Prebiotic oligosaccharides: supporting gut health in preterm infants – a guide for healthcare professionals

In this guide for healthcare professionals, we take a look at the importance of supporting the gut microbiota and the role that prebiotics can play in creating positive health outcomes in preterm infants.

preterm baby

Every year 15 million infants around the world are born too early and before completion of the 37th week of pregnancy, and preterm birth is the number one cause of child mortality around the world1.

Infants who are born prematurely often face multiple health concerns, including feed intolerance, poor gut barrier function and increased risk of infection2-4. The gut microbiota in these infants is considered to be important for protection against harmful microorganisms and for the maturation of the immune system5. Increasing evidence suggests that promoting a healthy microbiota is key to supporting the best possible outcomes in preterm infants3.

Good nutritional support of preterm infants has been shown to improve neonatal growth and developmental outcomes, including brain development, to support optimal long term health6,7.

The benefits of breast milk on the microbiota

Breast milk is universally recognised as promoting the best health outcomes in both preterm and term infants by providing a unique combination of nutrients and immune-protective factors8,9. A key benefit of breast milk is the promotion of a healthy gut microbiota, which is in part attributed to the presence of prebiotic oligosaccharides (OS) supporting gut intestinal flora development (figure 1)4,10.

Breastfed vs formula fed infants graphs

Figure 1

Adapted from: Harmsen, et al. 2000 Figure 1 – The microbiota of breastfed newborn infants is dominated by beneficial bifidobacteria (up to 90%) and has lower levels of harmful bacteria (such as E. coli and Bacteroides) compared to infants fed a formula without prebiotics during the first 20 days of life10.

Prebiotic oligosaccharides positively influence the gut microbiota

If breast milk is not available or available in sufficient amounts for a preterm infant, a specific preterm formula is recommended11. Several clinical studies have proven that a formula containing prebiotic OS (compared to a formula without prebiotic OS) helps to support the preterm gut microbiota in a number of different ways:

  • Increasing the number of bifidobacteria in the gut (Figure 2)12.
  • Promoting stool frequency patterns and consistency similar to breast milk fed infants12,13.
  • Reducing numbers of potentially pathogenic bacteria in the gut14.
  • Potentially improving enteral tolerance in very preterm infants13,15.
Number of bifodobacteria chart

Figure 2

Adapted from: Boehm, et al. 2002 Figure 2 – Preterm infants receiving a preterm formula with prebiotic OS for 28 days had significantly higher levels of bifidobacteria in the gut, compared to the group receiving a formula without prebiotic OS (p=0.0008).12

40 years of early life science

At Nutricia we have over 40 years of breast milk expertise with a dedicated team of around 250 specialist scientists collaborating with hospitals, laboratories and universities worldwide to ensure we’re leaders in this field. Science is at the heart of our nutrition and health commitment to help healthcare professionals support parents during the first 1,000 days. Our research and innovation delivers evidence-based nutritional solutions to support a child’s lifelong health, combining our Early Life Nutrition expertise with years of professional experience to develop a portfolio of products to support the nutritional needs of mums, mums-to-be, parents and partners and their babies.

Do you have a question?

Contact our team of experts for guidance on the use and composition of our product range, for support with queries regarding your Nutricia account and sampling service or to get in touch with your local Nutricia representative. We are available Monday to Thursday 9am-5pm and Friday 9am-4pm (except Bank Holidays)


IMPORTANT NOTICE: Breastfeeding is best for babies. Infant formula is suitable from birth when babies are not breastfed. Follow-on milk is only for babies over 6 months, as part of a mixed diet and should not be used as a breastmilk substitute before 6 months. We advise that all formula milks including the decision to start weaning should be made on the advice of a doctor, midwife, health visitor, public health nurse, dietitian, pharmacist or other professional responsible for maternal and child care. Foods for special medical purposes should only be used under medical supervision. May be suitable for use as the sole source of nutrition for infants from birth, and/or as part of a balanced diet from 6–12 months. Refer to label for details.

  1. World Health Organisation, Fact sheets: Preterm Birth
  2. Calkins KL, et al. Clin Perinatol 2014;41(2):331–345.
  3. Groer MW, et al. Microbiome 2014;2:(38):1-8.
  4. Neu J. World Rev Nutr Diet 2014;110:253–263.
  5. Neu, J., 2007. Gastrointestinal development and meeting the nutritional needs of premature infants. The American journal of clinical nutrition, 85(2), pp.629S-634S.
  6. Fewtrell, et. al. Growth in Early Life: Growth Trajectory and Assessment, Influencing Factors an Impact of Early Nutrition. Wiley 2016.
  7. Embleton, N.D. Early nutrition and later outcomes in preterm infants. In Nutrition and Growth (Vol. 106, pp. 26-32) 2013. Karger Publishers.
  8. Lechner BE et al. Neurodevelopmental outcomes of preterm infants fed human milk: a systematic review. Clinics in perinatology, 2017. 44(1), pp.69-83.
  9. Lewis, E.D et al. The importance of human milk for immunity in preterm infants. Clinics in perinatology, 2017. 44(1), pp.23-47.
  10. Harmsen HJM et al. J Pediatr Gastroenterol Nutr 2000;30(1):61–7.
  11. Agostoni C, et al. J Pediatr Gastroenterol Nutr 2010;50(1):85–91.
  12. Boehm GM, et al. Arch Dis Child Fetal Neonatal Ed 2002;86(3):F178–F181.
  13. Mihatsch WA, et al. Acta Paediatrica 2006;95(7):843–848.
  14. Knol JP, et al. J Pedaitr Gastroentreol Nutr 2005;40(1):36–42.
  15. Modi N, et al. Pediatr Res 2010;68(5):440-5.

You may also be interested in


Nutricia offers access to a wide range of support services and resources including:

  • • Our free Sampling Service to order product samples and have them sent to your patients' homes.
  • • A range of CPD accredited e-learning programmes.
  • • Order free paper copies of our support tools for yourself or to use with your patients.
  • • Sign up to receiving marketing communications and be the first to know about our free educational events & webinars, the latest scientific research and product updates.