The problem of intestinal microecology has attracted much attention from neonatologists in recent years. According to the International Classification of Human Diseases (ICD-10), published in 1997, the microecological system of the body is defined as a very complex, phylogenetically established, dynamic complex, which includes associations of microorganisms and products of their biochemical activity (metabolites) that are diverse in quantitative and qualitative composition in certain areas. environmental conditions.

There are many reasons why the ratio of normal microflora of the digestive tract changes. These changes can be either short-term - dysbacterial reactions, or persistent - dysbacteriosis.

The so-called dysbacterial reactions, or dysbiosis, are a state of the ecosystem in which the functioning of all its components- the human body, its microflora and the environment, as well as the mechanisms of their interaction, which leads to the occurrence of the disease. Intestinal dysbiosis (ID) is understood as qualitative and quantitative changes in the normal flora of a person characteristic of a given biotype, entailing pronounced clinical reactions of the macroorganism or resulting from any pathological processes in the body. DC should be considered as a symptom complex, but not as a disease. It is quite obvious that DC is always secondary and mediated by the underlying disease. This explains the absence of such a diagnosis as “dysbiosis” or “intestinal dysbiosis” in ICD-10, adopted in our country, as well as throughout the world.

As is known, during intrauterine development the fetal gastrointestinal tract is sterile. During birth, the newborn colonizes the gastrointestinal tract through the mouth, passing through the mother's birth canal, but a few hours after birth, E. Coli and streptococci bacteria can already be found in the baby's intestines, and they spread from top to bottom. And only 10 days after birth, various strains of bifidobacteria and bacteroides appear in the newborn’s gastrointestinal tract.

Normal microflora is a qualitative and quantitative ratio of various microbes of individual organs and systems, maintaining the biochemical, metabolic and immune balance of the macroorganism, necessary for maintaining human health.

Back in 1981, Hansson showed that children born through caesarean section, have a significantly lower content of lactobacilli than those that appeared naturally. Roberfroid in 2000 finally proved that only in children who are breastfed (breast milk), bifidobacteria predominate in the intestinal microflora, which is associated with a lower risk of developing gastrointestinal infectious diseases. It has long been known that when artificial feeding The child does not develop a predominance of any group of microorganisms. MacNelly, in a 1999 monograph, provides data that the composition of the intestinal flora of a child after 2 years is practically no different from that of an adult: more than 400 species of bacteria, most of which are anaerobes that are difficult to cultivate.

Causes of dysbiosis

Bengmark S. in 2000 presented factors influencing the density of microflora in various parts of the gastrointestinal tract in a newborn. These are: individual characteristics of intestinal motility; structural features of the neuromuscular apparatus of the infant’s intestines; congenital diseases Gastrointestinal tract (small intestinal diverticulum, ileocecal valve defects, strictures, adhesions, etc.); slowing down the passage of chyme through the colon (gastroduodenitis, scleroderma, Crohn's disease, necrotizing enterocolitis, etc.); changing the pH of the environment to the alkaline side; changes in the enzyme composition of the intestines (pancreas, liver); disturbance of the level of secretory IgA and iron; Not rational nutrition mothers of a breastfed child; features and mode of feeding a newborn.

It should be noted that the diet of a child older than one year, a teenager, an adult does not have such of great importance, as in the neonatal period and the first year of life.

The textbook of Neonatology (Shabalov N.P., 2004) describes the functions of normal intestinal microflora in newborns. This is participation in the final stages of digestion (breakdown of fiber, lactose, deconjugation of bile acids and transformation into fatty acids); synthesis of vitamins (B12, K, B1, B2, PP, biotin, folic acid) . Positive microflora has a powerful antagonistic effect due to high enzymatic activity; it affects the structure of the intestinal mucosa and the rate of regeneration and absorption, and also stimulates the local immune system (lymphatic follicles, production of lymphocytes, immunoglobulins).

Influence normal flora intestines on the health and development of the newborn is of enormous importance. This includes the fight against vitamin deficiency and enzymatic disorders; endogenous synthesis of nucleotides, essential amino acids (tryptophan) and peptides; regulation of adaptation processes; reducing the risk of intestinal infections and forming a protective barrier of the intestinal mucosa. .

The reasons for the development of microflora imbalance in newborns should first of all be considered late breastfeeding, as well as: artificial feeding, malnutrition of the mother, decreased reactivity of the child’s body, decreased acidity of gastric juice, intestinal hypoxia, intestinal obstruction, immunodeficiency states, thoughtless and uncontrolled use antibiotics, leading to the death of a significant part of the normal microflora and the proliferation of pathogenic and opportunistic microflora.

Dysbiosis is a qualitative and quantitative change in the composition of the intestinal microflora with an expansion of its sphere of influence.

Breast milk factors affecting microflora colonization

Only natural feeding can prevent the intestines of a newborn baby from unwanted consequences. The composition of breast milk is very complex. Its factors are compounds responsible, on the one hand, for stimulating the growth of normal microflora, and on the other hand, for suppressing foreign ones. Stimulate the growth of commensal bacteria: oligosaccharides (bifidus factor) and lactose. Fermentation of lactose lowers the pH of the intestinal contents, leading to the evolutionary selection of bacteria capable of utilizing it. Inhibit the colonization of pathogenic bacteria: secretory IgA, nutrients (fatty acids, lactoferrin), complex carbohydrate structures (glycoproteins, glycosaminoglycans, glycolipids, mucins, oligosaccharides).

As was clarified above, the formation of a child’s intestinal biocenosis occurs under the influence of intestinal microflora and birth canal mothers, breastfeeding and further nutrition. Correction of the resulting biocenosis can be carried out in two ways: by introducing pro- and prebiotics.

