Enteral feeding of premature infants with Saccharomyces boulardii

Background: Saccharomyces boulardii (SB) is a yeast that acts both as a probiotic and as a polyamine producer. Probiotics prevent the overgrowth of pathogens in the gut while polyamines enhance intestinal maturation. The aim of this randomized study was to investigate the ability of SB to modify the gut microbial ecology and its function. Methods: A total of 87 healthy babies with gestational age 28-32 weeks were studied. They were randomly assigned to receive a preterm formula to which SB or maltodextrins was added for 30 days. Evaluations were made on the following: SB tolerance and weight gain, faecal flora analysis, intestinal D-Xylose absorption and faecal lipid excretion. Results: SB was well tolerated by the infants. There was no difference in weight gain between the two groups. Median log of colony forming units per gram of faeces for Escherichia coli and enterococci was significantly lower in the SB group [E. coli: 2.67 (0.045) vs. 2.75 (0.058), P<0.001; enterococci: 2.14 (0.359) vs. 2.19 (0.138), P<0.05]. On the other hand, the number of bifidobacteria and staphylococci in the stools was significantly higher in the SB group [bifidobacteria: 2.65 (0.083) vs. 2.27 (0.075), P<0.001; staphylococci: 1.23 (0.869) vs. 0.6 (0.281), P<0.001]. D-Xylose and lipid absorption was not improved by SB [median blood D-xylose: 1.5 (0.4) mmol/l vs. 1.35 (0.3) mmol/l, P>0.1; median stool steatocrit: 64% (3.05%) vs. 65% (2.72%) P>0.5]. Conclusions: An SB-supplemented formula is well tolerated by preterm infants, it has a beneficial effect on stool flora bringing it closer to that of breast fed babies but it does not improve D-Xylose or lipid gut absorption. (C) 2003 Published by Elsevier Ireland Ltd.