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Effect of Probiotic Supplementation in Preventing Necrotizing Enterocolitis Sepsis and Mortality Among Preterm and

Hamdah T Kalantar1, Sara Galadari2, Ahmad Tariq Kalantar3

  • 1Medicine and Surgery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, ARE.

Cureus
|November 18, 2025
PubMed

Insights

Probiotic supplementation in preterm infants significantly reduces necrotizing enterocolitis (NEC) and improves feeding tolerance and hospital outcomes. Multi-strain probiotics show greater efficacy, though mortality remains unaffected.

Area of Science:

  • Neonatalogy
  • Microbiology
  • Gastroenterology

Background:

  • Preterm and VLBW infants possess immature gut barriers, dysbiosis, and underdeveloped immunity, increasing vulnerability to NEC and sepsis.
  • Necrotizing enterocolitis (NEC) and late-onset sepsis are major contributors to morbidity and mortality in vulnerable infant populations.
  • Probiotic supplementation is explored to restore gut microbial balance and enhance gastrointestinal maturation.

Purpose of the Study:

  • To systematically review the impact of probiotics on NEC, sepsis, mortality, feeding tolerance, and hospitalization in preterm and VLBW infants.
  • To evaluate clinical trends and strain-specific efficacy of probiotic interventions.
  • To assess related physiological outcomes, including inflammatory and metabolic markers.

Main Methods:

  • Systematic literature review adhering to PRISMA guidelines.
  • Inclusion of studies examining probiotic interventions in preterm or VLBW populations.
  • Narrative synthesis of extracted data on primary (NEC, sepsis, mortality) and secondary outcomes.

Main Results:

  • Multi-strain probiotics consistently reduced NEC incidence and improved feeding tolerance, accelerating oral feeding and shortening hospitalization.
  • Selected probiotics lowered C-reactive protein and total serum bilirubin, indicating systemic benefits.
  • Single-strain probiotics showed variable efficacy, and mortality outcomes were consistently unaffected by probiotic interventions.

Conclusions:

  • Probiotics are safe and offer clinically significant benefits for preterm and VLBW infants, especially in NEC prevention and improving feeding and hospital outcomes.
  • Multi-strain probiotic formulations appear more effective than single-strain options.
  • Strain selection is crucial for optimizing therapeutic outcomes in probiotic interventions for vulnerable infants.

Keywords:
feeding tolerancegut microbiotahospitalizationinflammationnecpreterm infantsprobioticssepsis

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