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Oral probiotics prevent NEC in VLBWI


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A recent CT published in Pediatrics. 2008 Oct;122(4):693-700, demonstrated the efficacy of oral probiotics in prevention of NEC.

Oral probiotics prevent necrotizing enterocolitis in very low birth weight preterm infants: a multicenter, randomized, controlled trial.

Lin HC, Hsu CH, Chen HL, Chung MY, Hsu JF, Lien RI, Tsao LY, Chen CH, Su BH.

OBJECTIVE: The goal was to investigate the efficacy of orally administered probiotics in preventing necrotizing enterocolitis for very low birth weight preterm infants. METHODS: A prospective, blinded, randomized, multicenter controlled trial was conducted at 7 NICUs in Taiwan, to evaluate the beneficial effects of probiotics in necrotizing enterocolitis among very low birth weight infants (birth weight: <1500 g). Very low birth weight infants who survived to start enteral feeding were eligible and were assigned randomly to 2 groups after parental informed consent was obtained. Infants in the study group were given Bifidobacterium bifidum and Lactobacillus acidophilus, added to breast milk or mixed feeding (breast milk and formula), twice daily for 6 weeks. Infants in the control group were fed with breast milk or mixed feeding. The clinicians caring for the infants were blinded to the group assignment. The primary outcome measurement was death or necrotizing enterocolitis (Bell's stage >or=2). RESULTS: Four hundred thirty-four infants were enrolled, 217 in the study group and 217 in the control group. The incidence of death or necrotizing enterocolitis (stage >or=2) was significantly lower in the study group (4 of 217 infants vs 20 of 217 infants). The incidence of necrotizing enterocolitis (stage >or=2) was lower in the study group, compared with the control group (4 of 217 infants vs 14 of 217 infants). No adverse effect, such as sepsis, flatulence, or diarrhea, was noted. CONCLUSION: Probiotics, in the form of Bifidobacterium and Lactobacillus, fed enterally to very low birth weight preterm infants for 6 weeks reduced the incidence of death or necrotizing enterocolitis.

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No, still we lack safety and long term outcomes according to last cochrane review (Alfaleh 2008)

I hear that there is follow up data at 2 years of age shows some increase of allergy in those feed with probiotics, any one come accross these data?

Jasim Anabrees


Riyadh, KSA

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  • 2 years later...
  • 2 weeks later...

Sounds interesting with a catchy title

Myth: Necrotizing enterocolitis: Probiotics will end the disease, and surgical intervention improves the outcome.

Caplan M, Frost B. Myth: Necrotizing enterocolitis: Probiotics will end the disease, and surgical intervention improves the outcome. Semin Fetal Neonatal Med. 2011 Apr 7. [Epub ahead of print] PubMed PMID: 21482212.


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The most recent Cochrane review (2011) evaluated recent research studies to determine if probiotics are associated with a decrease in necrotizing entercolitis or NEC. Cochrane’s meta-analysis concluded that use of lactoferrin alone reduced late on-set sepsis in infants weight less than 1000 grams, when compared to feedings of exclusive human milk alone.

There was also a significant decrease in late on-set sepsis when human milk feedings were supplemented with lactoferrin and lactobacillus rhamnosus.

However, lactoferrin given alone did not decrease the incidence of NEC. But when lactoferrin is paired with lactobacillus rhamnosus and human breast milk feedings, a reduction in NEC is seen. Studies state that no adverse effects were seen, but that long term neurological outcomes were not assessed.


Pammi M, Abrams SA. Oral lactoferrin for the prevention of sepsis and necrotizing enterocolitis in preterm infants. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007137. DOI: 10.1002/14651858.CD007137.pub3

Cochrane Review of Probiotics and NEC

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