الفهرس 
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Abstract
Summary
Premature neonates are generally considered a high risk group to a variety of illnesses. Previous studies have shown that the fecal flora in premature neonates admitted to NICU is qualitatively and quantitatively different from that of full-term ones.
Formulas containing certain synbiotic mixtures have been shown to promote a microbial community in bottle-fed infants similar to that seen in breast-fed infants. The introduction of lactulose and Lactobacillus acidophilus therapy to premature neonates was based on the assumption that altering the colonic microbiota towards a healthier composition through replacing the putrefactive species by saccharolytic species would improve the gastrointestinal and systemic health. Normalizing the intestinal microbiota and stabilizing the mucosal integrity with prebiotics and probiotics have been proved to offer beneficial effects in different aspects.
This study aimed to evaluate the role of lactulose alone and combined with lactobacillus acidophilus as regards fecal colonization with lactobacilli in premature neonates as the primary target.
The present study included 60 preterm neonates of gestational ages less than 35 weeks who were divided into 3 groups as follows:
group I: It included 20 preterm neonates who received formula feeding with prebiotic supplementation (Lactulose).
group II: It included 20 preterm neonates who received formula feeding with both prebiotic and live probiotic supplementation (Lactobacillus acidophilus).
group III: It included 20 preterm neonates who received formula feeding and the conventional treatment.
Neonates with severe congenital anomalies, clinically apparent chromosomal abnormalities and inborn error of metabolism were excluded.
The results of our study demonstrated that there was a highly statistical significant difference between the three groups regarding lactobacilli count in stool cultures both on the 7th day of treatment and on predischarge.
Moreover, the increase in lactobacilli count in stool cultures of group II was significantly higher compared to group I on the 7th day of treatment. While on predischarge, the difference was highly significant as regards lactobacilli count.
In addition, the study showed no statistical significant difference between the three groups as regards sepsis on the 7th day of treatment, mortality rate or duration till discharge from hospital.
As regards the effect of treatment on sepsis score, there has been a negative correlation between lactobacilli count and sepsis score on the 7th day of treatment in group II.
Our results also showed a statistical significant decrease in the duration needed to reach full oral intake in the synbiotic group (group II) when compared to the prebiotic group (group I), and a highly significant decrease in group II when compared to the control group (group III).