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Updated: Jan 4, 2026
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Published on: January 27, 2019
Incidence of necrotising enterocolitis before and after introducing routine prophylactic Lactobacillus and
Claire Robertson1,2, George M Savva3, Raducu Clapuci1
1Neonatal Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Insights
Routine daily multistrain probiotics significantly reduced necrotising enterocolitis (NEC) and late-onset sepsis in high-risk neonates. This intervention demonstrated a notable decrease in NEC rates, improving outcomes for vulnerable infants.
Area of Science:
- Neonatal Intensive Care
- Microbiome Research
- Pediatric Gastroenterology
Background:
- Necrotising enterocolitis (NEC) and late-onset sepsis are significant causes of morbidity and mortality in high-risk neonates.
- Current preventative strategies have limitations, necessitating novel therapeutic approaches.
Purpose of the Study:
- To evaluate the impact of routine daily multistrain probiotics on NEC, late-onset sepsis, and mortality rates.
- To compare outcomes in high-risk neonates before and after the implementation of probiotic therapy.
Main Methods:
- A single-centre retrospective observational study was conducted over a 10-year period (2008-2017).
- High-risk preterm neonates (<32 weeks gestation or <1500g birth weight) were included.
- Multistrain probiotics (initially dual-species, later triple-species) were administered daily after January 2013.
Main Results:
- NEC rates decreased significantly from 7.5% to 3.1% post-probiotic implementation (p=0.014).
- Late-onset sepsis incidence fell from 22.6% to 11.5% (p<0.0001).
- All-cause mortality showed a downward trend, though not statistically significant after adjustment.
Conclusions:
- Routine administration of multispecies Lactobacillus and Bifidobacterium probiotics is associated with a significant reduction in NEC and late-onset sepsis.
- The study found no safety concerns related to probiotic use.
- These findings support the routine use of combination probiotics for NEC prevention in very preterm infants.
Objective:
To compare rates of necrotising enterocolitis (NEC), late-onset sepsis, and mortality in 5-year epochs before and after implementation of routine daily multistrain probiotics administration in high-risk neonates.
Design:
Single-centre retrospective observational study over the 10-year period from 1 January 2008 to 31 December 2017.
Setting:
Level 3 neonatal intensive care unit (NICU) of the Norfolk and Norwich University Hospital, UK.
Patients:
Preterm neonates at high risk of NEC: admitted to NICU within 3 days of birth at <32 weeks' gestation or at 32-36 weeks' gestation and of birth weight <1500 g.
Intervention:
Prior to 1 January 2013 probiotics were not used. Thereafter, dual-species Lactobacillus acidophilus and Bifidobacterium bifidum combination probiotics were routinely administered daily to high-risk neonates; from April 2016 triple-species probiotics (L. acidophilus, B. bifidum, and B. longum subspecies infantis) were used.
Main Outcome Measures:
Incidence of NEC (modified Bell's stage 2a or greater), late-onset sepsis, and mortality.
Results:
Rates of NEC fell from 7.5% (35/469 neonates) in the pre-implementation epoch to 3.1% (16/513 neonates) in the routine probiotics epoch (adjusted sub-hazard ratio=0.44, 95% CI 0.23 to 0.85, p=0.014). The more than halving of NEC rates after probiotics introduction was independent of any measured covariates, including breast milk feeding rates. Cases of late-onset sepsis fell from 106/469 (22.6%) to 59/513 (11.5%) (p<0.0001), and there was no episode of sepsis due to Lactobacillus or Bifidobacterium. All-cause mortality also fell in the routine probiotics epoch, from 67/469 (14.3%) to 47/513 (9.2%), although this was not statistically significant after multivariable adjustment (adjusted sub-hazard ratio=0.74, 95% CI 0.49 to 1.12, p=0.155).
Conclusions:
Administration of multispecies Lactobacillus and Bifidobacterium probiotics has been associated with a significantly decreased risk of NEC and late-onset sepsis in our neonatal unit, and no safety issues. Our data are consistent with routine use of Lactobacillus and Bifidobacterium combination probiotics having a beneficial effect on NEC prevention in very preterm neonates.
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