Probiotics for preterm babies: Supplementation reduces bile acids in gastric residuals, shortens time to full feeds

By Tingmin Koe

- Last updated on GMT

Probiotics supplementation is linked to a shorter median time to full feeds in pre-term babies. ©Getty Images
Probiotics supplementation is linked to a shorter median time to full feeds in pre-term babies. ©Getty Images

Related tags Probiotics Infant Australia

Probiotics supplementation has shown to reduce the amount of bile acids – an important component of nutrition – in the gastric residuals of extremely pre-term babies, according to an RCT from Australia.

Findings of the RCT, published in Nutrients,​ also showed that probiotics supplementation is linked to a shorter median time to full feeds and reduces the duration of parenteral nutrition – the administration of nutrition via intravenous method.    

For instance, infants taking probiotics have a significantly shorter median TFF at 10 days versus 14 days as seen in the control group.

The double-blind RCT was conducted by researchers from the University of Western Australia, King Edward Memorial Hospital, and the Women and Infants Research Foundation.

It recruited extremely pre-term babies (less than 28 weeks in gestation) admitted into the hospital between September 2015 and October 2016.

A total of 183 pre-term infants were recruited into the trial.

Seventy-five of them took a single strain probiotic Bifidobacterium​ breve M-16V, 79 of them took a three-strain probiotics formulation.

The strains are Bifidobacterium​ breve M-16V, Bifidobacterium ​longum subsp. infantis M-63, and Bifidobacterium​ longum subsp. longum BB536.

The remaining 29 of them went into the control group which did not take any probiotics.

The researchers then collected gastric residuals from the infants’ stomach in the first two weeks of life for analysis.

One of the key findings was that infants taking probiotics, including both single and multi-strains ones, have a significantly shorter median time to full feed.

“Compared to the control group, the TFF was significantly reduced in SiMPro (single and multi-strain probiotics) trial infants (median 14 vs. 10 days) irrespective of their allocation to single- or three-strain probiotics,”​ the researchers said.

Probiotics supplementation also reduced the duration of parenteral nutrition for the infants. Those who took probiotics spent 10 days on parenteral nutrition, while the control group spent 16 days.

Feed volume

Probiotics supplementation was also linked to an increase in the volume of milk that the infants were fed on.

For instance, the median feed volume for the groups taking probiotic supplementation was at 54.8mL (for single-strain probiotic) and 50.9mL (for multi-strain probiotic), whereas that of the control group was 22.7mL.

However, this was not a statistically significant result.

“The higher median FVs and comparable GRVs in SiMPro vs. control group infants suggest the beneficial effects of probiotics on gastric emptying and gut motility,” ​the researchers said.

Darker green equals to more bile

Another finding that the researchers have found was that the darker the colour of the gastric residuals, the higher the content of the bile acids.

Gastric residuals refer to the volume of gastric fluid remaining in the stomach in between feeding. 

As there is no strong existing evidence to show that the colour of gastric residuals is linked to the amount of bile acids present, the researcher thus conducted an analysis to find out the link.

They found that the bile acids content was higher in dark green gastric residuals at 825.79 µmol/L, while that of pale green residuals had bile acids content at 338.1 µmol/L.

However, this is not a statistically significant result since the p-value ​was higher than 0.05 at 0.12.

Bile acids have important roles to play in the body.

For instance, it regulates gut motility and hepatic liquid, glucose, and energy homeostasis. It also has anti-inflammatory effects and may have an important role in regulating intestinal and hepatic components of innate immunity.

Thus, discarding dark green gastric residuals, due to its high bile acids, is a potential barrier to optimising enteral nutrition in extremely pre-term infants. 

“In summary, our results show that discarding dark green gastric residuals could result in significant loss of bile acids, an important nutrient, during early enteral nutrition in extremely premature infants.

“They provide further evidence to question the practice of routine monitoring and interpretation of GRs in preterm infants,” ​the researchers concluded.


Source: Nutrients

Composition of Coloured Gastric Residuals in Extremely Preterm Infants-A Nested Prospective Observational Study

Authors: Sanjay Patole and et al

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