Classification

Currently, biologically active substances used to improve the functioning of the digestive tract, regulate gastrointestinal microbiocenosis, prevent and treat some specific infectious diseases are divided into dietary supplements, functional nutrition, probiotics, prebiotics, synbiotics, bacteriophages and biotherapeutic agents. According to the literature, the first three groups are combined into one - probiotics. The use of probiotics and prebiotics leads to the same result - an increase in the number of lactic acid bacteria, natural inhabitants of the intestines. Thus, these drugs should be primarily prescribed to infants, the elderly, and those who are inpatient treatment.

Since probiotics have complex effects, including immunomodulatory ones, their administration should be carried out according to indications. For the formation of intestinal biocenosis and the prevention of dysbiosis, the use of prebiotics is more acceptable. Prebiotics are food for obligate saccharolytic flora and are divided into mono-, oligo- and polysaccharides. For the formation of bifidus-predominant flora in children of the first year of life, it is important to introduce prebiotics containing galactose.

PROBIOTICS

Definition

Probiotics are live microorganisms: lactic acid bacteria, often bifidobacteria, or lactobacilli, sometimes yeast, which, as the term “probiotic” implies, belongs to the normal inhabitants of the intestines healthy person.

Mechanism of action of probiotics: synthesis of AB substances, organic acids, proteases that inhibit the growth of intestinal flora; competition for adhesion receptors; stimulation of the immune response (increased phagocytic activity and increased content of IgA, T-killers, interferon concentration; correction of the production of anti-inflammatory cytokines; increased cytoprotection due to increased mucin production, decreased mucosal permeability.

Classification of probiotics

Lactobacilli
L. acidophilus
L.casei
L. delbrueckii subsp. Bulgaricus
L. reuteri
L. brevis
L. cellobiosus
L. curvatus
L. fermentum
L. plantarum

Gram-positive cocci
Lactococcus lactis subsp. cremoris
Streptococcus salivarius subsp. thermophilus
Enterococcus faecium
S. diaacetylactis
S. intermedius

Bifidobacteria
B. bifidum
B. adolescentis
B. animalis
B. infantis
B. longum
B. Thermophilum

Such a variety of drugs indicates a highly developed industry and the demand for probiotics. However, one cannot discount the fact that the pharmaceutical industry Western countries and the countries of the former socialist camp is different. Therefore, the studies presented below cannot be unconditionally applied to Russian neonatology. The microorganisms that make up probiotics are non-pathogenic, non-toxic, are contained in sufficient quantities, and remain viable when passing through the gastrointestinal tract and during storage.

Probiotics must meet the following requirements: contain strains of microbes whose effects have been clinically proven, comply age characteristics intestinal microbiocenosis, have acid resistance, antibiotic resistance and safety. They are not considered drugs and are considered as means that have a beneficial effect on people's health.

A recent controlled 6-month study assessed the effects of a probiotic mixture (Lactobacillus rhamnosus GG, L. rhamnosus LC705, Bifidobacterium breve Bb99, and Propionibacterium freudenreichii ssp. shermanii JS) on irritable bowel syndrome symptoms. Based on the results obtained, the authors conclude that this type of treatment is effective for IBS. Given the widespread prevalence of the disease and the lack of effective drugs for its treatment, even a small reduction in symptoms can have positive consequences for public health goals.

Last year's randomized controlled study(RPC) in 14 pediatric centers in Israel, Beer-Sheva demonstrated the effectiveness of long-term administration of Bifidobacterium lactis (BB-12) and Lactobacillus reuteri to children with respiratory disorders. Moreover, in infants the duration of fever significantly decreased, episodes of diarrhea became shorter, and indications for AB therapy were reduced. This study showed a major role for lactobacilli against bifidobacteria.

During the first 2 weeks after birth, there are practically no microbes in the intestines of premature babies that are beneficial for the healthy maturation and functional adaptation of their immune system, namely bifidobacteria and lactobacilli. Reduction of “normal” intestinal microflora and colonization by opportunistic pathogens in very low birth weight (VLBW) infants (7–1500 g) are, along with immaturity, formula feeding, and intestinal ischemia, risk factors for the development of necrotizing enterocolitis (NEC).

A recent RCT in Taiwan among 367 (180/187) very low birth weight (VLBW) infants showed that twice daily administration of probiotics in the form of Infloran (Lactobacillus acidophilus and Bifidobacterium infantis) during breastfeeding reduced the incidence and severity of NEC ( 2\180 versus 10\187) .

In a similar double-blind PKC study in perinatal center Shaare Zedek (Israel) 3 of 72 (4%) VLBW infants receiving a probiotic formula (0.35x109 CFU Bifidobacteria infantis, 0.35x109 CFU Streptococcus thermophilus and 0.35x109 CFU Bifidobacteria bifidus) achieved NEC versus 12 of 73 (16.4%) groups controls who were breastfed or mixed fed. Although there was no significant difference between the two groups in the incidence of stage 1 NEC, the incidence of severe NEC (Bell stage 2 or 3) in the study group was 1 of 72 (1%) versus 10 of 73 (14%) in the control group (P =0.013) .

The authors of the PKK study in Finland concluded that the use of probiotics in the mother's diet before delivery and then in breastfed infants has a positive effect on the maturation of intestinal immunity in children in the first year of life. Total IgM, IgA, and IgG levels at 12 months were higher in those infants who were exclusively breastfed for 8–3 months and received a probiotic. The authors showed that some constituents of breast milk (CD14) are probiotics and stimulate humoral immune responses, and also promote the active interaction of innate and acquired (adaptive) immune responses during the maturation of the normal immune response in the gastrointestinal tract of young children.

