By Dr. Mercola
When your baby is born premature or sick, you can feel pretty helpless. This feeling can be magnified if your newborn is unable to leave the hospital, since the hospital, although sometimes necessary, can feel like a cold and sterile place for your precious new child.
Of course, your goal is to do everything you can to give your new baby what he needs to get better so he can come home with you as soon as possible. One of the most important prerequisites for your newborn is establishing a healthy gastrointestinal tract.
For your baby, as for you, his gut is his first line of defense in terms of immunity. Without a well-functioning GI tract, he can't get the proper nourishment to grow, or defend himself against pathogens. So getting his gut up and running efficiently is crucial.
Fortunately, there is a natural approach that offers great benefits for neonates, as well as older children and adults. This approach involves boosting your baby's intestinal flora by feeding him fermented foods and/or a high quality probiotic supplement.
The Link Between Your Baby's Gut and Brain Development
Your baby gets his or her first "inoculation" of gut flora from your birth canal during childbirth. If your flora is abnormal, your baby's flora will also be abnormal; whatever organisms live in your vagina end up coating your baby's body and lining his or her intestinal tract.
Studies show that a growing number of women have unknown vaginal infections at childbirth, which can result in the passage of abnormal microflora onto their babies. This introduction of unfriendly flora, combined with antibiotic use, can predispose a baby to Gut and Psychology Syndrome (GAPS). GAPS can have very damaging long-term effects on a child's health, such as:
- ADHD/ADD and learning disabilities, such as dyslexia
- Mood disorders, such as depression and bipolar disorder
- A number of other psychological, neurological, digestive, and immunological, problems
This has profound implications for the autism epidemic. Rates of childhood autism are staggering, now 50 times higher in some areas than three decades ago. Not surprisingly, there is a matching epidemic of GAPS.
Dr. Natasha Campbell-McBride is a neurologist and neurosurgeon who has devoted years of her career to studying this phenomenon, and how to treat and prevent it. She believes nearly all children are born with normal, healthy brains. However, this normal brain function gets derailed by a malfunctioning digestive system, turning what should be a source of nourishment for your child into a source of toxicity.
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Pathogenic microbes in your baby's digestive tract damage the integrity of his or her gut wall, allowing all sorts of toxins and microbes to flood his or her bloodstream, and then enter the brain and disrupt its development.
Breastfeeding protects your baby from this abnormal gut flora, which is why breastfeeding is so crucial to your child's health. No infant formulas can do this.
Any time your baby is given a broad-spectrum antibiotic, his or her beneficial flora are wiped out, giving pathogenic flora a window of opportunity to overgrow and wreak havoc. It takes the "friendly flora" two weeks to two months to recover, but by then, some not-so-friendly ones have found a niche. The first symptoms you typically see are colic, loose stools, constipation, eczema, or respiratory infections.
Adding a vaccine that further stresses your baby's immature immune system is like adding fuel to a fire—conditions that raise your child's risk for a major adverse vaccine reaction. In other words, a vaccine could be the proverbial "final straw" if your baby has GAPS. But all of this may be corrected, or even averted, by the addition of some natural probiotics.
Fermented Foods Can Help Your Baby Avoid MAJOR Health Problems
Providing abundant probiotics in the form of fermented foods is one of the most powerful ways to restore your baby's beneficial gut flora. Oftentimes, a commercial probiotic supplement won't even be needed.
The first fermented food Dr. Campbell-McBride recommends for your infant is raw organic grass fed yogurt (not commercial yogurt from the grocery strore), because it's well tolerated by most infants and children. It's best to make your own yogurt at home from raw organic milk, and start with a very tiny amount. Once yogurt is well tolerated by your baby, then start introducing kefir. If you have any problems with dairy, you can substitute vegetables fermented with yogurt culture or kefir culture.
To learn more about introducing fermented foods to your infant, including a week-by-week schedule, please refer to this article by Dr. Campbell-McBride, or order a copy of her book, Gut and Psychology Syndrome, which has a large recipe section for fermenting your own foods at home and using them to benefit all members of your family. If your baby has a severe condition, then the addition of a high-quality probiotic supplement may be needed.
Supplemental Probiotics Can Also Be Useful
There have been more probiotic studies involving adults than those with children, and even fewer with infants. Precious little research has been devoted to the study of probiotics for neonates, especially extremely low birth weight neonates (ELBW), but scientific studies thus far are very promising.
One study in particular, published in BMC Medicine on August 2, 2011 by the Department of Neonatal Pediatrics in Nepean Hospital along with several other Australian hospitals, brings us closer to important evidence-based guidelines for the use of probiotics with preterm neonates. And it is their recommendations I will be discussing later in this article. But first, why use probiotics?
What Probiotics Can Do for You and Your Newborn
Probiotic bacteria are living microorganisms that have highly beneficial effects on your health. Most of these reside in your gastrointestinal tract. Most people, including many physicians, do not realize that 80 percent of your immune system is located in your digestive tract, making a healthy gut a major focal point if you want to achieve optimal health. The root of many health problems is related to an imbalance of intestinal bacteria.
