Probiotics and necrotizing enterocolitis

Pediatric Surgery International

Volumn 31, Issue 12, 2015, Pages 1111-1118

  Fleming, Paul ^a,b   Hall, Nigel J ^c,d   Eaton, Simon ^d  

^a HOMERTON UNIVERSITY HOSPITAL   (United Kingdom)

^b QUEEN MARY UNIVERSITY OF LONDON   (United Kingdom)

^c UNIVERSITY OF SOUTHAMPTON   (United Kingdom)

^d GREAT ORMOND STREET HOSPITAL   (United Kingdom)

Author keywords

Intestinal microbiota; Necrotizing enterocolitis; Premature infants; Prevention; Probiotics; Randomised controlled trials

Indexed keywords

PREBIOTIC AGENT; PROBIOTIC AGENT; SYNBIOTIC AGENT;

BIFIDOBACTERIUM INFANTIS; CHILDHOOD DISEASE; DRUG EFFECT; DRUG SAFETY; HUMAN; IMMUNE RESPONSE; INFANT MORTALITY; INTESTINE FLORA; LACTOBACILLUS ACIDOPHILUS; LACTOBACILLUS RHAMNOSUS; META ANALYSIS (TOPIC); MICROBIOME; NECROTIZING ENTEROCOLITIS; NONHUMAN; PATHOGENESIS; PREMATURITY; PRIMARY PREVENTION; PRIORITY JOURNAL; REVIEW; ENTEROCOLITIS, NECROTIZING; NEWBORN; RANDOMIZED CONTROLLED TRIAL (TOPIC); VERY LOW BIRTH WEIGHT;

ENTEROCOLITIS, NECROTIZING; HUMANS; INFANT, NEWBORN; INFANT, PREMATURE; INFANT, VERY LOW BIRTH WEIGHT; PROBIOTICS; RANDOMIZED CONTROLLED TRIALS AS TOPIC;

EID: 84947044190     PISSN: 01790358     EISSN: 14379813     Source Type: Journal    
DOI: 10.1007/s00383-015-3790-0     Document Type: Review

References (84)