The latest study by Italian scientists from the University of Turin shows the high role of Lactobacillus reuteri in the treatment of intestinal colic (infantile colicky) in newborns. The so-called infantile intestinal colic - common problem in children in the first months of life, however, more than 70% have functional intestinal colic. In the vast majority of cases, these colics are not a disease, but an adaptation of the baby’s gastrointestinal tract to new conditions. Despite more than 40 years of experience in the fight against infantile colic, scientists cannot figure out what comes first: colic or disorders of the intestinal microflora.

Until recently, the proven effect of relieving this condition belonged to dicycloverine, as well as simethicone, a drug that promotes the breakdown of foam and the release of gases in the usual way or resorption through the intestinal wall. And since this drug does not affect the functioning of the stomach and intestines, is not absorbed and is excreted unchanged, it is approved for use in newborns from the moment of birth.

Francesco Savino and colleagues found that the intestinal microflora of children suffering from colic contains much less lactobacilli and more often anaerobic gram-negative microorganisms. Within 7 days of administration of 100 million live L. reuteri bacteria in their randomized, blinded, prospective study, colic symptoms were significantly reduced in 95% of infants, compared with a group of infants where only 7% responded to therapy with 60 mg/day simethicone (p< .001) .

PREBIOTICS

Definition

Prebiotics are non-digestible food ingredients that promote health by selectively stimulating the growth and/or metabolic activity of one or more groups of bacteria found in the colon.

The effect of prebiotics is as follows: they reduce the pH of stool; reduce ammonia production; activate the immune system; reduce the growth potential of clostridia, candida, listeria, etc.; increase the absorption of Ca from food by 40-60%; enhance energy supply and regeneration of the colon epithelium.

Classification of prebiotics

• Fructose-oligosaccharides
• Inulin
• Galacto-oligosaccharides
• Lactulose
• Lactitol

To date, the properties of prebiotics such as mannose-, maltose-, xylose- and glucose-oligosaccharides have been little studied. Prebiotics are food for obligate saccharolytic flora and are divided into mono-, oligo- and polysaccharides.

For a food component to be classified as a prebiotic, it must have: the ability not to be broken down or absorbed by upper sections gastrointestinal tract; the possibility of use as a selective substrate for beneficial microorganisms, stimulating their growth or metabolic activity; the ability to lead to normalization of the composition of the intestinal microflora and induce local and systemic responses that are beneficial for the body as a whole.

Oligosaccharides

The most important function of the newborn's intestinal bifid flora is the fermentation of dietary fiber - oligosaccharides. The functions of dietary fiber are extensive. These include: stimulation of the growth of bifidobacteria and lactobacilli acidophilus; "bifidus factor" of mother's milk; adsorption of toxic products and their excretion in feces; meeting energy needs by 6-9%; antioxidant activity (protecting the intestinal mucosa from free radicals); creation of fixation sites for intestinal microorganisms, which determine a favorable intestinal ecology; increased peristalsis.

Inulin

Inulin is a polysaccharide found in the tubers and roots of dahlias, artichokes and dandelions. It is a fructosan because its hydrolysis produces fructose. It has been shown that inulin, in addition to stimulating the growth and activity of bifidobacteria and lactobacilli, increases calcium absorption in the large intestine, i.e. reduces the risk of osteoporosis, affects lipid metabolism, reducing the risk of atherosclerotic changes in the cardiovascular system and, possibly, preventing the development of type II diabetes mellitus, there is preliminary evidence of its anticarcinogenic effect.

Lactulose

Lactulose is a synthetic disaccharide not found in nature, in which each galactose molecule is linked by a -1,4 bond to a fructose molecule. Lactulose enters the large intestine unchanged (only about 0.25-2.0% is absorbed unchanged in the small intestine) and serves as a nutrient substrate for saccharolytic bacteria. Lactulose has been used in pediatrics for more than 40 years to stimulate the growth of lactobacilli in infants.

The drug Duphalac, registered on the Russian market and approved for use in infants, can be used at any age in a prebiotic dose of 3 ml per day for both the prevention and treatment of dysbiosis, in the latter case, together with probiotics.

Other prebiotics

Calcium pantothenate is involved in the processes of acetylation and oxidation in cells, carbohydrate and fat metabolism, acetylcholine synthesis, and stimulates the formation of corticosteroids in the adrenal cortex. It is utilized by bifidobacteria and helps to increase their biomass.

PAMBA is para-amino-methyl-benzoic acid (analogue of Ambien), inhibiting the action of proteolytic enzymes of opportunistic bacteria and fungi, stimulating the growth and reproduction of bifido- and lactoflora.

Lysozyme helps normalize disturbed microflora. Most active against gram-positive pathogenic and opportunistic bacteria. Lysozyme has a bifidogenic, immunomodulatory, anti-inflammatory effect, stimulates metabolic and reparative processes and erythropoiesis, improves digestion, increases the body's anti-infective and antitoxic resistance, has an antibacterial effect and exhibits synergism with many antibiotics.

Review

Several RCTs conducted on adult volunteers have shown a pronounced stimulatory effect of oligosaccharides, especially those containing fructose, on the growth of bifidobacteria and lactobacilli in the large intestine.

Oligosaccharides, including N-acetylglucosamine, glucose, galactose, fucose oligomers or other glycoproteins, which constitute a significant proportion of breast milk, are specific factors for the growth of bifidobacteria.

One double-blind RCT in Hungary showed the effectiveness of adding oligosaccharides (a mixture of galacto- and fructooligosaccharides) to an early infant feeding formula at a dose of 0.4 g/100ml. At the beginning of the study there was a statistically significant effect (p< 0.05) в группах отмечено не было, однако уже на 14 сутки количество колоний бифидофлоры увеличилось, по отношению с контрольной группой, практически в 2 раза (9 x 1012 против 5 x 1010) и оставалось такой и на 28 сутки .

