Oral probiotics prevent necrotizing enterocolitis in very low birth weight neonates

Objective To test the hypothesis that normalizing the intestinal flora by administration of prophylactic probiotics would provide a natural defense, thereby reducing both the incidence and severity of necrotizing enterocolitis (NEC) in preterm neonates. Study design Neonates : 1500 g birth weight were randomized to either receive a daily feeding supplementation with a probiotic mixture (Bifidobacteria infantis, Streptococcus thermophilus, and Bifidobacteria bifidus; Solgar, Israel) of 109 colony forming units (CFU)/day or to not receive feed supplements. NEC was graded according to Bell's criteria. Results For 72 study and 73 control infants, respectively, birth weight (1152 +/- 262 g vs 1111 +/- 278 g), gestational age (30 3 weeks vs 29 4 weeks), and time to reach full feeds (14.6 +/- 8.7 days vs 17.5 +/- 13.6 days) were not different. The incidence of NEC was reduced in the study group (4% vs 16.4%; P =.03). NEC was less severe in the probiotic-supplemented infants (Bell's criteria 2.3 +/- 0.5 vs 1.3 +/- 0.5; P =.005). Three of 15 babies who developed NEC died, and all NEC-related deaths occurred in control infants. Conclusion Probiotic supplementation reduced both the incidence and severity of NEC in our premature neonatal population.