Probiotic Supplementation for Preterm Neonates--What Lies Ahead?

Systematic reviews of randomized controlled trials indicate that probiotic supplementation significantly reduces the risk of necrotizing enterocolitis (NEC) without adverse effects in preterm very-low-birthweight neonates. A change in practice in favor of probiotic supplementation is justified considering the health burden of NEC in this population. The reduction in the risk of NEC seems to occur even when the baseline incidence of the illness is as low as 5%. Facilitation of feed tolerance is a significant benefit of probiotics considering that optimizing enteral nutrition is a priority in extremely preterm neonates, including those with intrauterine growth restriction, who are at a higher risk for feed intolerance and NEC. The increasing number of reports on routine use of probiotics indicates that difficulty in accessing clinically proven and safe probiotic products is not a significant barrier towards a change in practice. Strategies to address important gaps in knowledge and the impact of routine use of probiotic supplementation are reviewed to prepare for what lies ahead in this field.