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Probiotics in breast-fed healthy term infants: imperative or superfluous?

Pediatric Research (2025)Cite this article

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Elie Metchnikoff, a Russian embryologist and Nobel Laureate for his work on phagocytosis in 1908, introduced a visionary idea which he called “orthobiosis.” He proposed that health and longevity arise from harmony within our cells (ontogeny) and with our environment (phylogeny). He viewed the colon as a “vestigial cesspool,” where harmful bacteria disrupted this harmony, and believed that consuming fermented milk rich in Lactobacillus bulgaricus could help restore balance, decrease toxins, and slow the aging process.1 A century later, our understanding of probiotics and the gut microbiome echoes his thinking in many ways. The term “microbiome” was popularized by another Nobel Laureate, Joshua Lederberg in 2001.2 Since then, over 1500 systematic reviews have examined the role of probiotics in human health, including over 400 in children.

Gut microbiota patterns in healthy term infants can shape long-term immune tolerance and disease susceptibility. Mode of birth (vaginal vs. C-section), type of feeding (breast milk vs. formula), and early antibiotic exposure can promote dysbiosis, potentially disrupting the maturation of mucosal immunity and possibly increasing the risks of both short and long-term morbidities. The beneficial effects of probiotics are compelling in preterm infants, including a reduction in the risk of necrotizing enterocolitis (NEC), mortality, and late-onset infections.3 However, the case for the use of probiotics in healthy term infants is not so clear. There is some evidence suggesting their efficacy in childhood disorders, including infantile colic, acute and persistent diarrhea, allergic diseases, asthma, and obesity, but the cumulative evidence is not robust, and thus precludes strong recommendations.4,5,6,7,8

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Data sharing is not applicable to this article, as no datasets were generated or analyzed during the current study.

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Funding

M.P.’s effort is partly supported by funding from NIH (R01HD112886).

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  1. Division of Neonatology, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA

    Muralidhar H. Premkumar & Mohan Pammi

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  1. Muralidhar H. Premkumar
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  2. Mohan Pammi
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Muralidhar Premkumar wrote the first draft of the manuscript and Mohan Pammi provided critical intellectual input. Both authors approved the final version of the manuscript to be published.

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Correspondence to Mohan Pammi.

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Premkumar, M.H., Pammi, M. Probiotics in breast-fed healthy term infants: imperative or superfluous?. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04485-0

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