{"doi":"10.1097/mpg.0b013e31829291d2","title":"Probiotics for the Prevention of Necrotizing Enterocolitis","abstract":null,"journal":"Journal of Pediatric Gastroenterology and Nutrition","year":2013,"id":669278,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":262737,"name":"Camilia R. Martin","orcid":"0000-0003-2783-6126","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Probiotics for the Prevention of Necrotizing Enterocolitis","abstract":"See “Efficacy of Different Probiotic Combinations on Death and Necrotizing Enterocolitis in a Premature Rat Model” by Wu et al on page 23. Accruing evidence suggests that probiotics may protect against necrotizing enterocolitis (NEC) in the preterm infant (1); however, more data are needed at both the basic science and clinical research levels before routine administration of probiotics can be adopted as the standard of care in this vulnerable population. There are several unresolved questions. First, what is/are the most effective probiotic(s), singularly or in combination, to achieve the desired medical benefits? Multiple studies of probiotic administration have been conducted; however, these studies are heterogeneous in the probiotics used, the timing of initial dose and duration of treatment, and the number of infants enrolled—often statistically underpowered to measure the effect of the probiotic(s) on the primary outcome with confidence (2). Second, what is the mechanism by which probiotics exert their potential beneficial effects? Although literature exists in this area, it remains unclear whether these mechanisms are similar in an immature host with altered intestinal development to the extremely premature infant. Third, what are the short- and long-term safety profiles of probiotics, which may not necessarily be shared among the different candidate probiotic organisms or across the different gestational age or birth weight groups? To date, there has not been an adequate study of probiotic administration at the extreme of prematurity (<28 weeks of gestational age and/or <1000-g birth weight) that allows for safety assessment. There is reason to remain cautious. There have been case reports of bacteremia in infants receiving probiotics and, in clinical trials, an increased risk of infections in critically ill children and increased mortality in adults with acute pancreatitis (3–5). The study by Wu et al in this issue of the Journal of Pediatric Gastroenterology and Nutrition attempts to address the first question (6). Using a rat model of NEC with enteral bacterial administration followed by hypoxia to induce disease, 9 different combinations of probiotics were studied. The authors found that Lactobacillus plantarum alone or Bifidobacterium bifidum and Bifidobacterium longum in combination was effective in reducing both NEC and mortality compared with mice not exposed to any probiotic, with the latter combination being the most effective. The approach by Wu et al is a helpful first step in identifying methods by which basic science models can help reduce the complexities of therapies before embarking on large-scale human trials. This observation, however, is just the beginning to establishing the optimal probiotic combination for use in premature infants. Outside of intestinal colonization rates using fecal samples, it remains unknown from this study what biological mechanisms explain the reduction in NEC and mortality. The evaluation of any proposed treatment for neonatal diseases requires an understanding of how the intervention modulates immune function and organogenesis along the developmental timeline of a growing preterm infant. NEC likely encompasses a spectrum of many disease processes that evolves over time, which culminates in dysregulated inflammation and intestinal injury. Thus, it is critical to apply a developmental systems biology approach in evaluating the efficacy and safety of treatments for NEC including probiotics. This generates a number of important questions, which remain unanswered: What are the changes in intestinal development with exposure to specific probiotics? What are the elicited host immunologic responses with probiotic exposure—systemically and locally within the gastrointestinal tract? What are the specific mechanisms that are engaged and protective against NEC? The answers to these questions are not merely academic. Collectively, the data generated by these questions will precisely define treatment failures and treatment successes and ultimately identify promising treatments that will likely have not just 1 desirable effect but may have multiple desirable effects.","is_dataset_classified":null,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"23535765","pmcid":null,"openalex_id":"https://openalex.org/W2333737537","authors":[],"funders":[],"total_grants":0,"fwci":1.0746,"citation_percentile":0.7750507,"influential_citations":0,"citation_trend":[{"year":2013,"count":1},{"year":2014,"count":3},{"year":2015,"count":1},{"year":2017,"count":1}],"oa_status":"closed","license":"http://onlinelibrary.wiley.com/termsAndConditions#vor","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdf/10.1097/MPG.0b013e31829291d2","host_type":"publisher"},{"url":"https://doi.org/10.1097/mpg.0b013e31829291d2","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/23535765","host_type":"repository"}],"fields_of_study":["Infant Nutrition and Health","Clinical Nutrition and Gastroenterology","Intestinal Malrotation and Obstruction Disorders","Animals","Disease Models, Animal","Enterocolitis, Necrotizing","Female","Male","Pregnancy","Premature Birth","Probiotics"],"mesh_terms":["Animals","Disease Models, Animal","Female","Male","Pregnancy","Probiotics","Enterocolitis, Necrotizing","Premature Birth"],"keywords":["Necrotizing enterocolitis","Probiotic","Medicine","Gestational age","Enterocolitis","Population","Low birth weight","Birth weight","Intensive care medicine","Pediatrics","Internal medicine","Pregnancy","Environmental health"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Zero hunger"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-14T14:51:54.312648Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}