The infant gut microbiota is a dynamic ecosystem that significantly influences immune development, nutrient metabolism, and overall health.
Disruptions in this system, such as those caused by antibiotics or cesarean delivery, may be counteracted through targeted nutritional interventions using prebiotics, probiotics, and synbiotics.
Prebiotics are nondigestible dietary fibers that selectively stimulate the growth of beneficial microorganisms.
Key prebiotics used in infant formulas include galacto-oligosaccharides (GOS) and 2′-fucosyllactose (2′-FL), both of which mimic human milk oligosaccharides. Endika et al. (2023) used an in vitro colon model to demonstrate how GOS and 2′-FL enhance gut microbial resilience following antibiotic exposure. The supplementation restored short-chain fatty acid (SCFA) production, notably butyrate and propionate, which are critical for gut epithelial health and immune modulation.
Ferro et al. (2022) further showed that infants consuming prebiotic-enriched formula had significantly higher Bifidobacterium counts, with improved stool consistency and lower fecal pH – both markers of healthy gut function.
Probiotics are live microorganisms that confer health benefits when consumed in adequate amounts (Hill et al., 2014).
Probiotic strains from the Bifidobacteriaceae and Lactobacillaceae families have been shown to enhance colonization resistance against pathogens in preterm infants.
A study by Plummer et al. (2021) demonstrated that probiotic supplementation in preterm neonates reduced the incidence of necrotizing enterocolitis (NEC) and late-onset sepsis.
These effects are attributed to improved gut barrier integrity and competitive exclusion of harmful bacteria.
Synbiotics, combining prebiotics and probiotics, provide a synergistic approach to gut microbiota modulation. Ferro et al. (2022) reported that synbiotic use not only increased Bifidobacterium levels but also improved markers of gut health such as stool frequency and reduced pathogen load.
Importantly, Martin-Pelaez et al. (2022) found that administering synbiotics during pregnancy and lactation helped align the microbiota of cesarean-born infants with that of vaginally delivered peers. This may reduce the risk of allergy and metabolic syndromes later in life.
Prebiotics, probiotics, and synbiotics offer promising, evidence-based strategies to promote infant gut health. They mitigate disruptions caused by antibiotics and non-physiological birth modes, improve microbial diversity, and support immune development.
Widespread implementation in neonatal and maternal care could transform early-life microbiome management.
References
Endika, M. F., Barnett, D. J. M., Klostermann, C. E., Schols, H. A., Arts, I. C. W., Penders, J., Nauta, A., Smidt, H., & Venema, K. (2023). Microbiota-dependent influence of prebiotics on the resilience of infant gut microbiota to amoxicillin/clavulanate perturbation in an in vitro colon model. Frontiers in microbiology, 14, 1131953. https://doi.org/10.3389/fmicb.2023.1131953
Ferro, L. E., Crowley, L. N., Bittinger, K., Friedman, E. S., Decker, J. E., Russel, K., Katz, S., Kim, J. K., & Trabulsi, J. C. (2023). Effects of prebiotics, probiotics, and synbiotics on the infant gut microbiota and other health outcomes: A systematic review. Critical reviews in food science and nutrition, 63(22), 5620–5642. https://doi.org/10.1080/10408398.2021.2022595
Hill, C., Guarner, F., Reid, G., Gibson, G. R., Merenstein, D. J., Pot, B., Morelli, L., Canani, R. B., Flint, H. J., Salminen, S., Calder, P. C., & Sanders, M. E. (2014). Expert consensus document. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature reviews. Gastroenterology & hepatology, 11(8), 506–514. https://doi.org/10.1038/nrgastro.2014.66
Martín-Peláez, S., Cano-Ibáñez, N., Pinto-Gallardo, M., & Amezcua-Prieto, C. (2022). The Impact of Probiotics, Prebiotics, and Synbiotics during Pregnancy or Lactation on the Intestinal Microbiota of Children Born by Cesarean Section: A Systematic Review. Nutrients, 14(2), 341. https://doi.org/10.3390/nu14020341
Plummer, E. L., Danielewski, J. A., Garland, S. M., Su, J., Jacobs, S. E., & Murray, G. L. (2021). The effect of probiotic supplementation on the gut microbiota of preterm infants. Journal of medical microbiology, 70(8), 001403. https://doi.org/10.1099/jmm.0.001403
Vievermanns, K., Dierikx, T. H., Oldenburger, N. J., Jamaludin, F. S., Niemarkt, H. J., & de Meij, T. G. J. (2024). Effect of probiotic supplementation on the gut microbiota in very preterm infants: a systematic review. Archives of disease in childhood. Fetal and neonatal edition, 110(1), 57–67. https://doi.org/10.1136/archdischild-2023-326691