Prebiotic oligosaccharides in premature infants

Objective: The aim of the study was to determine the impact of increasing doses of 2 prebiotic oligosaccharides and of an ‘‘all-human diet’’ on the intestinal microbiota of premature infants. Methods: Twelve premature infants receiving formula feedings were randomly assigned to receive either galacto-oligosaccharide (FþGOS) or a pooled concentrated donor human milk product containing human milk oligosaccharides (FþHMO) in increasing doses during a 5-week period. A second group of 15 premature infants received their mother’s own milk fortified with either a concentrated donor human milk product (HþH) or a bovine powdered fortifier (HþB). Serial stool specimens from each infant were analyzed by terminal restriction fragment length polymorphism and quantitative polymerase chain reaction for bacterial composition. Results: All of the infants studied had relatively low levels of bifidobacteria and no measurable Lactobacilli. Infants from the FþGOS and FþHMO groups demonstrated an increase in relative numbers of Clostridia with increasing doses. Compared with the HþB group, the infants in the FþHMO and the HþH groups showed an unexpected trend toward an increase in gProteobacteria over time/dose. Principal coordinate analyses and Shannon diversity scores were not significantly different among the 4 groups. Infants in the HþH group received more antibiotics during the study period than those in the other groups. Two of the infants receiving GOS developed feeding intolerance. Conclusions: None of the prebiotic interventions resulted in significant increases in bifidobacteria compared with baseline specimens or the HþB group; however, many of the infants did not receive the highest doses of GOS and HMO, and antibiotic use in the HþH group was high.