Routine Supplement of Prebiotics and Probiotics to Newborn Infants Is Not Recommended
Touraj Shafai, MD, PhD, FAAP
Inland Empire Children’s Medical Group
Chapter 2 California Breastfeeding Coordinator
To the Editor.—
Kuitunen and co-workers1 reported that they have ascertained that prebiotics and probiotics may be safely administered to pregnant and nursing mothers and their newborn infants. However, it seems that the authors made several false assumptions, and then they proceeded to prove the long-term safety of prebiotic and probiotic supplements in newborn infants. These false assumptions include reduction in the incidence of infections, allergy, and autoimmune disorders. In addition, the study was basically flawed, because they did not separate the breastfed and formula-fed infants. Breast milk provides many benefits to infants, including reduction in the rate of allergies, infection, and autoimmune disorders, which the authors claimed to be the result of supplementation of prebiotics and probiotics. The authors reported that 70% of the infants in both groups were breastfed, and they pointed to a reduction in infection rates in infants who were receiving supplements versus those in the placebo group. The authors reported a slight decrease in the group receiving supplements (90%) versus those in the placebo group (97%). However, the authors did not report whether they were examining all respiratory infections (upper and lower) or the rate of hospitalization from lower respiratory infections. A meta-analysis of several reports on the rate of hospitalizations from lower respiratory infections demonstrated a significant reduction of 72% in exclusively breastfed infants as compared with formula-fed infants.2
Similarly, the reduction in the rate of otitis media in the supplemented group was not significant (15% vs 19% in the placebo group). Several meta-analyses that compared the rate of otitis media in exclusively breastfed versus formula-fed infants revealed significant reduction in otitis media of 50% in breastfed infants.2
Gastroenteritis occurred at approximately the same rate in both groups at 13% vs 14%. Recent studies have demonstrated significant reduction of 64% in exclusively breastfed infants from gastroenteritis from any cause. It seems that the infants in the study had a significantly higher rate of infection, even for the infants who were breastfed; therefore, one would naturally assume that supplementation with prebiotics and probiotics actually negated the immunity that breastfeeding provided to the infants.
The prebiotic bifidus factor in human breast milk is species specific, and other oligosaccharides may not have the same efficacy. Similarly, the probiotic in breastfed infants’ intestinal tract is bifidobacter, and other probiotics may not provide the same function.
Rubaltelli et al3 reported that the bifidobacter colony count in the stools of breastfed infants was higher than the stools of oligosaccharide-supplemented formula-fed infants.
Finally, the World Health Organization and United Nations Children’s Fund (UNICEF) recommend exclusive breastfeeding for all newborns with no supplementation. The type of research that Kuitunen and co-workers have reported seems to pose serious moral and ethical concerns.
- Kukkonen K, Savilahti E, Haahtela T, et al. Long-term safety and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized, double-blind, placebo-controlled trial. Pediatrics. 2008;122 (1):8 –12[Abstract/Free Full Text]
- Agency for Healthcare Research and Quality. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville, MD: Agency for Healthcare Research and Quality; 2007. Evidence Report/Technology Assessment No. 153. Available at: www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf. Accessed January 9, 2009
- Rubaltelli FF, Biadaioli R, Pecile P, Nicoletti P. Intestinal flora in breast- and bottle-fed infants. J Perinat Med. 1998;26 (3):186 –191[ISI][Medline]
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