Belgian scientists believe that adding a mixture of inulin and galactooligosaccharide in a 1:9 ratio to the early feeding formula throughout the neonatal period improves the bifidogenic effect in the postnatal period and reduces incidents of atopic diathesis in children in the late neonatal period.

A study by German scientists confirms the role of prebiotic supplements in breast and bottle feeding as modulators of the immune system in the postnatal development of infants.

And Italian researchers prove that with the introduction of galacto-oligosaccharides and fructo-oligosaccharides into the early nutritional formula, fecal pH becomes significantly higher, which leads to a decrease in the activity of pathogenic microflora.

This year's double-blind RCCT in Chile showed the positive role of prebiotics in increasing the population of Lactobacillus and Bifidobacteria during antibiotic therapy in 140 children. In the nutritional formula, the prebiotic was prescribed in a course of 21 days during AB therapy and subsequently.

Synbiotics

A mixture of probiotics and prebiotics are combined into a group of synbiotics that have a beneficial effect on the health of the host organism, improving the survival and engraftment of live bacterial supplements in the intestine and selectively stimulating the growth and activation of metabolism of endogenous lactobacilli and bifidobacteria.

Only 3 drugs of this series are registered on the territory of the Russian Federation: biovestin-lacto (contains bifidogenic factors and biomass of B. bifidum, B. adolescentis, L. plantarum); maltidophilus (contains maltodextrin and biomass of B. bifidum, L. acidophilus, L. bulgaricus); bifido-bak (includes fructooligosaccharides from Jerusalem artichoke and a complex of bifidobacteria and lactobacilli).

The Institute of Nutrition in the Netherlands conducted a double-blind RPCT on a small cohort of infants (19\19\63), dividing them into 3 groups: probiotic group, prebiotic group and control. The study showed a statistically significant decrease in bifid flora in the control group in the first month, however, by the 4th month of life, the effect of the metabolic activity of the flora was similar in all groups.

Side effects of pro- and prebiotics

Despite many studies, as well as more than 50 years of use of these drugs in clinical medicine, there remains a number of unresolved problems associated with long-term consequences.

Gastroenterologists from France consider and prove 4 potential side effects probiotics: development of infectious complications, production of harmful metabolites, excessive immune stimulation, transgenic reactions.

Such effects are excluded from prebiotics, which are not microbial agents. However, prebiotics may cause osmotic effects in the liver and enzymatic disturbances in the colon. Some of the prebiotics can cause intestinal colic, flatulence, and diarrhea, which can be relieved by increasing the dose.

Conclusions

Conclusion

Much research in the last decade has been devoted to improving the intestinal microecology of newborns, so in Japan, prebiotics have been added to early feeding formulas for more than 20 years and only recently began to be officially introduced in Europe.

However, there is a potential risk of long-term effects from using early formula feeding. Prolonged administration of pro- and prebiotics to premature infants can generate an increase in specific IgA and IgM antibodies against them.

An important fact It is also becoming clear that ways to normalize the intestinal microflora are being reviewed and scientifically substantiated, where pro- and prebiotics come first, rather than biotherapeutic agents, bacteriophages or antibiotics.

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Probiotics are biologically active preparations that contain live bacteria from normal intestinal microflora. Probiotics for children prevent the development of dysbiosis and have a therapeutic effect when the disease manifests itself. Timely administration of probiotics in children of the first year of life contributes to the formation of the body's protective reactions against aggressive factors of pathogenic microflora.

The first probiotic that humanity began to use for cooking medicinal products food, is considered Lactobacillus bolgaricus. The only microorganism whose name mentions the territory where it was isolated from cells of plant origin.

The discovery of the Bulgarian lactobacilli became the basis for the production of lactic acid products endowed with healing and excellent taste. And although their preparation was first started more than 8 thousand years ago, the technology for the production of feta cheese and yoghurt is still used in certain territories of Central Asia, Russia and Ukraine.

In the 80s of the twentieth century, microorganisms capable of normalizing intestinal flora were given the name “probiotics”. It fully reflects the purpose of the drugs – “for life”. By restoring the balance between beneficial and harmful bacteria, probiotics exhibit better qualities in protecting the body from infections and cancer, normalize digestion, and relieve skin manifestations and synthesize vitamins.

Dosage forms

Dry

The very first probiotics were represented exclusively by dry cultures of microorganisms. For drying, the lyophilization method is used. First, the biomaterial is severely frozen, and then dried in a vacuum chamber with all the liquid evaporating. The bacteria do not die, but go into a state of suspended animation - suspension of vital activity, which will resume under more favorable conditions.

The advantage of dry probiotics is: long term storage (in ampoules, tablets, capsules or vials), which reaches 2 years. However, there are also disadvantages. Lyophilization weakens the beneficial qualities of bacteria and reduces their ability to attach to the intestinal epithelium. It will take about 8 hours for bacteria to emerge from suspended animation and begin active activity—the time during which some of them will leave the body.

Liquid

The production of liquid forms of probiotic preparations preserves their viability in an environment where metabolic products of microorganisms are also located. The bacteria begin to show their activity within a couple of hours after ingestion. Liquid forms of probiotics are easily dosed in drops and are widely used in pediatric practice to treat children under one year of age.

These drugs have another advantage. Various ingredients can be added to their composition. For example, prebiotics. They provide food for beneficial microorganisms, increase their reproduction, colonization and effective properties for normalizing the biological environment of the intestine.

