Safety and efficacy of probiotic administration to preterm infants: ten common questions

Area of Science:

• Neonatal Medicine
• Microbiome Research
• Gastroenterology

Background:

• Necrotizing enterocolitis (NEC), death, and sepsis are significant risks for preterm infants.
• Extensive research, including >50,000 infants across 29 countries, supports probiotic benefits.
• Despite evidence, routine prophylactic probiotic use in preterm infants is not widespread globally.

Purpose of the Study:

• To summarize probiotic-specific discussions from the 2019 NEC Society Symposium.
• To address common questions regarding the intestinal microbiome and probiotic administration in preterm infants.
• To incorporate recent strain-specific analyses and ESPGHAN guidelines.

Main Methods:

• Review of talks from the 2019 NEC Society Symposium.
• Inclusion of a recent strain-specific network analysis.
• Consideration of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) position statement.

Main Results:

• Prophylactic probiotics demonstrate a decreased risk of necrotizing enterocolitis, death, and sepsis in preterm infants.
• Evidence from numerous randomized controlled trials and observational studies supports efficacy.
• Strain-specific analyses and expert guidelines provide further context.

Conclusions:

• Routine prophylactic probiotic administration should be considered for preterm infants based on demonstrated benefits.
• Addressing knowledge gaps and promoting evidence-based practices are crucial for wider adoption.
• Further research and guideline dissemination can improve outcomes for vulnerable neonates.