Bifidobacteria Found in Breastmilk – Implications on Infant Nutrition
For many years, research has shown that breastmilk contains prebiotics – non-digestible carbohydrates that stimulate the growth of probiotics and balance the intestinal flora. It was originally thought that breastmilk did not contain probiotics, but merely promoted the growth of bifidobacteria due to the presence of the prebiotics. However, recent research has proven that breastmilk does contain probiotics – numerous strains of bifidobacteria – which have been shown to balance the intestinal flora and help develop a healthy immune system in infants. Clinical trial results showed that more than 85% of breastmilk samples contained bifidobacteria,1,2 further supporting the immune benefits offered by probiotics.
In infancy, bifidobacteria help promote gut barrier function and modulate immune system response.3-8 In our increasingly sterile environment, infants born via C-section, who receive antibiotics, or who are formula-fed (without probiotic-supplementation) stand to benefit the most from bifidobacteria supplementation.
Probiotic benefits can be maintained through childhood when supplementation is continued as solid foods are introduced into a toddler’s diet. A routine infant or toddler formula containing bifidobacteria helps to build a predominance of bifidobacteria in the gut, and positively promote a balanced intestinal flora.
Why choose bifidobacteria for infant formula?
Bifidobacteria are naturally found in breastmilk, impacting the microbial composition of an infant’s intestinal flora. They make up 80–90% of the total intestinal flora of breastfed infants.9,10 Supplementation helps increase acidification of the gut lumen, secretory IgA production and mucin, and decreases gut barrier permeability.3-6,10-13 Recommending a routine infant formula containing bifidobacteria would be a natural choice after breastfeeding is discontinued.
Probiotics for preterm infants
In the NICU, preterm infants who are receiving formula are most often fed with a formula that is specially designed to meet their unique nutritional needs. Unfortunately necrotizing enterocolitis (NEC) is a prevalent condition in this fragile population. It is often devastating, associated with increased morbidity and mortality in preterm infants.14 The exact pathogenesis of NEC is still not fully understood, but mucosal injury from a number of factors seems to be one main reason.
The associated effects of bifidobacteria on gut barrier function and general immune-system support have been studied in the context of many disease states, including NEC. Emerging science has indicated positive results when probiotics were used in preterm infants with NEC. In a meta-analysis of 9 trials with 1425 preterm infants, probiotic supplementation significantly reduced the incidence of severe NEC (stage II–III), and mortality.14 NEC is primarily a disease of preterm infants. Of the 1–7.7% of NEC cases in the NICU, 10% may occur in term infants, so these findings may be relevant in this population as well.15 At present, there are no preterm formulas containing probiotics, so breastmilk is the sole source of probiotic cultures for these infants. However, once the preterm infant is ready to progress to a routine formula, a probiotic-supplemented formula could be considered.
Bifidobacteria supplementation is safe from birth for all infants
Probiotic use has a robust safety record in infants5,16 – right from birth. Bifidobacteria is one of the most commonly studied, and widely used probiotics. It has been extensively studied in infants for nearly 20 years, and has not been shown to cause negative effects such as infection when consumed. Specifically, Nestlé has been nourishing infants with formula containing Bifidobacterium lactis (B. lactis) for more than 15 years and in 30 countries — and has recently brought these beneficial formulas to the U.S.
In 2007, the first FDA-authorized routine infant formula in the U.S. containing bifidobacteria was introduced. There are formulas with beneficial cultures available that may be used routine infants (from 0-12 months) as a supplement to, or an alternative to breastmilk when breastfeeding is not an option. A formula, with beneficial cultures for older babies and toddlers was introduced in 2008 and is appropriate for toddlers (9–24 months) as they transition to solid foods.
- Gueimonde M, Laitinen K, Salminen S, Isolauri E. Breast milk: a source of bifidobacteria for infant gut development and maturation? Neonatology 2007;92:64–6.
- Gronlund MM, Gueimonde M, Laitinen K, Kociubinski G, Grönroos T, Salminen S et al. Maternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic disease. Clin Exp Allergy2007;37:1764–72.
- Fukushima Y, Kawata Y, Hara H, Terada A, Mitsuoka T. Effect of a probiotic formula on intestinal immunoglobulin A production in healthy children.Int J Food Microbiol1998;42:39–44.
- Langhendries JP, Detry J, Van Hees J, Lamboray JM, Darimont J, Mozin MJ et al. Effect of a fermented infant formula containing viable Bifidobacteria on the fecal flora composition and pH of healthy full-term infants. J Pediatr Gastroenterol Nutr1995;21:177–81.
- Saavedra JM, Abi-Hanna A, Moore N, Yolken RH. Long-term consumption of infant formulas containing live probiotic bacteria: tolerance and safety. Am J Clin Nutr2004;79:261–7.
- Stratiki Z, Sevastiadou S, Stamouli K, Kastanidou O, Skouroliakou M, Kostalos C. The effect of a bifidobacter supplemented bovine milk on intestinal permeability of preterm infants. Early Hum Dev 2007;83:575–9.
- Walker WA, Isolauri E. Understanding the use of probiotics in pediatric populations. Contemp Ped 2007;Suppl:1–6.
- Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents. Pediatrics 2005;115:5–9.
- Yoshioka H, Iseki K, Fujita K. Development and differences of intestinal flora in the neonatal period in breast-fed and bottle-fed infants. Pediatrics 1983;72:317–21.
- Fooks LJ, Gibson GR. Probiotics as modulators of the gut flora. Br J Nutr2002;88(Suppl 1):S39–S49.
- Fukushima Y, Li S-T, Hara H, Terada A, Mitsuoka T. Effect of follow-up formula containing Bifidobacteria (NAN BF) on fecal flora and fecal metabolites in healthy children. Bioscience Microflora 1997;16:65–72.
- Kirjavainen PV, Arvola T, Salminen SJ, Isolauri E. Aberrant composition of gut microbiota of allergic infants: a target of bifidobacterial therapy at weaning? Gut2002;51:51–5.
- Mack DR, Lebel S. Role of probiotics in the modulation of intestinal infections and inflammation. Curr Opin Gastroenterol 2004;20:22–6.
- AlFaleh K, Bassler D. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database of Systemic Reviews 2008:1–19.
- Kosloske AM. Epidemiology of necrotizing enterocolitis. Acta Paediatr Suppl 1994;396:2–7.
- Szajewska H, Setty M, Mrukowicz J, Guandalini S. Probiotics in Gastrointestinal Diseases in Children: Hard and Not-So-Hard Evidence of Efficacy. J Pediatr Gastroenterol Nutr 2006;42(5):454–75.