You may be surprised to learn that the bacteria in your gut outnumber the cells in your body by a factor of ten to one—you have 100 trillion bacteria living in your GI tract, comprised of as many as 500 different species. Collectively, each of us carries around several pounds of bacteria inside us! In adults, probiotics have been found to:
- Modulate immune responses via your gut's mucosal immune system, aiding in the production of antibodies and keeping pathogens under control
- Act as an anti-inflammatory, reducing CRP levels and proinflammatory cytokines
- Prevent allergies by training your immune system to distinguish between pathogens and non-harmful antigens and respond appropriately
- Digest and absorb certain carbohydrates (starches, fiber and sugars)
- Produce vitamins (B vitamins and vitamin K), absorb minerals and eliminate toxins
Studies have documented beneficial probiotic effects in a variety of disorders including the following:
|Inflammatory bowel disease (IBD)
||Irritable bowel syndrome (IBS)
||Constipation and diarrhea
||Eradication of H. pylori infection, which is associated with ulcers
|Strengthened immune response
|Cirrhosis of the liver
Probiotics even influence the activity of hundreds of genes, helping them to express in a positive, disease-fighting manner. Probiotics have been shown to provide a number of benefits to infants and children.
For example, daily supplements of probiotic foods may reduce your child's risk of eczema and allergy by 58 percent, according to one study. Another study found that a daily dose of Lactobacillus reuteri can help improve your baby's colic. But this is turning out to be just the tip of the iceberg when it comes to what probiotic supplementation can do for your newborn.
A Terrible Disease in Newborns: Necrotizing Enterocolitis (NEC)
One of the most dangerous complications in premature or sick babies is necrotizing enterocolitis, or NEC, which involves the death of intestinal tissue. The exact cause of NEC is still unknown. It is hypothesized that a decrease in blood flow to the bowel prevents the bowel form producing the mucus that protects the gastrointestinal lining. NEC may also be caused by a bacterial imbalance in the intestine. According to the National Institute of Health, the following infants have a higher risk for NEC:
- Premature babies
- Babies fed concentrated formula
- Babies who have received blood exchange transfusions
- Babies in a nursery where an outbreak has occurred
NEC is a serious disease, with complications that include intestinal perforation, peritonitis, and sepsis. Standard treatments include replacing oral feedings with intravenous feedings, antibiotic treatment, and sometimes inserting a tube into the stomach to allow the escape of accumulated gas. Sometimes surgery is required to remove dead intestinal tissue.
Despite advances in neonatal intensive care over the past 20 years, the incidence of NEC in preterm neonates has not changed. Mortality of NEC remains around 25 percent, accounting for 1.4 percent of all infant deaths. Early, aggressive treatment improves your baby's chance of survival. This is clearly a disease you would NOT want your baby to have!
Probiotics Show Great Promise in Preventing NEC
Since NEC is an intestinal disease, the Australian researchers chose to investigate whether building up a baby's gut flora would have a positive benefit in preventing or treating NEC. The results were remarkable! They concluded that probiotic supplementation does indeed significantly reduce NEC risk and mortality in pre-term neonates. In fact, probiotics reduced the incidence of NEC in neonates by at least 30 percent.
Although the Australian study was not specific to ELBW babies, one prior study in 2005 did find that probiotics reduced the incidence and severity of NEC in that particular group. This is one of the areas where a great deal more research needs to be done.
Besides probiotic supplementation, there are two other important factors that I should mention with respect to lowering your baby's risk of developing this deadly disease:
- Breastfeeding your baby is of utmost importance. In one U.K. study, babies fed formula were found to be 6 to 10 times more likely to develop NEC than babies exclusively fed breast milk.
- There is evidence that phthalates can bring about NEC in at-risk babies by creating inflammation in their bodies. NEC is associated with excessive inflammation. Neonates, especially premature neonates, are exposed to extraordinarily high concentrations of phthalates via exposure to the plastic medical equipment commonly used in neonatal intensive care units. So I would urge you to avoid all unnecessary exposure to these plastics, and urge your hospital to use phthalate-free equipment in their NICU.
Neonatal Probiotic Guidelines
As a result of their extensive research, the Australian researchers put together a set of guidelines for neonatal probiotic use, which I'll summarize below. If your physician is unfamiliar with these guidelines, I would encourage you to share them with him or her, along with a copy of the study, which should convince even the most skeptical physician about the benefits of probiotic treatment for newborns.
I'll also include a table summarizing the recommendations at the end of the article, for easy reference.
What are the Best Strains to Use?
According to the Australian study, bifidobacteria and lactobacilli are the species of choice for neonates, based on the evolution of a preterm baby's gut flora. Lactobacilli are a minor component of your baby's intestinal microbiota. Human strains of these bacilli are preferable because of their natural occurrence, long-term safety record for infants, and "adaptability to both mucosal and dairy ecosystems," according to the report.
