, infants, and toddlers. Use of lactobacilli and bifidobacteria might help prevent and treat atopic disorders by altering intestinal microflora and stabilizing the mucosal barrier function. Nevertheless, the data available today are insufficient for indiscriminately recommending the use of probiotics in children with food allergies.     

Probiotics in the treatment and prevention of allergies

Probiotics are live microbial food supplements which have been demonstrated to have beneficial effects on human health. The definition of probiotics has evolved along with active research on host-microbe crosstalk. It has become evident that the foundation of healthy gut microbiota lies in early infancy and the initial process of intestinal colonization. Conversely, the generation of immunophysiological regulation in the gut depends on the establishment of the optimal microbiota. Recent characterization of the immunomodulatory potential of specific strains of the gut microbiota, beyond the effect on the composition of the microbiota, has led to novel applications, e.g., in allergic diseases.In allergic disease, several targets for probiotic intervention have emerged: degradation/structural modification of enteral antigens, normalization of the properties of aberrant indigenous microbiota and of gut barrier functions, regulation of the secretion of inflammatory mediators, and promoting development of the immune system. Future probiotics will have more thoroughly clarified mechanisms to either control specific physiological processes in the evolution of allergic disease or in their dietary management. The modern view on probiotic therapy is based on specific effects of clearly defined strains.     

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??Necrotizing enterocolitis??NEC?? is considered to be the most common gastrointestinal emergency among neonates. Although the pathogenesis of NEC is incompletely understood??there are several established risk factors??including prematurity??altered intestinal blood flow/oxygen delivery??formula feeding and bacterial infection. Recently??a large number of studies showed that intestinal flora imbalance had been implicated as key risk factor in the pathogenesis of NEC. After birth??the neonatal gut must acquire a healthy complement of commensal bacteria??which leads to deficient or abnormal microbial colonization of the gut??may protect the immature gut from inflammation and injury. Providing a healthy complement of commensal bacteria can maintain the intestinal microflora balance??shift the balance of intestinal microbiota from a pathegenic to protective complement of bacteria??protect the gut from inflammation and subsequent injury??and prevent NEC. We review the relationship between intestinal microbiota and NEC in preterm infants??the mechanism of probiotics in preventing NEC??and the efficacy and safety of probiotics in preterm infants.