Probiotics in preterm infants

Preterm infants are prone to delayed gastrointestinal colonization, reduced microbial diversity in the bowel, acquisition of antibiotic-resistant strains, loss of strains associated with antibiotic treatment, and increased intestinal bacterial translocation. These effects make the preterm infant more susceptible to antibiotic-resistant infections, systemic inflammatory response syndrome, and necrotizing enterocolitis (NEC). Meta-analysis of the available double-blinded controlled randomized trials supports the hypothesis that probiotics accelerate early enteral feeding advancement and reduce morbidity and mortality. Although these results are promising, large trials are required in the future to prove these effects. Currently, the most effective probiotic or combination of probiotics, dosage and timing are unknown. Efficacy and safety need to be established for each product. There is currently insufficient data available to recommend the routine use of probiotics in preterm infants.