Assortment by groups

Russian epidemiologists, pediatricians and biologists have approved more than a hundred types of medicinal preparations containing beneficial bacteria for any child’s body age category. They may be:

• monocomponent, that is, contain only one type of microorganisms: “Bifidumbacterin”, “Lactobacterin”, “Colibacterin”, “Bactisporin”;
• multicomponent, which include several types of beneficial microorganisms: “Bifiform” (enterococci and bifidobacteria), “Bifikol” (Escherichia coli and bifidobacteria), “Linex” (lacto- and bifidobacteria, enterococci), “Bifiform Malysh” (lacto- and bifidobacteria );
• combination drugs, including microorganisms and additives that enhance the effect of beneficial bacteria, that is, probiotics and prebiotics: “Acipol” (polysaccharide of kefir grains and lactobacilli), “Bifiliz” (lysozyme and bifidumbacteria);
• sorbed, represented by colonies of bacteria fixed on the sorbent: “Florin forte” (lacto- and bifidumbacteria adsorbed on activated carbon), “Bifidumbacterin forte” (bifidumbacteria on activated carbon).

Monocomponent drugs are indicated if it is clearly identified insufficient quantity bacteria of a specific species. More effective in terms of activity against harmful microorganisms: multicomponent and combined probiotics.

Mechanism of action

After ingestion, probiotic preparations pass through the entire digestive tract and remain in the optimal environment of the large intestine.

Beneficial bacteria adhere (attach) to mucous membranes, forming colonies of cells of the same type. As a result of their vital activity, active substances with antibiotic properties, amino acids and enzymes are formed. By suppressing the growth of harmful microflora, they normalize intestinal motility, microflora balance, and synthesize vitamins and substances necessary to improve immunity.

For newborns

The neonatal period is 28 days, during which the baby’s body adapts to new living conditions. Gap amniotic sac, with which childbirth begins, forever deprives him of his sterile habitat and opens the way to a new world. The first things a newborn will encounter will be microorganisms.

Invisible bacteria will begin to actively settle on the skin, mucous membranes and in the intestines while the child is passing through the birth canal. They will continue to form their colony families with what enters the intestines. breast milk, will take advantage of the opportunity during contact with the mother, medical personnel and care items.

Among the huge army of bacteria, both beneficial and potentially harmful representatives will form the intestinal microflora. The first are lacto- and bifidobacteria, as well as a type of Escherichia coli with normal enzymatic properties. From the first days of the baby’s life, they will take an active part in the digestion processes, will protect themselves from harmful microbes and external factors, and will begin to synthesize vitamins and substances for the formation of immunity.

Representatives of the second group do not show their harmful properties until suitable conditions for aggression arise. And the main one is a decrease in the number of beneficial microorganisms. Their niche in the intestines will begin to be intensively occupied by conditionally harmful flora (staphylococcus, Klebsiella, Proteus, Citrobacter, fungi, E. coli with altered properties), causing dysbacteriosis.

The main probiotics in this important period of life will be lacto- and bifidobacteria, which are part of mother's milk. Breastfeeding is a natural source of useful biomaterial for building the baby’s immune system.

Artificial feeding deprives the child of important microorganisms in establishing the balance of intestinal flora. These are children at risk, prone to frequent diseases, and primarily to dysbacteriosis. That is why all formulas for artificial feeding are enriched with lacto- and bifidobacteria, and the diet of a newborn baby, on the recommendation of a doctor, can be supplemented with fermented milk formulas.

If necessary, probiotic preparations without lactose and cow's milk protein are indicated from the first days of life:

• "Bifiform Baby";
• "Normoflorin-L" (lactobacteria);
• "Normoflorin-B" (bifidobacteria and prebiotic lactitol);
• "Narine";
• "Liveo Baby" (bifidobacteria, prebiotic fructooligosaccharide and triglyceride auxiliary component vegetable oil): to normalize stool.

During treatment with antibiotics

The need to prescribe antibiotics is always associated with the threat of dysbacteriosis. Antibiotics are not selective to microorganisms. By destroying pathogenic bacteria, they cause irreparable harm to the beneficial intestinal microflora. As a result, after treatment, signs of dysbiosis appear - loose stools or a tendency to constipation, bloating, flatulence, intestinal colic.

To maintain the balance of microflora while taking antibiotics, it is advisable to prevent dysbiosis with microorganisms resistant to antibacterial drugs. Probiotics and prebiotics for children give good results.

“Hilak Forte” has proven itself better than others in pediatric practice, without contraindications for children from the first days of life. This prebiotic contains metabolic products that are produced by normal intestinal microflora, causes the death of pathogenic microbes and frees up space for the development of beneficial microorganisms.

Of the probiotics, Linex is the most effective. Its composition of lacto-, bifidobacteria and enterococcal strains has an antagonistic effect against pathogenic microbes and normalizes the qualitative and quantitative composition of beneficial bacteria.

After taking antibiotics, a course of drugs with a beneficial effect on the intestinal flora is prescribed. The duration of taking prebiotics, probiotics and synbiotics (a complex of prebiotics and probiotics in one preparation), vitamins with prebiotic components is from 3 to 4 weeks.

A good effect for children is given by the appointment of “Liveo” with 4 beneficial strains of bacteria in its composition, “Linex”. The list of prebiotics includes “Hilak Forte” and “Pikovit Prebiotic”.

Organizing your diet and its composition will help normalize your intestinal flora after antibiotics are prescribed. After suffering from illnesses, you should not give your baby fatty and high-calorie carbohydrate foods. Juices, fruits and vegetables in the diet will bring more benefits to the body's restoration of strength. Rich in plant fiber, they will provide “food” for beneficial bacteria, accelerate their growth and help quickly balance the normal composition of microflora.

Efficiency

Comments and reviews from parents regarding the effectiveness of treatment of dysbiosis in children under one year old and several years old are ambiguous. The same drugs can have a miraculous effect after three doses in one child and have no effect during long-term treatment in another.

