Probiotics for preventing necrotising enterocolitis in preterm neonates - The past, present, and the future

Although survival of very preterm neonates has improved in the surfactant era necrotizing enterocolitis (NEC) continues to be major cause of mortality and morbidity. Despite decades of research the pathogenesis of NEC is poorly understood. Historically, apart from antenatal glucocorticoids and postnatal preference to early feeding with human milk, neonatologists have had not many options to minimize the risk of NEC in preterm neonates. Probiotics supplementation has given a fresh outlook for prevention of NEC in preterm neonates. Evidence from many recent randomized controlled trials have shown that probiotics can significantly reduce the risk of NEC, all cause mortality and time to full feeds in preterm VLBW neonates. Some important issues need to be addressed (e.g. optimal strains, dose, and duration, combination of probiotic organisms) before this therapy becomes a safe routine in high-risk preterm neonates. This brief review covers the current evidence, and future for probiotic supplementation in preterm neonates.