"All the sudden the baby stops being active. It stops crying and breastfeeding," says Dr. Pinaki Panigrahi, a pediatrician at the University of Nebraska Medical Center College of Public Health, who led the study.
"By the time the mother has a chance to bring the baby to the hospital, the baby dies," he says. "In hospitals in India, you see so many babies dying of sepsis, it breaks your heart."
For the past 20 years, Panigrahi has been working on a way to prevent sepsis.
Early on he thought probiotic bacteria might be the answer because they work well on another infection that affects preemies, called necrotizing enterocolitis. It damages the intestines.
The tricky part, Panigrahi says, was figuring out the best strain of bacteria to protect against sepsis.
"We screened more than 280 strains in preliminary animal and human studies," Panigrahi says. "So it was a very methodical process."
In the end, the one that seemed the most promising was a strain of Lactobacillus plantarum isolated from the diaper of a healthy Indian baby. So Panigrahi and his team decided to move forward with a large-scale study on thousands of babies in rural India.
They were shocked by how well the bacteria worked.
Babies who ate the microbes for a week — along with some sugars to feed the microbes — had a dramatic reduction in their risk of death and sepsis. They dropped by 40 percent, from 9 percent to 5.4 percent.
But that's not all. The probiotic also warded off several other types of infections, including those in the lungs. Respiratory infections dropped by about 30 percent.
"That was a big surprise, because we didn't think gut bacteria were going to work in a distant organ like the lung," Panigrahi says.
The treatment worked so well that the safety board for trial stopped the study early. "We were planning to enroll 8,000 babies, but stopped at just over 4,000 infants," Panigrahi says.
The only significant side effect seen in the study was abdominal distension, which occurred in six babies. But there were more cases reported in the placebo group than in the group that got the probiotic.
Panigrahi estimates a course of the probiotic costs about $1 per baby. "It can be manufactured in a very simple setting," Panigrahi says, "which makes it cheap."
Now if you think about what's going on here, it almost seems counterintuitive. Remember sepsis is a bacterial infection. So the researcher are preventing a bacterial infection with bacteria.
How is that possible? "Essentially these bacteria have a whole number of health benefits that we have just started to understand in the past couple of years, says Dr. Pascal Lavoie, a neonatologist at BC Children's Hospital in Vancouver, British Columbia.
First off, these beneficial bacteria can push out harmful bacteria in the baby's gut by changing the environment or simply using up resources, Lavoie says.
The probiotic bacteria also produces a compound that strengthens the wall of the intestine. "It acts as a barrier to prevent the bad bacteria from going through the wall into the blood," he says.
And, the probiotic bacteria can jump-start a baby's immune system.
"They can promote maturation of the immune system in a healthier way," Lavoie says. "Probiotics can be much more powerful than drugs."
But like drugs, they need to be fully tested before they become routine in maternity wards around the world, Lavoie says. That means testing the probiotic in more locations and on babies who have the highest risk for sepsis — those born prematurely or underweight.
"Sepsis is such a important problem around the world," Lavoie says. "This study has huge potential."
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