1. Hall NJ, Eaton S, Pierro A (2013) Necrotizing enterocolitis: prevention, treatment, and outcome. J Pediatr Surg 48(12):2359–2367
2. Fitzgibbons SC, Ching Y, Yu D, Carpenter J, Kenny M, Weldon C, Lillehei C, Valim C, Horbar JD, Jaksic T (2009) Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 44(6):1072–1075
3. Thyoka M, De Coppi P, Eaton S, Khoo K, Hall NJ, Curry J, Kiely E, Drake D, Cross K, Pierro A (2012) Advanced necrotizing enterocolitis part 1: mortality. EurJ Pediatr Surg 22(1):8–12
4. Zani A, Cananzi M, Fascetti-Leon F, Lauriti G, Smith VV, Bollini S, Ghionzoli M, D’Arrigo A, Pozzobon M, Piccoli M, Hicks A, Wells J, Siow B, Sebire NJ, Bishop C, Leon A, Atala A, Lythgoe MF, Pierro A, Eaton S, De Coppi P (2014) Amniotic fluid stem cells improve survival and enhance repair of damaged intestine in necrotising enterocolitis via a COX-2 dependent mechanism. Gut 63(2):300–309
5. Caplan M, Frost B (2011) Myth: necrotizing enterocolitis: Probiotics will end the disease, and surgical intervention improves the outcome. Semin Fetal Neonatal Med 16(5):264–268
6. Kelleher J, Mallick H, Soltau TD, Harmon CM, Dimmitt RA (2013) Mortality and intestinal failure in surgical necrotizing enterocolitis. J Pediatr Surg 48(3):568–572
7. Rees CM, Pierro A, Eaton S (2007) Neurodevelopmental outcomes of neonates with medically and surgically treated necrotizing enterocolitis. Arch Dis Child Fetal Neonatal Ed 92(3):F193–F198
8. Downard CD, Renaud E, St Peter SD, Abdullah F, Islam S, Saito JM, Blakely ML, Huang EY, Arca MJ, Cassidy L, Aspelund G (2012) Treatment of necrotizing enterocolitis: an American pediatric Surgical association outcomes and clinical trials committee systematic review. J Pediatr Surg 47(11):2111–2122
9. van Acker J, de Smet F, Muyldermans G, Bougatef A, Naessens A, Lauwers S (2001) Outbreak of necrotizing enterocolitis associated with Enterobacter sakazakii in powdered milk formula. J Clin Microbiol 39(1):293–297
10. Rotbart HA, Levin MJ (1983) How contagious is necrotizing enterocolitis? Pediatr Infect Dis 2(5):406–413
11. Scheifele DW (1990) Role of bacterial toxins in neonatal necrotizing enterocolitis. J Pediatr 117(1 Pt 2):S44–S46
12. Scheifele DW, Olsen EM, Pendray MR (1985) Endotoxinemia and thrombocytopenia during neonatal necrotizing enterocolitis. Am J Clin Pathol 83(2):227–229
13. Cheu HW, Brown DR, Rowe MI (1989) Breath hydrogen excretion as a screening test for the early diagnosis of necrotizing enterocolitis. Am J Dis Child 143(2):156–159
14. de Meij TGJ, van der Schee MPC, Berkhout DJC, van de Velde ME, Jansen AE, Kramer BW, van Weissenbruch MM, van Kaam AH, Andriessen P, van Goudoever JB, Niemarkt HJ, de Boer NKH. Early detection of necrotizing enterocolitis by fecal volatile organic compounds analysis. J Pediatr. doi:10.1016/j.jpeds.2015.05.044
15. Garner CE, Ewer AK, Elasouad K, Power F, Greenwood R, Ratcliffe NM, Costello BD, Probert CS (2009) Analysis of Faecal volatile organic compounds in preterm infants who develop necrotising enterocolitis: a pilot study. J Pediatr Gastroenterol Nutr 49(5):559–565
16. Ley RE, Peterson DA, Gordon JI (2006) Ecological and evolutionary forces shaping microbial diversity in the human intestine. Cell 124(4):837–848. doi:10.1016/j.cell.2006.02.017
17. Qin J, Li R, Raes J, Arumugam M, Burgdorf KS, Manichanh C, Nielsen T, Pons N, Levenez F, Yamada T, Mende DR, Li J, Xu J, Li S, Li D, Cao J, Wang B, Liang H, Zheng H, Xie Y, Tap J, Lepage P, Bertalan M, Batto JM, Hansen T, Le Paslier D, Linneberg A, Nielsen HB, Pelletier E, Renault P, Sicheritz-Ponten T, Turner K, Zhu H, Yu C, Li S, Jian M, Zhou Y, Li Y, Zhang X, Li S, Qin N, Yang H, Wang J, Brunak S, Dore J, Guarner F, Kristiansen K, Pedersen O, Parkhill J, Weissenbach J, Meta HITC, Bork P, Ehrlich SD, Wang J (2010) A human gut microbial gene catalogue established by metagenomic sequencing. Nature 464(7285):59–65. doi:10.1038/nature08821
