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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 . |