Probiotics: Nature’s Diaper Cream

Key Takeaways:

• Diaper rash is impacted by gut health and rising pH of stool.
• Evivo works with breast milk to reduce the pH of the gut, increasing the proportion of good bacteria.¹
• Reduced pH inactivates enzymes that contribute to diaper rash.
• Parents of babies who take Evivo report relief from diaper rash, decreased gas and fussiness, less loose or watery stools, and improved sleep.^3,4

Diaper rash is a common and difficult issue for newborns and their caregivers. While we usually recommend frequent diaper changes and barrier creams for prevention, researchers now believe that the microbiome and gut health may help in relieving diaper rash.

Gut health is a hot topic in newborn care, especially how probiotics influence the infant microbiome and can be a tool for clinicians starting in labor and delivery. One goal of probiotics is to seed, or colonize, the gut with good bacteria that can provide health benefits. Since newborns are born with relatively sterile GI tracts, choosing the correct species and strain of probiotic is essential to maximize benefit. For infants, the probiotic strain B. infantis EVC001 substantially and persistently replenishes good bacteria in the infant gut microbiome when consumed in combination with breast milk. This synergy maximizes infant nutrition and creates a protective environment in the baby’s gut.

Unfortunately, 90% of babies in the United States are missing B. infantis, likely due to the unintended impacts of modern hygiene and medical practices, including cesarean sections, antibiotics, and infant formula. This deficit contributes to gut bacterial imbalance (dysbiosis). Thankfully, researchers at the University of California – Davis were studying breast fed infants and developed a method to restore good bacteria with B. infantis through supplementation with Evivo, which is an infant probiotic containing the proprietary strain of B. infantis called EVC001. 100% of babies who received Evivo replenished the B. infantis in their guts, resulting in up to an 70% increase of good bacteria compared to exclusively breast-fed infants not receiving the probiotic.²

So how does restoring the microbiome impact diaper rash? Through reduction of the fecal pH. Current research shows a link between diaper rash and rising pH levels in baby poop. Higher pH environments allow for increased activity of digestive enzymes that contribute to skin breakdown. Over the last 100 years, the average fecal pH of breastfed infant stool has risen to 6.5 compared to a historic average of around 51; This means stool is more then 10 times less acidic than it used to be!

Evivo works by consuming special nutrients in breast milk called human milk oligosaccharides (HMOs) which are 15% of the solid component of breast milk and otherwise wasted by babies who lack B. infantis. B. infantis works by converting the HMOs to lactate and acetate, decreasing the pH of the gastrointestinal tract. A study by Frese et al. (2017) showed a significant difference in stool pH from 5.97 in the control group to 5.15 in babies who received B. infantis EVC001 for 21 days (p<0.01)². This decrease in pH promotes the growth of many good bacteria and inactivates digestive enzymes that contribute to skin irritation and subsequent diaper rash.

Stool quality can also impact skin breakdown. A phase one clinical trial by Smilowitz et al showed a decrease in the number of watery stools in babies receiving B. infantis EVC001 in Evivo compared to a control group3. In addition, the babies receiving Evivo had better formed stools and a reduction in the number of daily stools ³, which can also protect delicate infant skin.

As clinicians, we can appreciate the sentiment that “an ounce of prevention is worth a pound of cure” when it comes to the wellbeing of our patients. With the average newborn using up to 12 diapers per day, it’s no surprise that their little bums get irritated and excoriated. When mixed with breast milk and fed to baby daily, B. infantis EVC001 has been reported by parents to clear up diaper rash within days.4 Studies also show babies fed B. infantis EVC001 have less gas and fussiness, and improved sleep, so babies, and their caregivers, are more comfortable. ⁴

About the Author
Payal Adhikari, MD, Pediatrician, Clinical Implementation Director

Dr. Adhikari is a board-certified pediatrician and responsible for educating physicians and health systems about Infinant Health’s scientific mission, helping them adopt advances like Evivo to protect the most precious patients. Prior to medical school, Dr. Adhikari was a strategic consultant in the Healthcare division of Huron Consulting Group and later became a pediatrician in Chicago, IL. In addition to seeing patients, Dr. Adhikari enjoys spending time with her husband and two kiddos.

Citations

1. Henrick, Bethany M., et al. “Elevated fecal pH indicates a profound change in the breastfed infant gut microbiome due to reduction of Bifidobacterium over the past century.” MSphere 3.2 (2018): e00041-18.
2. Frese, et al. Persistence of supplemented Bifidobacterium longum subsp. infantis EVC001 in breastfed infants. MSphere 2.6 (2017): e00501-17.
3. Smilowitz, Jennifer T., et al. “Safety and tolerability of Bifidobacterium longum subspecies infantis EVC001 supplementation in healthy term breastfed infants: a phase I clinical trial.” BMC pediatrics 17.1 (2017): 1-11.
4. Dimitratos et al. Symptomatic relief from at-home use of activated Bifidobacterium infantis EVC001 probiotic in infants: results from a consumer survey on the effects on diaper rash, colic symptoms, and sleep. Benef Microbes. 2021:1-8. doi:10.3920/bm2020.0229.