The answer to this question is given by the “School of Doctor Komarovsky”. Popular for his well-founded conclusions, TV presenter, pediatrician and candidate of medical sciences Evgeniy Komarovsky clearly explains the problem.

In his opinion, there is no diagnosis of “intestinal dysbiosis” as such. This condition is the result of a specific cause affecting the digestive system. The most common factors that provoke an imbalance of intestinal microflora:

• infectious diseases;
• violation of the diet in qualitative and quantitative terms;
• change in living conditions;
• stress.

Until the cause is eliminated, no probiotics, prebiotics or vitamins can normalize intestinal microflora. In order to prevent dysbiosis, Komarovsky recommends, first of all, establishing a diet, eliminating feeding the child between timed meals, and introducing foods into the diet, the list of which is regulated by the age of the baby.

After birth, the child adapts to new living and nutritional conditions. It is at this moment that problems with the digestive system begin. It is important to monitor the condition of the newborn in the first months of life. The baby's immunity is still weak, beneficial bacteria fight pathogens, the stomach and intestines learn to digest new food and contract. It is necessary to strengthen the immune system to prevent viral diseases.

Probiotics are biologically active food supplements that contain various strains of beneficial bacteria, including bifidobacteria and lactobacilli. Thanks to these drugs, the newborn’s body is populated with beneficial microbes that help destroy representatives of pathogenic bacterial flora. Probiotics stop pathological processes, improve the functioning of the digestive system and strengthen the immune system.

Features of the formation of the baby's microflora

During intrauterine development, the child is nourished through the mother's blood. The fetal digestive tract is in “standby” mode. A child is born with a sterile stomach and intestines, after which his body begins to be actively populated by various microorganisms. The baby is placed on the mother's breast immediately after birth so that its body is populated with microflora that will help digest food.

In order for the child’s process of adaptation to the new environment to be painless, he needs help. To do this, use probiotics with bifidobacteria and lactobacilli, which strengthen the immune system. These drugs are sold in a dosage form convenient for newborns. They are prescribed to restore the natural bacterial flora and suppress pathogenic microbes.

In addition to beneficial bacteria, the newborn’s body is colonized by clostridia, Klebsiella, and Candida fungi. These microorganisms actively multiply when there is a deficiency of bifidobacteria and lactobacilli in the infant's body. In this case, probiotics help the immune system fight pathogenic microbes.

When the number of beneficial bacteria decreases, the protective forces body, and this threatens infectious diseases. In addition, the newborn often burps, diarrhea, and abdominal pain occur.

Despite the fact that probiotics with bifidobacteria and lactobacilli are safe, they can only be used after a doctor’s prescription. Indications for taking probiotic drugs:

• Colic in the intestines;
• Flatulence;
• The baby burps frequently and profusely;
• Slow ;
• Problems with bowel movements (diarrhea or constipation);
• Digestive disorders;
• Diabetes mellitus or infectious diseases in the mother;
• Early (28–37 weeks) or complicated labor;
• Late toxicosis in the expectant mother;
• Inability to breastfeed.

When breastfed, a newborn practically does not need probiotics, since he receives everything he needs through breast milk.

Basics

As already mentioned, probiotics are medications that contain beneficial live bacterial cultures. Lacto- and bifidobacteria for newborns normalize the natural bacterial flora of the digestive tract and strengthen the immune system. With proper and timely use of these drugs, the body's defenses are restored.

Probiotics have the following beneficial properties:

• Promote the production of elements of group B, K, and digestive enzymes.
• Removes toxic substances from the body.
• Reduce intestinal permeability.
• Beneficial bacteria prevent dysbacteriosis after taking antibacterial drugs. Because antibiotics destroy not only pathogenic, but also beneficial microorganisms from the intestines of a newborn. And this threatens with flatulence, defecation disorders, etc.
• Probiotics are used to treat digestive disorders caused by rotaviruses, as well as serious diseases that suppress the immune system (tuberculosis, oncology, etc.).
• Lacto- and bifidobacteria normalize stool when complementary foods are introduced. The drug increases the number of microorganisms that normalize digestion.
• Facilitate the absorption of protein and carbohydrate foods.
• Probiotics are used in the complex treatment of colds and flu. Beneficial bacteria strengthen the immune system and increase the newborn’s body’s resistance to infection.

Probiotics are available in liquid and dry form. The liquid dosage form is preferable for infants, as they retain viability beneficial microbes, which act immediately after administration. Besides liquid preparations Easier to dose, they can be mixed with milk, formula or water. Liquid probiotics are combined with other medications or vitamins.

Probiotics in dry form are not so useful, since they act after 6–8 hours, during which part of the drug is excreted from the body. To make them, beneficial bacteria are first frozen and then vacuum dried. Therefore, they exhibit useful qualities only after entering favorable conditions.

Thus, liquid probiotics, which contain more beneficial microorganisms, are suitable for newborns. In addition, the bacteria do not dry out and live in their usual environment.

Rules for choosing probiotics for newborns

When choosing a drug, you should take into account not only the dosage form, but also the composition of the drug. Classification of probiotics depending on their composition:

• Monocomponent are preparations that contain 1 type of beneficial microorganisms.
• Two-component probiotics contain lactobacilli and bifidobacteria.
• Complex - medicines that contain live bacteria and food for them (prebiotics).

Two-component and complex probiotics are considered the most effective. Single-component drugs are prescribed in cases where the strain of bacteria that is missing is known.

The range of probiotics is quite wide, and therefore it is recommended to purchase drugs as prescribed by a doctor. Doctors advise choosing medications that do not contain dyes or flavors. In addition, you should pay attention to the concentration of beneficial microorganisms, their minimum amount is 10⁷ CFU (colony-forming unit). It is important to pay attention to the expiration date, as liquid probiotics have a limited shelf life.