18. Cerutti A, Rescigno M (2008) The biology of intestinal immunoglobulin A responses. Immunity 28(6):740–750. doi:10.1016/j.immuni.2008.05.001
19. Macpherson AJ, Harris NL (2004) Interactions between commensal intestinal bacteria and the immune system. Nat Rev Immunol 4(6):478–485. doi:10.1038/nri1373
20. Rakoff-Nahoum S, Paglino J, Eslami-Varzaneh F, Edberg S, Medzhitov R (2004) Recognition of commensal microflora by toll-like receptors is required for intestinal homeostasis. Cell 118(2):229–241. doi:10.1016/j.cell.2004.07.002
21. Guinane CM, Cotter PD (2013) Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ. Ther adv Gastroenterol 6(4):295–308. doi:10.1177/1756283X13482996
22. Zhang H, DiBaise JK, Zuccolo A, Kudrna D, Braidotti M, Yu Y, Parameswaran P, Crowell MD, Wing R, Rittmann BE, Krajmalnik-Brown R (2009) Human gut microbiota in obesity and after gastric bypass. Proc Natl Acad Sci 106(7):2365–2370. doi:10.1073/pnas.0812600106
23. Frank DN, St Amand AL, Feldman RA, Boedeker EC, Harpaz N, Pace NR (2007) Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci 104(34):13780–13785. doi:10.1073/pnas.0706625104
24. Tissier H (1900) Recherches sur la flore Intestinale des Nourrissons. Thesis no 529, Paris, Paris
25. Funkhouser LJ, Bordenstein SR (2013) Mom knows best: the universality of maternal microbial transmission. PLoS Biol 11(8):e1001631. doi:10.1371/journal.pbio.1001631
26. Jimenez E, Marin ML, Martin R, Odriozola JM, Olivares M, Xaus J, Fernandez L, Rodriguez JM (2008) Is meconium from healthy newborns actually sterile? Res Microbiol 159(3):187–193. doi:10.1016/j.resmic.2007.12.007
27. Dominguez-Bello MG, Blaser MJ, Ley RE, Knight R (2011) Development of the human gastrointestinal microbiota and insights from high-throughput sequencing. Gastroenterology 140(6):1713–1719. doi:10.1053/j.gastro.2011.02.011
28. Penders J, Thijs C, Vink C, Stelma FF, Snijders B, Kummeling I, van den Brandt PA, Stobberingh EE (2006) Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics 118(2):511–521. doi:10.1542/peds.2005-2824
29. Dominguez-Bello MG, Costello EK, Contreras M, Magris M, Hidalgo G, Fierer N, Knight R (2010) Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci 107(26):11971–11975. doi:10.1073/pnas.1002601107
30. Gronlund MM, Gueimonde M, Laitinen K, Kociubinski G, Gronroos T, Salminen S, Isolauri E (2007) Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease. Clin Exp Allerg J Br Soc Allerg Clin Immunol 37(12):1764–1772. doi:10.1111/j.1365-2222.2007.02849.x
31. Gronlund MM, Lehtonen OP, Eerola E, Kero P (1999) Fecal microflora in healthy infants born by different methods of delivery: permanent changes in intestinal flora after cesarean delivery. J Pediatr Gastroenterol Nutr 28(1):19–25
32. Morelli L (2008) Postnatal development of intestinal microflora as influenced by infant nutrition. J Nutr 138(9):1791S–1795S
33. Martin R, Langa S, Reviriego C, Jiminez E, Marin ML, Xaus J, Fernandez L, Rodriguez JM (2003) Human milk is a source of lactic acid bacteria for the infant gut. J Pediatr 143(6):754–758. doi:10.1016/j.jpeds.2003.09.028
34. Barrett E, Deshpandey AK, Ryan CA, Dempsey EM, Murphy B, O’Sullivan L, Watkins C, Ross RP, O’Toole PW, Fitzgerald GF, Stanton C (2015) The neonatal gut harbours distinct bifidobacterial strains. Arch Dis Child Fetal Neonatal Ed. doi:10.1136/archdischild-2014-306110
35. Hopkins MJ, Sharp R, Macfarlane GT (2001) Age and disease related changes in intestinal bacterial populations assessed by cell culture, 16S rRNA abundance, and community cellular fatty acid profiles. Gut 48(2):198–205
