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Probiotics for preterm neonates: what will it take to change clinical practice?

N Ofek Shlomai1, G Deshpande, S Rao

  • 1Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, W.A., Australia.

Neonatology
|November 28, 2013
PubMed

Insights

Probiotic supplementation significantly reduces the risk of necrotizing enterocolitis (NEC) and mortality in preterm infants. Despite strong evidence, routine use is delayed, urging faster adoption for improved infant outcomes.

Area of Science:

  • Neonatalogy
  • Gastroenterology
  • Pediatric Surgery

Background:

  • Necrotizing enterocolitis (NEC) is a severe condition in preterm infants, leading to high mortality and significant morbidity.
  • Infants requiring surgery for NEC face even higher mortality and long-term neurodevelopmental risks.

Purpose of the Study:

  • To evaluate the efficacy of probiotic supplementation in preventing NEC and reducing mortality in preterm infants.
  • To address the reluctance in adopting routine probiotic prophylaxis despite robust evidence.

Main Methods:

  • Systematic reviews of randomized controlled trials (RCTs) were analyzed.
  • Data from 25 RCTs (approx. 5,000 neonates) and routine use reports (approx. 3,000 neonates) were considered.

Main Results:

  • Probiotics significantly reduce NEC risk (RR 0.39) and all-cause mortality (RR 0.52) in preterm infants.
  • Adverse effects of probiotics are rare, and they facilitate enteral feeding.

Conclusions:

  • The evidence for probiotic supplementation in preventing NEC is conclusive and robust.
  • Routine probiotic prophylaxis should be adopted promptly to achieve zero tolerance for NEC, rather than awaiting further trials.

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