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Probiotics  new generation in pediatrics  Carlos D. Ramos-Perea M.D. F.A.A.P Catedrático Asociado Escuelas de Medicina  Ponce y Central del  Caribe     Pediatra- Neonatólogo- Cuidados Intensivos HOSPITAL  MATERNO-INFANTIL SAN ANTONIO MAYAGUEZ, P.R.
Objectives  ,[object Object]
Define :PROBIOTICS AND PREBIOTICS
Understand factors that affect bacterial colonization of the intestinal tract.
Review data supporting clinical benefits of probiotics particularly bifidobacteria and that is safe and well tolerated by infants and children.
GOOD START REVIEW,[object Object]
PROBIOTICS:
Non pathogenic microoranism resistant to acid & bile that can, adhere to epithelial tissue, transiently colonize GI, produce antimicrobial, modulate immune response and influence metabolic activity of intestinal flora.,[object Object]
Cont. facts about probiotics ,[object Object]
BIFIDOBACTERIA AND LACTOBACILLI are the most commonly studied genera of all probiotics.,[object Object]
PH gets lower, and creates poor environment for growth.
Lactobacillus  contains lactase within their cell wall, adhering to the intestinal microvillus, digesting lactose.
Non fermented milk containing L.bulgaricus significantly reduced both breath hydrogen results and symptoms of lactose int.    De verse et all am j clin nutr 2001:73
Human Intestinal Flora (Microbiota) ,[object Object]
Trillions of bacteria
Important for healthy intestinal function & nutrition
Motility, digestion, intestinal trophism
Critical for immune system development and response
Gut barrier function and immuno-modulation7
INTESTINAL  ANATOMY GALT
Intestinal Flora (A Balanced Ecosystem) 13 Pseudomonas Potentially Harmful Bacteria ,[object Object]
Infections
Production of ToxinsPotentially Helpful Bacteria ,[object Object]
Stimulation of immune functions
Aid in digestion and/or absorption
Synthesis of vitaminsProteus Staphylococci Clostridia Enterococci E. coli Lactobacilli Streptococci Eubacteria Potential Probiotics Bacteria (When Ingested) Bifidobacteria Bacteroides Adapted from: Gibson 1995
Ingestion of Bacteria (Transient Intestinal Bacteria) have a Lengthy History 15 Monks Perfect Fermentation Pasteurization Sumerians (Cheese) Celts & Huns(Kefir) Abraham (Milk & curds) 2000  3500 BC 2000 BC AD Antibiotics Probiotics In the last 100 years, we drastically changed our ingestion of microbes and our microbial environment
Bacteria Proposed as Beneficial (HYSTORY) ,[object Object]
Lactic acid bacteria are important for human health and longevity
Ingested bacteria can have positive influence on health:16 Elie Metchnikoff (1845-1916)
Commonly Used Probiotics ,[object Object]
B. lactis (Bb12)
B. longum
B. breve
B. infantis
LACTOBACILLI
L. casei
L. rhamnosus (GG)
L. reuterii
L. plantarum17
Live Active Cultures of Bacteria in the Food Supply 18
BIFIDOBACTERIA ,[object Object]
Produce short chain fatty acids: acetate and lactate
Survive intestinal digestion and appear in  stool
Predominant flora of breast fed infants19 Bifidobacterium lactis Nomenclature: B. lactis also: B. animalis sub-species lactis, also B. bifidum, strain Bb12
Bifidobacteria Supplementation can Increase colonization with Bifidobacteria 20 Langhendries 1995
Number of Scientific Publications on Probiotics 21
Nestle research center ,[object Object]
Translocated bacteria influence colonization of infant bowel contribute to education of infant gut.
For MULTIPLE and VARIABLE reasons some infants can't  breast feed. Research has proven that formula with probiotics provide the same flora as breast feed reducing allergies, infections and improve defenses.,[object Object]
 Diet in early life is a mayor factor for this ecosystem.
 Since breast milk is not sterile and contains among other species bifidobacteria. It contains also oligosaccharides that promote growth of bifidobacteria.,[object Object]
NRC CONT. ,[object Object]
80% of immunologically active cells are contained in the gut.(GALT)
Germ free animals revealed underdeveloped mucosal inmune system with very small PEYER patches,decreased lymphocytes in mucosa and absent IGA producing cells.
The signaling of bacteria through receptors in mucosa are responsible for development of immune system.		,[object Object]
Antimicrobial activities of probiotics include the (1) production of bacteriocins/ defensins , (2) competitive inhibition with pathogenic bacteria, (3) inhibition of bacterial adherence translocation, and (4) reduction of luminal pH. Probiotics bacteria can also enhance intestinal barrier function by (5) increasing mucus production.
(mechanical defense) Mucus layer Categorized depends on cytokine profile Promote- eos recruitment Encourage T cell prolif. And macrophage activ. Inflammatory defense The balance between T lymph important role in modulating immune response Over expression proinflamatory

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Probiotics in pediatrics.pptx mmm