36. Schwiertz A, Gruhl B, Lobnitz M, Michel P, Radke M, Blaut M (2003) Development of the intestinal bacterial composition in hospitalized preterm infants in comparison with breast-fed, full-term infants. Pediatr Res 54(3):393–399. doi:10.1203/01.PDR.0000078274.74607.7A
37. Adlerberth I, Wold AE (2009) Establishment of the gut microbiota in Western infants. Acta Paediatr 98(2):229–238. doi:10.1111/j.1651-2227.2008.01060.x
38. Westerbeek EA, van den Berg A, Lafeber HN, Knol J, Fetter WP, van Elburg RM (2006) The intestinal bacterial colonisation in preterm infants: a review of the literature. Clin Nutr 25(3):361–368. doi:10.1016/j.clnu.2006.03.002
39. Rouge C, Goldenberg O, Ferraris L, Berger B, Rochat F, Legrand A, Gobel UB, Vodovar M, Voyer M, Roze JC, Darmaun D, Piloquet H, Butel MJ, de La Cochetiere MF (2010) Investigation of the intestinal microbiota in preterm infants using different methods. Anaerobe 16(4):362–370. doi:10.1016/j.anaerobe.2010.06.002
40. Sears CL (2005) A dynamic partnership: celebrating our gut flora. Anaerobe 11(5):247–251. doi:10.1016/j.anaerobe.2005.05.001
41. Neu J, Walker WA (2011) Necrotizing enterocolitis. New Eng J Med 364(3):255–264. doi:10.1056/NEJMra1005408
42. de la Cochetiere MF, Piloquet H, des Robert C, Darmaun D, Galmiche JP, Roze JC (2004) Early intestinal bacterial colonization and necrotizing enterocolitis in premature infants: the putative role of Clostridium. Pediatr Res 56(3):366–370. doi:10.1203/01.PDR.0000134251.45878.D5
43. Claud EC (2009) Neonatal necrotizing enterocolitis—inflammation and intestinal immaturity. Anti-Inflamm Antiallerg Agents Med Chem 8(3):248–259. doi:10.2174/187152309789152020
44. Wang Y, Hoenig JD, Malin KJ, Qamar S, Petrof EO, Sun J, Antonopoulos DA, Chang EB, Claud EC (2009) 16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitis. ISME J 3(8):944–954. doi:10.1038/ismej.2009.37
45. Mai V, Young CM, Ukhanova M, Wang X, Sun Y, Casella G, Theriaque D, Li N, Sharma R, Hudak M, Neu J (2011) Fecal microbiota in premature infants prior to necrotizing enterocolitis. PLoS One 6(6):e20647. doi:10.1371/journal.pone.0020647
46. Stewart CJ, Marrs EC, Nelson A, Lanyon C, Perry JD, Embleton ND, Cummings SP, Berrington JE (2013) Development of the preterm gut microbiome in twins at risk of necrotising enterocolitis and sepsis. PLoS One 8(8):e73465. doi:10.1371/journal.pone.0073465
47. Brower-Sinning R, Zhong D, Good M, Firek B, Baker R, Sodhi CP, Hackam DJ, Morowitz MJ (2014) Mucosa-associated bacterial diversity in necrotizing enterocolitis. PLoS One 9(9):e105046. doi:10.1371/journal.pone.0105046
48. Metchnikoff E, Mitchell PC (1907) The prolongation of life; optimistic studies. W. Heinemann (ed); G.P. Putnam’s Sons, London, New York
49. Food and Agriculture Organization of the United Nations., World Health Organization. (2006) Probiotics in food: health and nutritional properties and guidelines for evaluation. FAO food and nutrition paper, vol 85. Food and Agriculture Organization of the United Nations: World Health Organization, Rome
50. Sanders ME, Guarner F, Guerrant R, Holt PR, Quigley EM, Sartor RB, Sherman PM, Mayer EA (2013) An update on the use and investigation of probiotics in health and disease. Gut 62(5):787–796. doi:10.1136/gutjnl-2012-302504
51. Millar, Bacon C, Smith SL, Walker V, Hall MA (1993) Enteral feeding of premature infants with Lactobacillus GG. Arch Dis Child 69(5 Spec No):483–487
52. Kitajima H, Sumida Y, Tanaka R, Yuki N, Takayama H, Fujimura M (1997) Early administration of Bifidobacterium breve to preterm infants: randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 76(2):F101–F107
53. Hoyos AB (1999) Reduced incidence of necrotizing enterocolitis associated with enteral administration of Lactobacillus acidophilus and Bifidobacterium infantis to neonates in an intensive care unit. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 3(4):197–202
