Para-probiotics for Preterm Neonates-The Next Frontier.
Para-probiotics for Preterm Neonates-The Next Frontier.
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DOI：
10.3390/nu10070871
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发表时间：
2018-07-05
期刊：
影响因子：
5.9
通讯作者：
Patole S
中科院分区：
文献类型：
--
作者：
Deshpande G;Athalye-Jape G;Patole S
目前的证据支持在早产儿中使用益生菌来预防坏死性小肠结肠炎、死亡率和迟发性脓毒症。尽管有强有力的证据，但由于包括益生菌败血症，促炎反应和抗生素耐药性传播在内的担忧，这种干预措施的采用并不普遍。肠道完整性可能受损的危重极早产儿因易位而发生益生菌败血症的风险更高。在大多数国家，益生菌作为食品补充剂出售，质量控制较差。益生菌作为“活微生物”的传统定义受到了挑战，因为许多专家质疑益生菌有益作用背景下生存力的重要性。副益生菌（幽灵益生菌）被定义为非活微生物细胞（完整或破碎）或粗细胞提取物（即，具有复杂的化学组成），当以足够的量施用（口服或局部）时，其赋予人类或动物消费者益处。目前的证据表明，副益生菌可能是早产儿益生菌的安全替代品。高质量的临床前和临床研究，包括充分的动力随机对照试验（RCT）是必要的早产儿探索这一新的前沿。
Current evidence supports the use of probiotics in preterm neonates for prevention of necrotizing enterocolitis, mortality and late onset sepsis. Despite the strong evidence, the uptake of this intervention has not been universal due to concerns including probiotic sepsis, pro-inflammatory response and transmission of antibiotic resistance. Critically ill extremely preterm neonates with potentially compromised gut integrity are at higher risk of probiotic sepsis due to translocation. In most countries, probiotics are sold as food supplements with poor quality control. The traditional definition of probiotics as “live microorganisms” has been challenged as many experts have questioned the importance of viability in the context of the beneficial effects of probiotics. Paraprobiotics (ghost probiotics), are defined as non-viable microbial cells (intact or broken) or crude cell extracts (i.e., with complex chemical composition), which, when administered (orally or topically) in adequate amounts, confer a benefit on the human or animal consumer. Current evidence indicates that paraprobiotics could be safe alternatives to probiotics in preterm neonates. High-quality pre-clinical and clinical studies including adequately powered randomised controlled trials (RCTs) are warranted in preterm neonates to explore this new frontier.
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