The Role of Probiotics in the Prevention of Childhood Infections
Although common acute respiratory and gastrointestinal infections are a part of childhood, they pose a significant burden on families and the healthcare and social care system. An unexpected role in their prevention can be played by the gut microbiome, specifically its support through certain probiotics. However, it is necessary to choose products supported by clinical studies.
Microbiome and Immune System
According to recent findings, a child's microbiome begins to form during pregnancy, with important milestones for its development being birth and the first 2 years of life. During this time, a stable intestinal bacterial colonization specific to the individual should develop, which under physiological conditions persists throughout life. The development of the microbiome during this period goes hand in hand with the development and maturation of the immune system, and both processes are intricately interconnected.
A potential imbalance in the development of the gut microbiome can not only lead to a decreased ability to defend against acute infections but also to disturbances in the immune system that persist into adulthood (for instance, associations with allergic or autoimmune diseases are discussed).
Probiotics in the Prevention of Childhood Infections
These findings naturally led to hypotheses that the use of probiotics in the first months and years of life could reduce the incidence of acute infectious diseases. This is also suggested by the results of a 2016 meta-analysis, which found that probiotics reduce the risk of respiratory infections in children. However, its limitation was the inclusion of studies with a wide range of probiotic bacterial strains and age ranges of the subjects; the applicability of the findings from this meta-analysis to clinical practice is thus questionable.
Randomized Clinical Study with L. reuteri
A closer look is provided by clinical studies of specific strains. For example, a 2014 study where children aged 6–36 months attending preschool facilities were given drops containing the strain Lactobacillus reuteri DSM 17938 (L. reuteri Protectis) at a daily dose of 1×108 CFU (5 drops). Among the 168 children taking the probiotic, compared to an equally large group receiving placebo, there was a significantly lower incidence and shorter duration of respiratory infections and diarrheal diseases, both during the 3-month period of administration and the subsequent 3-month follow-up (all p < 0.05). The average number of days with a respiratory infection was 4.6 ± 1.8 days for a child taking a placebo, and only 1.5 ± 0.6 days in the group taking L. reuteri (p = 0.01). There were also fewer episodes of fever, doctor visits, child absences from preschool, and parent absences from work. No adverse events related to the use of the probiotic were reported.
Drops containing L. reuteri Protectis are also available on the Czech market in combination with vitamin D, which also contributes, among other things, to the proper function of the immune system.
Nutrition from Conception to the Second Birthday
270 days of pregnancy and 2× 365 days after birth total a neat "thousand". This is a period of individual development during which environmental factors have a fundamental impact on health later in life. The higher awareness of prospective or new parents and the better healthcare for pregnant women, newborns, and infants are therefore promoted by the 1000 days initiative, whose policy has been spontaneously adopted by the American Academy of Pediatrics (AAP), UNICEF, and many other organizations. It addresses hygiene issues, the elimination of toxins from the diet, supports breastfeeding, ensures proper nutrition, and the intake of vitamins and minerals. Given the aforementioned findings, probiotics could likely be included as one of the pillars of this "proper early care".
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Sources:
1. Boženský J. Prevention of infections. In: Probiotics and their practical use in PLDD practice. OSPDL ČLS JEP.
2. Gutierrez-Castrellon P., Lopez-Velazquez G., Diaz-Garcia L. et al. Diarrhea in preschool children and Lactobacillus reuteri: a randomized controlled trial. Pediatrics 2014; 133 (4): e904–e909, doi: 10.1542/peds.2013-0652.
3. Why the first 1000 days of life matter. The European Foundation for the Care of Newborn Infants (EFCNI), 2018 May. Available at: www.efcni.org/wp-content/uploads/2018/05/2018_04_23_EFCNI_1000Tage_Factsheet_web.pdf
4. First 1000 days: the critical window to ensure that children survive and thrive. UNICEF, 2017 May. Available at: www.unicef.org/southafrica/SAF_brief_1000days.pdf
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