Probiotics to improve the gut microbiome in premature infants: are we there yet?

Gut microbiome maturation in infants born prematurely is uniquely influenced by the physiological, clinical, and environmental factors surrounding preterm birth and early life, leading to altered patterns of microbial succession relative to term infants during the first months of life. These differences in microbiome composition are implicated in acute clinical conditions that disproportionately affect preterm infants, including necrotizing enterocolitis (NEC) and late-onset sepsis (LOS). Probiotic supplementation initiated early in life is an effective prophylactic measure for preventing NEC, LOS, and other clinical concerns relevant to preterm infants. In parallel, reported benefits of probiotics on the preterm gut microbiome, metabolome, and immune function are beginning to emerge. This review summarizes the current literature on the influence of probiotics on the gut microbiome of preterm infants, outlines potential mechanisms by which these effects are exerted, and highlights important clinical considerations for determining the best practices for probiotic use in premature infants.

Automated summary

Gut microbiome maturation in premature infants is influenced by various factors, leading to different microbial succession patterns compared to term infants. These differences contribute to clinical conditions like NEC and LOS in preterm infants. Early probiotic supplementation has proven effective in preventing these conditions and has additional benefits on the preterm gut microbiome, metabolome, and immune function. This review highlights the influence of probiotics on the gut microbiome of preterm infants and discusses clinical considerations for their use.