Related Experiment Video
Updated: Sep 14, 2025
Probiotic Studies in Neonatal Mice Using Gavage
Published on: January 27, 2019
Description of probiotic use in preterm infants in England and Wales 2016-2022
Alice Aveline1,2, Lisa Szatkowski3, Janet Berrington4,5
1Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK aa2522@ic.ac.uk.
Insights
Probiotic use in preterm infants increased significantly, with over half receiving them by 2022. However, some infants in probiotic units did not receive them, highlighting variability in care for premature infants.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Microbiome Research
Background:
- Probiotics are increasingly used in neonatal units for preterm infants.
- Understanding current probiotic usage patterns and influencing factors is crucial for optimizing care.
- Variability in probiotic administration may impact outcomes for vulnerable infants.
Purpose of the Study:
- To describe the current use of probiotics in preterm infants (<32 weeks gestational age) in neonatal units.
- To explore factors associated with probiotic exposure and non-exposure in this population.
- To provide data for future research on probiotic safety and efficacy in neonates.
Main Methods:
- An observational study utilizing prospectively recorded health data from England and Wales.
- Included 48,048 infants born at <32 weeks gestational age admitted to neonatal units (2016-2022).
- Analyzed probiotic use, timing of initiation, discontinuation, and factors influencing administration.
Main Results:
- Probiotic use rose from 9% to 54% between 2016 and 2022.
- Probiotics were initiated around postnatal day 5, earlier for more mature infants, and often after enteral feeds.
- 23% of infants in 'probiotic units' did not receive probiotics, often due to lower gestational age or higher illness severity.
Conclusions:
- Over half of very preterm infants received probiotics by 2022, but significant variation in use persists.
- Nearly a quarter of infants in high-usage units did not receive probiotics, indicating potential disparities in care.
- Findings inform interpretation of observational data and guide future clinical trials on probiotics for preterm infants.
Objective:
To describe the use of probiotics among preterm infants in neonatal units and explore factors that influence exposure.
Design:
Observational study using prospectively recorded health data.
Setting:
England and Wales.
Patients:
48 048 infants born at <32 weeks gestational age (GA) and admitted to a neonatal unit between 1 January 2016 and 31 December 2022.
Main Outcome Measures:
Measures of probiotic use (number and proportion of infants exposed to probiotics, postnatal age of first probiotic exposure and discontinuation).
Results:
The proportion of infants who received probiotics increased from 9% to 54% over the study period. Median GA of infants given probiotics was 29+3 weeks (IQR 27+3-30+6). Probiotics were started on median day 5 (IQR 2-8), earlier for those born at >28 weeks GA (median day 4, IQR 2-7), most frequently after enteral feeds (66% of exposed infants) and were usually discontinued between 32 and 36 weeks postmenstrual age (PMA) (47% at 32+0-33+6 weeks PMA, 33% at 34+0-35+6 weeks PMA). Among infants cared for in probiotic neonatal intensive care units (defined as units where 50% or more infants born <32 weeks gestation were exposed to probiotics), 23% were never given probiotics. Infants from whom probiotics were withheld had a lower gestational age, lower birth weight z score and higher illness severity score or were more mature.
Conclusions:
By 2022, over half of infants born at <32 weeks GA were exposed to probiotics, but almost one quarter did not receive them despite being in a probiotic unit. Our findings help inform the interpretation of observational data and the design of future studies addressing the continued uncertainty around the safety and efficacy of probiotics.
