Probiotic Therapy for Prevention of Necrotizing Enterocolitis in Preterm Infants – A Review

Purpose: Preterm infants are prone to systemic infections due to increased intestinal permeability to potentially pathogens resulting from immature intestinal function, frequent use of broad-spectrum antibiotics, delay in initiating enteral feeding, infection control procedures and sterilization of milk. Very Low Birth Weight infants, particularly Extremely Low Birth Weight infants are at higher risk due to abnormal pattern of colonization, which may contribute to the pathogenesis of neonatal Necrotizing Enterocolitis (NEC). Dietary intervention through probiotic supplementation is widely adopted for the prophylaxis of NEC and nosocomial infections throughout the world. Design/Methodology/Approach: This review paper is based upon systematic review of randomized controlled trials, metaanalyses, research papers and books related to the short and longterm administration of single or mixed probiotic cultures for the prevention of NEC only in preterm infants. Clinical trials and cohort studies concerning manipulation of the intestinal microbiota in premature infants are also included. Evidence based data published in the English language retrieved from three databases Pub Med, Science Direct and Cochrane Reviews, published in The Cochrane Library from 2000-2016, using a combination of key words like necrotizing enterocolitis, probiotics and preterm infants have been considered. Findings: All probiotic strains are not equally efficacious for preventing NEC and application of probiotic combinations may be advantageous. Due to heterogeneity of probiotic formulations exclusive administration of probiotics in premature infants is not recommended and should be introduced along with breast milk as routine clinical practice for neonatal health care. Originality/Value: Probiotic foods have been found effective in modulating gastrointestinal flora to prevent NEC but safety aspects must be evaluated prior to consideration of probiotic therapy for preterm infants and neonates.