The developing intestinal microbiome: probiotics and prebiotics.

The microbes in the human intestinal tract interact with the host to form a 'superorganism'. The functional aspects of the host microbe interactions are being increasingly scrutinized and it is becoming evident that this interaction in early life is critical for development of the immune system and metabolic function and aberrations may result in life-long health consequences. Evidence is suggesting that such interactions occur even before birth, where the microbes may be either beneficial or harmful, and possibly even triggering preterm birth. Mode of delivery, use of antibiotics, and other perturbations may have life-long consequences in terms of health and disease. Manipulating the microbiota by use of pro- and prebiotics may offer a means for maintenance of 'healthy' host microbe interactions, but over-exuberance in their use also has the potential to cause harm. Considerable controversy exists concerning the routine use of probiotics in the prevention of necrotizing enterocolitis. This chapter will provide a brief overview of the developing intestinal microbiome and discuss the use of pro- and prebiotics in preterm infants.