Lacto- and bifidobacteria help fight diseases and strengthen the immune system. The choice of probiotics depending on the composition and disease:

• If the natural bacterial flora of the intestine is disrupted, single-component drugs are taken. They are often prescribed to newborns who are bottle-fed or who have taken antibacterial drugs. The best choice is Hilak Forte.
• For infectious intestinal diseases, for example, acute diarrhea, it is recommended to choose complex preparations containing sorbents. For intestinal infections, antibiotics are prescribed, which must be combined with probiotics. For example, Biovestin, Bifidumbacterin.
• For constipation or difficult stool ejection, it is recommended to use Bifiform, Biogaia, Symbifer. The course of treatment lasts 1 week.

Only a doctor can help you choose the most suitable drug.

Popular drugs for infants

Medicines are allowed to be given to newborns only for medical reasons. However, parents should know the list of effective drugs with bifidobacteria and lactobacilli:

• Simbiter-M for children is a drug with live lacto- and bifidobacteria. Dosage form– powder that is mixed with breast milk or water. The drug is resistant to the effects of gastric and pancreatic juice, and therefore normalizes the microflora of the oral cavity, stomach, and intestines. Recommended for use by newborns from 1 month to 3 years.
• Hilak Forte normalizes the natural bacterial flora and eliminates flatulence. This drug is used to prevent dysbiosis after treatment with antibiotics. The drug contains metabolites of lactobacilli, streptococci and Escherichia coli. used from birth.
• Narine is a dietary supplement based on lactobacilli. In essence, it is a starter from which a fermented milk drink is prepared. The product is intended for children from 5 days of life.
• BioGaia in the form of drops is prescribed from birth. Lactobacilli for newborns are prescribed for colic and difficult stool ejection. Use with caution when diabetes mellitus and kidney dysfunction. It is most often used to treat bottle-fed infants.

• Bifidum-multi1 is a drug based on bifidobacteria that restores the natural bacterial flora and prevents dysbacteriosis. The medicine can be mixed with milk or formula. Suitable for children from birth to 3 years.
• Bifiform Baby is a dietary supplement containing bifidobacteria and streptococci. The probiotic preparation normalizes the intestinal bacterial flora. Dietary supplements are prescribed to children from birth to 2 years.
• Linex with bifidobacteria, lactobacilli and enterococci is allowed to be used from birth. Available in the form of capsules with powder inside. Before use, the capsule is opened and the powder is mixed with milk, formula or water.
• Acipol with lactobacilli and kefir grains eliminates harmful bacteria from the newborn’s body, strengthens the immune system. The drug is intended for infants from 3 months to 3 years. Available in capsule form, it is used in the same way as Linex.
• Biovestin with Bifidobacterium adolescentis. Available in the form of an emulsion for oral administration. Designed for newborns from the first days of life.

Before using medications, you should consult your doctor.

Contraindications to taking probiotics

A deficiency of beneficial bacteria in the baby's body indicates a dysfunction of the digestive tract. For this reason, it is recommended to take lacto- and bifidobacteria. In some children, such probiotics provoke an allergic reaction.

Probiotics should not be taken in the following cases:

• Hypersensitivity to the main or auxiliary components;
• Colds, which are accompanied by cough and runny nose.

Thus, probiotics with lacto- and bifidobacteria are allowed to be used for the prevention and treatment of dysbiosis for medical reasons. In order for the drugs to show their best therapeutic properties, parents must follow the dosage and frequency of administration determined by the doctor.

After past diseases When treatment was carried out with antibiotics, the child needs to restore the intestinal microflora. This is where probiotics and prebiotics come to the rescue. Preparations with beneficial microflora are prescribed not only for diseases of the gastrointestinal tract: they are indicated for strengthening the immune system and for preventing diseases viral in nature, as well as in a number of other cases. How effective are they, which ones are considered the best? Let's consider the mechanism of their work, the main indications, and also learn about the most effective drugs.

Beneficial microflora intestines is necessary to prevent viral diseases and dysbiosis

How does this work?

When a person is healthy, millions of bacteria live in his body - useful and not so, most of which help break down nutrients. Sometimes the balance of microflora is disturbed for some reason, and then there are fewer beneficial microorganisms. This can happen as a result of undergoing a course of therapy with drugs that kill the bacteria that cause the disease, and at the same time cleanse the intestines of all other types of microorganisms. As a result, the functioning of the gastrointestinal tract is disrupted, which in turn leads to a decrease in immunity.

Probiotics are live bacteria - microorganisms that live in the human body and have a positive effect on its vital functions. Probiotic preparations contain different strains of bacteria.

There are bifido-containing, coli-containing, and lactose-containing preparations. The composition may also contain yeast-like fungi, enterococci, aerococci, depending on the manufacturer and purpose. Probiotics are available in liquid and dry form.

Probiotics not only allow you to populate the intestines with the right microorganisms and overcome pathogenic flora that causes various unpleasant symptoms, but also make it possible to increase immunity and effectively fight ailments. In this article, we'll look at inexpensive yet effective gut probiotics. You will find reviews, as well as a list of drugs with prices, just below.

When are probiotics prescribed?

According to the American Gastroenterological Association, probiotics are currently most commonly prescribed to treat the following diseases and conditions:

1. Infectious diarrhea, caused by rotavirus infection, including in infants and young children - strains of lactobacilli of the species Lactobacillus rhamnosus and Lactobacillus casei.
2. - probiotic strains of lactic acid bacteria Bifidobacterium infantis and Lactobacillus plantarum and fungi Sacchromyces boulardii, as well as a combination of probiotics can help with bowel movements.
3. Antibiotic-associated diarrhea- Saccharomyces boulardii can prevent recurrences of the most dangerous and most common antibiotic-associated diarrhea caused by Clostridium difficile.