They also recommend using a probiotic formula with multiple strains of each species for optimal benefit, as opposed to single strains.
What Dose Should You Give Your Baby?
Even though your baby's GI tract has millions of naturally occurring bacteria, probiotic supplementation must be implemented with care so as not to overwhelm his immature immune system. Preterm neonates are more "fragile" and often suffer from poor nutrition, impaired immune status, and frequent exposure to infectious agents. Too many probiotics can result in excess replication in his gut, which can lead to bacteremia.
Probiotic complications are more likely if your infant already has compromised gut integrity, which is why it's important to pay attention to his probiotic dose. The probiotic should be diluted with breast milk or water, to about 1.0 to 1.5ml per dose.
Researchers suggest the following dosing guidelines:
- Neonates less than 32 weeks gestation: 3 x 109 cfu/day ("cfu" stands for colony forming units)
- Extremely low birth weight neonates (ELBW): 1.5 x 109 cfu/day until they reach enteral feeds of 50-60 ml/kg/day.
When to Start and Stop Your Baby on Probiotics
Probiotics should be started as early as possible, before pathogens can colonize your baby's intestinal tract and before antibiotics destroy his natural flora. In most scientific trials, probiotics are typically started with the start of enteral feedings, but they have been started as early as in the first four hours of life.
Speaking of antibiotics, newborn babies—especially sick newborns and premature newborns—often receive antibiotics of some kind. If your baby does receive antibiotics, it is very important he receive probiotics to rebuild his gut flora, since antibiotics kill the good bacteria, along with the bad. Ideally, he should receive probiotics BEFORE the antibiotics. The healthier his gut flora is, the more resistant he'll be to infection in the first place.
According to the Australian study:
"Owing to the development of aberrant gut flora and delayed colonization by normal commensal strains in preterm neonates, early preferential feeding with breast milk and minimizing exposure to antibiotics are crucial to optimize the benefits of probiotic supplementation. Neonates given antibiotics at birth have been reported to retain abnormal microbial flora four weeks later, indicating the damaging effect of these agents. Strategies for preventing sepsis are also crucial in optimizing the benefits of probiotic supplementation, as sepsis needs treatment with antibiotics (anti-probiotics)."
Although you may not be able to avoid antibiotics entirely, you should avoid them as much as possible, especially prolonged exposure to them.
Probiotics may need to be stopped during an acute illness such as sepsis, NEC or perinatal asphyxia (oxygen deprivation). If your baby is on probiotics, you and your baby's healthcare providers should watch for signs of intolerance, such as abdominal distension, flatulence, vomiting or diarrhea.
What to Look for in a Probiotic Supplement
Not all probiotics are created equal, so make sure you select a high quality one. You should only use a product from a company with good manufacturing practices and strict quality control. The probiotic should be formulated in such a way to ensure the bacteria survive to their final destination—your child's digestive tract. This is accomplished by the addition of something to feed the bacteria themselves (sometimes called a prebiotic).
Even the type of packaging is important as it maintains the viability of the products to ensure therapeutic activity. Probiotics are live anaerobic organisms that are sensitive to oxygen, moisture and heat—designed to thrive in the gut environment. Manufacturing and packaging should involve limited exposure to oxygen.
The bottom line is, you should become well informed before implementing any strategy. Partner with your pediatrician, and don't be afraid to share information. Be vigilant about your child's health from the day he is born. I think the Australian study is a giant leap forward in support of a more holistic approach to your child's health. A good deal more research is needed about the use of probiotics in newborns. But already, we have a firm scientific basis to confidently say that probiotics can have a major positive impact on your baby's health.
As promised, the following chart is a summary of the guidelines suggested in the latest study, for easy reference.
Summary of Suggested Protocols for Use of Probiotics in Neonates
(From Deshpande et al., BMC Medicine 2011)
|When to Start
||When the neonate is ready for enteral feeds, preferably within first 7 days of life
|When to Stop
||May need to stop the supplementation during an acute illness, such as sepsis, NEC, or perinatal asphyxia
||Combination of strains containing Lactobacillus and at least one Bifidobacterium species is preferable; Lactobacillus GG alone may not be effective
||Neonates less than 32 weeks gestation: 3 x 109 cfu/day in a single dose; ELBW neonates: 1.5 x 109 cfu/day in single dose until they reach enteral feeds of 50-60 ml/kg/day
||Solution should be diluted to keep the osmolality below 600 mOsm/L
||Sterile water or breast milk (NOTE: leftover solution should be discarded after giving small doses as it may become contaminated)
|Volume for Administration
||1.0 to 1.5 ml per dose
||Patients should be monitored for intolerance (abdominal distension, diarrhea, vomiting), probiotic sepsis, and adverse effects (flatulence, loose stools) of additives such as prebiotic oligosaccharides.