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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. Reference 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