{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:28:15Z","timestamp":1791404895447,"version":"4.3.3"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health with \u201cCurrent Research funds\u201d"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Pediatric Short bowel syndrome (SBS) is the leading cause of intestinal failure and is characterized by persistent dysbiosis that negatively impacts intestinal adaptation and growth. Although microbiota modulation via pre-, pro-, and synbiotics represents a promising strategy, current evidence remains fragmented. This narrative review aims to critically assess the efficacy and safety of such interventions in the management of pediatric SBS. Methods: A structured literature search was conducted on PubMed up to November 2025. Fourteen relevant studies were included, comprising clinical trials, preclinical animal models, and significant case reports regarding the use of biotics in SBS. Results: The analysis reveals a microbiological dichotomy based on nutritional status: parenteral nutrition (PN)-dependent patients exhibit an excess of Proteobacteria associated with infectious risk, whereas weaned patients present a metabolic risk of D-lactic acidosis due to carbohydrate fermentation. Regarding efficacy, long-term synbiotic treatments (&gt;12 months) demonstrated significant improvements in growth and nutritional status, likely mediated by increased production of short-chain fatty acids (SCFAs) and mucosal adaptation, unlike short-term probiotic cycles. However, serious adverse events (Lactobacillus sepsis and D-lactic acidosis) were reported, predominantly in patients with central venous catheters or malabsorption. Conclusions: Biotics offer therapeutic potential for intestinal failure, but their use cannot be empirical. The safety profile should be carefully selected, especially in central venous catheter (CVC) carriers. Future strategies must evolve towards precision medicine, prioritizing non-D-lactate-producing strains and personalized protocols based on the patient\u2019s nutritional phase.<\/jats:p>","DOI":"10.3390\/children13030349","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T14:55:01Z","timestamp":1772463301000},"page":"349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Pre-, Pro-, Post- and Synbiotics in Pediatric Short Bowel Syndrome: A Narrative Review of Current Evidence"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2875-2804","authenticated-orcid":false,"given":"Roberta Giusy","family":"Ruiz","sequence":"first","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"},{"name":"Department of Paediatrics, Universit\u00e0 Cattolica del Sacro Cuore, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9052-0266","authenticated-orcid":false,"given":"Annalisa","family":"Morelli","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"},{"name":"Department of Medicine, Surgery and Dentistry \u201cScuola Medica Salernitana\u201d, Pediatrics Section, University of Salerno, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3805-8192","authenticated-orcid":false,"given":"Rosangela","family":"Grieco","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"},{"name":"Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza-University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2912-3154","authenticated-orcid":false,"given":"Sabrina","family":"Cardile","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2464-0913","authenticated-orcid":false,"given":"Teresa","family":"Capriati","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3869-1815","authenticated-orcid":false,"given":"Chiara Maria","family":"Trovato","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6929-3943","authenticated-orcid":false,"given":"Giulia","family":"Bolasco","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5343-2080","authenticated-orcid":false,"given":"Daniela","family":"Knafelz","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiammetta","family":"Bracci","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8561-1868","authenticated-orcid":false,"given":"Arianna","family":"Alterio","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3926-0729","authenticated-orcid":false,"given":"Antonella","family":"Diamanti","sequence":"additional","affiliation":[{"name":"Digestive Diseases and Nutritional Rehabilitation Unit, Nutritional Treatments of Complex Diseases Research Unit, Bambino Ges\u00f9 Children\u2019s Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1097\/MPG.0b013e3181819007","article-title":"Overview of pediatric short bowel syndrome","volume":"47","author":"Duro","year":"2008","journal-title":"J. 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