Tolerance, safety, and effect on the faecal microbiota of an enteral formula supplemented with pre- and probiotics in critically ill children.

OBJECTIVES: The aim of this study was to demonstrate the tolerance and safety of an enteral formula containing prebiotics/probiotics, and its effect on the faecal microbiota in critically ill children. SUBJECTS AND METHODS: Ninety-four patients between 1 and 3 years old under mechanical ventilation requiring enteral feeding were randomised to receive either a test formula containing a synbiotic blend (composed of 2 probiotic strains [Lactobacillus paracasei NCC 2461 and Bifidobacterium longum NCC 3001], fructooligosaccharides [FOS], inulin, and Acacia gum), or a control formula. Patients remained in the intensive care unit for 7 days and were examined at day 14. Tolerance was assessed by overall caloric intake and time to reach caloric goal. Safety was assessed by abdominal distention, vomiting, and stool frequency. Microbiota was analysed by culture- and molecular-based methods. RESULTS: Overall caloric intake and time to reach caloric goal were similar between groups (noninferiority was shown). Abdominal distention, vomiting, and stool frequency were not affected by the supplementation with pre- and probiotics. Faecal bifidobacteria were higher in the test group at the end of the study. A similar trend was observed for total lactobacilli. L paracasei NCC 2461 and B longum NCC 3001 were detected in 80.4% and 17% of the test group patients, respectively. Enterobacteria levels remained unchanged during hospitalisation in the control group but diminished in the test group. CONCLUSIONS: The enteral formula supplemented with synbiotics was well tolerated by children in intensive care units; it was safe and produced an increase in faecal bacterial groups of previously reported beneficial effects.

Epidemiology, clinical presentations and burden of rotavirus diarrhea in children under five seen at Ramathibodi Hospital, Thailand.

BACKGROUND: To be able to monitor the impact of rotavirus vaccines in the future, the authors designed the present study along with the Rotavirus Surveillance Project-Thailand. OBJECTIVE: To examine the epidemiology, clinical presentation, and direct medical cost of rotavirus-caused diarrhea in Thailand MATERIAL AND METHOD: Clinical presentations of all diarrhea cases during the study period were analyzed Rotavirus diarrhea was confirmed with polyacrylamide gel electrophoresis. Serological typing was characterized by reverse transcription-polymerase chain reaction. RESULTS: Between April 2001 and March 2002, 239 under 5-year-old diarrhea cases admitted in Ramathibodi Hospital, Thailand were identified Clinical presentations and laboratory results were analyzed from 85 cases. Rotavirus was identified in 48.2% of the specimens. The most common serotypes were G9 (67%), G4 (23%), and GI (2%) respectively. The most common age of rotavirus diarrhea was 12-17 months. The seasonal peak was during November 2001 to January 2002 (the cool and dry season in Thailand). The predominant symptoms were watery diarrhea, fever, and vomiting. Rotavirus diarrhea tended to have more dehydration and metabolic acidosis than other causes. The G4 serotype was associated with the most severe presentations. CONCLUSION: The proportion of rotavirus diarrhea in the present study was 48%. The mean direct medical cost per episode of rotavirus diarrhea per child was 2,101 baht (approximately 52 US $).