54. Dani C, Biadaioli R, Bertini G, Martelli E, Rubaltelli FF (2002) Probiotics feeding in prevention of urinary tract infection, bacterial sepsis and necrotizing enterocolitis in preterm infants. A prospective double-blind study. Biol Neonate 82(2):103–108. doi:10.1159/000063096
55. Costalos C, Skouteri V, Gounaris A, Sevastiadou S, Triandafilidou A, Ekonomidou C, Kontaxaki F, Petrochilou V (2003) Enteral feeding of premature infants with Saccharomyces boulardii. Early Hum Dev 74(2):89–96
56. Bin-Nun A, Bromiker R, Wilschanski M, Kaplan M, Rudensky B, Caplan M, Hammerman C (2005) Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates. J Pediatr 147(2):192–196. doi:10.1016/j.jpeds.2005.03.054
57. Lin HC, Su BH, Chen AC, Lin TW, Tsai CH, Yeh TF, Oh W (2005) Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics 115(1):1–4. doi:10.1542/peds.2004-1463
58. Manzoni P, Mostert M, Leonessa ML, Priolo C, Farina D, Monetti C, Latino MA, Gomirato G (2006) Oral supplementation with Lactobacillus casei subspecies rhamnosus prevents enteric colonization by Candida species in preterm neonates: a randomized study. Clin Infect Dis Off Publ Infect Dis Soc Am 42(12):1735–1742. doi:10.1086/504324
59. Mohan R, Koebnick C, Schildt J, Schmidt S, Mueller M, Possner M, Radke M, Blaut M (2006) Effects of Bifidobacterium lactis Bb12 supplementation on intestinal microbiota of preterm infants: a double-blind, placebo-controlled, randomized study. J Clin Microbiol 44(11):4025–4031. doi:10.1128/JCM.00767-06
60. Deshpande G, Rao S, Patole S (2007) Probiotics for prevention of necrotising enterocolitis in preterm neonates with very low birthweight: a systematic review of randomised controlled trials. Lancet 369(9573):1614–1620
61. AlFaleh K, Anabrees J, Bassler D (2010) Probiotics Reduce the risk of necrotizing enterocolitis in preterm infants: a meta-analysis. Neonatology 97(2):93–99
62. Beattie LM, Hansen R, Barclay AR (2010) Probiotics for preterm infants: confounding features warrant caution. Pediatrics 126(3):e742–e743. doi:10.1542/peds.2010-1949C(author reply e743–e745)
63. Neu J, Shuster J (2010) Nonadministration of routine probiotics unethical–really? Pediatrics 126(3):e740–e741. doi:10.1542/peds.2010-1949A(author reply e743–e745)
64. Garland SM, Jacobs SE, Tobin JM, Opie GF, Donath S, ProPrems study G (2010) A cautionary note on instituting probiotics into routine clinical care for premature infants. Pediatrics 126(3):e741–e742. doi:10.1542/peds.2010-1949B(author reply e743–e745)
65. Mihatsch WA, Braegger CP, Decsi T, Kolacek S, Lanzinger H, Mayer B, Moreno LA, Pohlandt F, Puntis J, Shamir R, Stadtmuller U, Szajewska H, Turck D, van Goudoever JB (2012) Critical systematic review of the level of evidence for routine use of probiotics for reduction of mortality and prevention of necrotizing enterocolitis and sepsis in preterm infants. Clinical nutrition 31(1):6–15. doi:10.1016/j.clnu.2011.09.004
66. Jacobs SE, Tobin JM, Opie GF, Donath S, Tabrizi SN, Pirotta M, Morley CJ, Garland SM, ProPrems Study G (2013) Probiotic effects on late-onset sepsis in very preterm infants: a randomized controlled trial. Pediatrics 132(6):1055–1062. doi:10.1542/peds.2013-1339
67. PIPs Study. https://www.npeu.ox.ac.uk/pips
68. AlFaleh K, Anabrees J (2014) Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database Syst Rev 4:CD005496. doi:10.1002/14651858.CD005496.pub4
69. Janvier A, Lantos J, Barrington K (2013) The politics of probiotics: probiotics, necrotizing enterocolitis and the ethics of neonatal research. Acta Paediatr 102(2):116–118. doi:10.1111/apa.12083
70. Millar M, Wilks M, Fleming P, Costeloe K (2012) Should the use of probiotics in the preterm be routine? Arch Dis Child Fetal Neonatal Ed 97(1):F70–F74. doi:10.1136/adc.2009.178939
