الفهرس 
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Abstract
It has been suggested that the over growth of bowl pathogens might be prevented by inducing the colonization of the bowel with non
pathogenic bacteria (probiotics) of species normally resident in the gut of
infants. In particular, probiotics compete with other microbes binding
sites and substrates in the bowel and produce a wide range of
antimicrobial substances. Lactobacillus LB, a strain of lactobacilli was
found to be effective in the treatment and prevention of infantile diarrhea,
indicating a role of this probiotic in stimulating and regulating the
intestine’s host defense mechanisms.
It has been suggested that probiotics can reduce the overgrowth of
pathogens in the bowels of infants and contribute to the reduction of the
incidence of nosocomial infections in PICU which are associated with
increased morbidity and mortality in infants.
The purposes of this study were to evaluate the role of probiotics
and prebiotics supplementation in infantile gastroenteritis and to
investigate their effect on infants’ growth during the period of
hospitalization.
Our study was a randomized control, follow-up clinical trial
conducted on 65 critically ill infants, who were admitted to PICU in
Menofyia university hospital during the period from March 2013 to
December 2013. The study was conducted after taking an informed
consent from parents of each studied patient and all infants were
artificially fed.
Infants were randomly assigned, by sealed envelope technique, into two
groups:
Group 1: Fifteen infants who received one sachet containing 10 billion of
lyophilized heat-killed L. acidophilus LB twice daily starting
with the first day of admission till discharge from hospital and
also receive formula containing galacto-oligosaccharide as
prebiotic supplementation then regular evaluation clinically and
lab is done they were 22 male and 28 female mean age was
(12.2 ± 7.3) months and mean weight was (8.1 ± 3.2.kg).
Group 2: Fifty infants of matched age , sex suffering from gastroentritis
who did not receive probiotics nor prebiotic supplementation
serving as controls they were 7 male and 8 female and mean
age was (13.9 ± 6.7) months and mean weight was ( 9.6 ± 2.4 )
kg.
• On admission all infants were subjected to full clinical history,
including personal, present, past, family, nutritional history, Thorough
clinical examination ,general examination including general look, vital
signs, pulse, temperature, blood pressure, respiratory rate, local
examination including signs of dehydration, nutritional status, fever,
oral tolerance, and stools characteristics were recorded and laboratory
investigation Including CBC, electrolytes, blood and stool cultures,
serum albumin and total protein were done.
At follow-up daily intake of probiotics and prebiotics: The
probiotics group received standard dose supplemented by Lactobacillus
LB twice daily starting with the first day of admission till discharge from
hospital., Follow-up for signs of dehydration and Follow up of growth
parameters (rate of weight gain, till the end of the study).
The duration of follow up was the whole duration of length of stay
in the hospital.
All clinical and laboratory parameters were statistically analyzed
comparing the probiotics and the control groups.
No significant statistical difference as regard frequency of stool,
vital signs (HR,RR) and signs of dehydration in group1 when compared
to group 2 while vomiting was more in group 2 when compared to group
1 at time of admission.
Highly significant statistical difference between intake of pro and
prebiotic and reduction of frequency of stool (motions/day) mean was
(1.32±0.61) in probiotic group while mean was (2.63 ±1.25) in control
group and also reduction of number of vomiting (times/day) at time of
discharge which was lesser in group 1 when compared to group 2 mean in
probiotic group was (0.78±0.23) when compared to control mean was
(1.72 ±0.68).
Weight gain (gm/day) were higher in probiotic group (although
non-significant) (17.7 ± 18.2) when compared to control group (9.2 ±
8.8).
There was significant difference between intake of pro and prebiotic and
length of stay in hospital (days) which was lower in probiotic group with
mean (5.5 ± 1.9) and duration ranged from 6-7 days when compared to
control group the mean was (7.0 ± 1.8) and duration ranged from7-8
days.
There was highly significant statistical difference between intake
of pro and prebiotics and reduction in duration of vomiting (days) during
gastroenteritis in probiotic group mean was (3.4 ± 0.9) and duration
ranged from 3-4 days while in control group mean was (4.9 ± 0.8) ) and
duration ranged from 5 -6 days. There was highly significant statistical
difference between intake of pro and prebiotics and reduction duration of
diarrhea (days) in probiotic group the mean was(4.5 ± 1.4) and duration ranged from 4-6 days when compared to control group the mean was (6.1
± 1.4) and duration ranged from 6-8 days.
There was highly significant statistical difference between intake
of pro and prebiotics and reduction duration of fever (days) in probiotic
group mean was (2.9 ± 0.9) and duration ranged from 2-3 days when
controlled to control group mean was (3.9 ± 0.7) and duration ranged
from 4 -5 days. There was no significant difference in clinical outcome
among studied groups.
We conclude that
Probiotics and prebiotics supplementation has a role in treatment of
gastroentritis in critically ill infants. Furthermore, its positive impact on
growth is yet to be elucidated .