Infants born by C-section miss the exposure to the maternal vaginal microbiota and this absence of microbial inoculation has been associated with a delayed colonization of commensal bacterial members such as Bifidobacterium. This compromised microbial inoculation may impact the health of the newborn. Epidemiological data from cohort studies indicate associations between C-section and, immune and metabolic disorders such as asthma, and obesity.
The objective of this study was to determine the effect of a specific mixture of short-chain galactooligosaccharides and long-chain fructooligosaccharides (scGOS/lcFOS, ratio 9:1) and Bifidobacterium breve M-16V in restoring the delayed colonization of Bifidobacterium observed in term C-section delivered infants.
Methods
In a multi-country, double-blind, randomised controlled study, 153 infants born by elective C-section were randomised to receive (1) an infant formula supplemented with scGOS/lcFOS (0.8g/100ml) and B. breve M-16V (7.5×108CFU/ 100ml), or (2) a formula supplemented with scGOS/lcFOS (0.8g/100ml), or (3) a control formula from birth until age 4 months. As a reference group, 30 vaginally born, breast fed infants were studied in parallel. Stool samples were collected at day 3, day 5, week 4, week 8, week 12, week 16, and week 22 (6 weeks post-intervention). The proportion of bifidobacteria, different Bifidobacterium species such as B. longum and the probiotic strain B. breve M-16V were determined with molecular tools, pH and SCFA were also measured in the stool samples.
Results
The data confirm the delayed colonization of Bifidobacterium in C-section delivered infants. The synbiotic supplementation resulted in a significant higher proportion of bifidobacteria from the first days of life (p=0.006) and this bifidogenic effect remained significant until 1 month of age (p=0.029) compared to the control group. The prebiotic group showed a significant bifidogenic effect at age 1 month (p=0.048) compared to the control group. In the synbiotic arm, B. breve M-16V was still detected in 37 % of the infants at week 22 indicating a persistence of the probiotic strain. A significant lower faecal pH and a higher acetate level were observed in the synbiotic group from the first days of life and this remained significant until 1 month of age compared to the control group. A lower number of subjects with adverse events of eczema/atopic dermatitis was reported in the synbiotic group (n=3) compared to the control (n=10), and prebiotic group (n=9), after correction for family allergy history.
Conclusion
An infant formula supplemented with scGOS/lcFOS and B. breve M-16V is able to restore the delayed colonization of Bifidobacterium in C-section delivered infants from the first days of life. This bifidogenic effect is associated with a positive modulation of the gut ecosystem milieu. These effects may have potential long term health benefits.