71. Shinefield HR, Ribble JC, Eichenwald HF, Boris M, Sutherland JM (1963) Bacterial interference: its effect on nursery-acquired infection with Staphylococcus aureus. V. An analysis and interpretation. Am J Dis Child 105:683–688
72. Blair EB, Tull AH (1969) Multiple infections among newborns resulting from colonization with Staphylococcus aureus 502A. Am J Clin Pathol 52(1):42–49
73. Lu P, Sodhi CP, Jia H, Shaffiey S, Good M, Branca MF, Hackam DJ (2014) Animal models of gastrointestinal and liver diseases. Animal models of necrotizing enterocolitis: pathophysiology, translational relevance, and challenges. Am J Physiol Gastrointest Liver Physiol 306(11):G917–G928
74. Siggers RH, Siggers J, Boye M, Thymann T, Molbak L, Leser T, Jensen BB, Sangild T (2008) Early administration of probiotics alters bacterial colonization and limits diet-induced gut dysfunction and severity of necrotizing enterocolitis in preterm pigs. J Nutr 138(8):1437–1444
75. Cilieborg MS, Thymann T, Siggers R, Boye M, Bering SB, Jensen BB, Sangild PT (2011) The Incidence of necrotizing enterocolitis is increased following probiotic administration to preterm pigs. J Nutr 141(2):223–230
76. Liu YY, Fatheree NY, Mangalat N, Rhoads JM (2012) Lactobacillus reuteri strains reduce incidence and severity of experimental necrotizing enterocolitis via modulation of TLR4 and NF-kappa B signaling in the intestine. Am Physiol Gastrointest Liver Physiol 302(6):G608–G617
77. Ganguli K, Collado MC, Rautava J, Lu L, Satokari R, von Ossowski I, Reunanen J, de Vos WM, Palva A, Isolauri E, Salminen S, Walker WA, Rautava S (2015) Lactobacillus rhamnosus GG and its SpaC pilus adhesin modulate inflammatory responsiveness and TLR-related gene expression in the fetal human gut. Pediatr Res 77(4):528–535. doi:10.1038/pr.2015.5
78. Patel RM, Myers LS, Kurundkar AR, Maheshwari A, Nusrat A, Lin PW (2012) Probiotic bacteria induce maturation of intestinal claudin 3 expression and barrier function. Am J Pathol 180(2):626–635
79. Khailova L, Patrick SKM, Arganbright KM, Halpern MD, Kinouchi T, Dvorak B (2010) Bifidobacterium bifidum reduces apoptosis in the intestinal epithelium in necrotizing enterocolitis. Am J Physiol Gastrointest Liver Physiol 299(5):G1118–G1127
80. Ganguli K, Meng D, Rautava S, Lu L, Walker WA, Nanthakumar N (2013) Probiotics prevent necrotizing enterocolitis by modulating enterocyte genes that regulate innate immune-mediated inflammation. Am J Physiol Gastrointest Liver Physiol 304(2):G132–G141
81. Shiou S-R, Yu Y, Guo Y, He S-M, Mziray-Andrew CH, Hoenig J, Sun J, Petrof EO, Claud EC (2013) Synergistic protection of combined probiotic conditioned media against neonatal necrotizing enterocolitis-like intestinal injury. PLoS One 8(5):e65108. doi:10.1371/journal.pone.0065108
82. Guo S, Guo Y, Ergun A, Lu L, Walker WA, Ganguli K (2015) Secreted metabolites of Bifidobacterium infantis and Lactobacillus acidophilus protect immature human enterocytes from IL-1β-induced inflammation: a transcription profiling analysis. PLoS One 10(4):e0124549. doi:10.1371/journal.pone.0124549
83. Good M, Sodhi CP, Ozolek JA, Buck RH, Goehring KC, Thomas DL, Vikram A, Bibby K, Morowitz MJ, Firek B, Lu P, Hackam DJ (2014) Lactobacillus rhamnosus HN001 decreases the severity of necrotizing enterocolitis in neonatal mice and preterm piglets: evidence in mice for a role of TLR9, vol 306. vol 11. doi:10.1152/ajpgi.00452.2013
84. Dilli D, Aydin B, Fettah ND, Ozyazici E, Beken S, Zenciroglu A, Okumus N, Ozyurt BM, Ipek MS, Akdag A, Turan O, Bozdag S (2015) The ProPre-Save study: effects of probiotics and prebiotics alone or combined on necrotizing enterocolitis in very low birth weight infants. J Pediatr 166(3):545–551. doi:10.1016/j.jpeds.2014.12.004(e541)