In addition, a gastroenterologist can prescribe probiotics if the patient complains of stool disorders, colic and frequent bloating and flatulence, a feeling of heaviness in the stomach, as well as other conditions.

How to take it correctly?

It is very important to choose the right probiotic to treat a specific condition. To select a probiotic, you can use the following simple rules:

1. If you suspect a bacterial infection of the intestine(acute or chronic) it is recommended to take complex preparations containing lactobacilli and bifidobacteria at the same time (for example, Bacteriobalance, Bifidin, Linex, etc.).
2. If you suspect viral infection intestines(acute or chronic) it is recommended to take drugs containing lactobacilli (for example, Lactobacterin, Narine, Biobakton, Primadophilus, etc.).
3. If you suspect fungal infection intestines and genital organs (intestinal and vaginal candidiasis), it is recommended to take medications containing bifidobacteria (for example, Probiform, Biovestin, Bifidumbacterin, etc.).

During therapy, it is recommended to first take drugs with lactobacilli, then with bifidobacteria, and only after that with colibacteria (for example, Colibacterin). You can immediately start taking complex medications that simultaneously contain bifidobacteria and lactobacilli.

Probiotics and prebiotics: what's the difference?

The names of these two groups of drugs are very similar, so they are often confused.

• Probiotics are live microorganisms that belong to the normal intestinal microflora.
• Prebiotics are organic chemicals that have the ability to create excellent conditions for the proliferation of normal intestinal microflora.

It should be noted that the effect of both prebiotics and probiotics is similar, because each of the groups of these drugs normalizes the intestinal microflora.

Useful properties

Most probiotic bacteria belong to two genera: lactobacilli (Lactobacillus) and bifidobacteria (Bifidobacterium), although you should know that there are many other types of probiotic bacteria.

These drugs are capable of:

1. Produce substances that prevent various infections.
2. Prevent bacteria harmful to humans from attaching to the intestinal wall and inhibit their growth.
3. Inhibit secretion or destroy toxins secreted by some “bad” ones. human body bacteria.
4. Stimulate the strengthening of the mucous layer in the intestines as a barrier against infections.
5. Increase the effectiveness of the immune system by secreting antibodies to certain viruses.
6. Produce B vitamins necessary for food metabolism, preventing anemia that occurs due to vitamin deficiency
7. B6 and B12, as well as maintaining skin and nervous system health.

The described effects are, to a greater or lesser extent, characteristic of all microorganisms related to probiotics. However, the mechanisms of these effects have not yet been fully elucidated.

Probiotics for the intestines: list and prices

To maintain intestinal health, the following medications may be prescribed:

• Linex is one of the most famous probiotics that are common in Russia. It contains three components of microflora, which are located in different parts of the intestine. Price 350-500 rub.
• . It is often used in pediatrics for conditions characterized by disturbances in the colonization of the intestinal flora, in combination with antibiotics and other drugs. Contains Bifidobacterium bifidum N1 in dry powder form. Price 350-400 rub.
• More concentrated bifidobacteria are contained in Probifor - one sachet contains about 10 servings of bacteria that are found in Bifidumbacterin. Price 500-600 rub.
• . In addition to probiotic strains of lacto- and bifidobacteria, it contains Escherichiacoli. Combined with antibiotic therapy, thanks to the protective capsule it easily overcomes acidic environment stomach. It is one of the best capsule probiotics for adults. Price 350-400 rub.
• Florin forte. It is a powder containing lacto- and bifidobacteria. It is prescribed for both adults, children and newborns. Thanks to the combination of bacteria, it has a complex effect, but does not combine well with some antibiotics. Price 500-550 rub.

Depending on the time of creation and improvement, several generations of probiotics are distinguished:

• I generation - classic monocomponent preparations, consisting of one strain of microorganisms - typical inhabitants of the intestines (bifidumbacterin, lactobacterin, etc.);
• II generation - self-eliminating antagonists (bactisubtil, enterol, biosporin, etc.);
• III generation - multicomponent preparations (symbiotics), consisting of several (from 2 to 30) strains of bacteria (Bifilong, etc.) or several types of bacteria (Linex, Bifikol, etc.);
• IV generation - combined preparations (synbiotics), consisting of a strain of bacteria and ingredients that promote their growth, reproduction and metabolic activity (bifiliz, kypacid, etc.);
• V generation – multicomponent combination preparations (synbiotics), consisting of several types of bacteria and ingredients that promote their growth, reproduction and metabolic activity (floristin, bifiform, etc.).

In addition, the form of the probiotic must be taken into account. They are all divided into:

• Dry probiotics(lactobacterin, bifidumbacterin, colibacterin, etc.);
• Liquid forms (biovestin, biovestin-lacto, floristin, trilact, bifidum No. 791 BAG, liquid bifido- and lactobacterins, lactoflor, etc.);
• Sorption forms s (ecoflor, probifor, bifidobacterin forte, bificol forte, etc.);
• Enteric-coated capsules(Linex, Bifiform).

And if previously liquid probiotics for the intestines were considered the best, today capsule preparations are increasingly common. Modern technologies make it possible to effectively preserve all the necessary bacteria in a capsule. Those who take probiotics unanimously declare that taking the drugs in capsules is much more convenient, like taking a vitamin: take it out of the package, drink it with water and forget...

Probiotics in foods

Sources of prebiotics are: dairy products, bread, cereals, peas, corn flakes, garlic, bananas, onions, beans and some other types of foods. One of the most popular products One that provides probiotic intake is yogurt.

In addition, their sources are: most dairy products, for example, cheese, kefir, cottage cheese, buttermilk. Some other examples of probiotics include sauerkraut, kimchi, pickles, bread, wine, soy sauce.