Effectiveness of Probiotics on Necrotizing Enterocolitis in Preterm Infants: A Narrative Review

Abstract

Background: Necrotizing enterocolitis (NEC) is a devastating gastrointestinal emergency predominantly affecting preterm infants, contributing significantly to mortality and morbidity in neonatal intensive care units. Given the limitations of current treatments, the exploration of prophylactic strategies, including probiotic supplementation to modulate gut microbiota, has become a key area of research. Objective: This narrative review critically evaluates the evidence on the efficacy of probiotics in the prevention and treatment of NEC in preterm and very low birth weight (VLBW) infants. Methods: A systematic search was conducted in PubMed, Web of Science, and Google Scholar for articles published. Keywords included "Necrotizing enterocolitis," "Probiotics," and "prematurity." The review included peer-reviewed, full-text randomized controlled trials (RCTs) focusing on preterm infants and assessing the role of probiotics on NEC incidence, severity, and related outcomes. Seven RCTs met the final inclusion criteria. Results: The synthesis of seven RCTs revealed that five demonstrated a significant beneficial effect of probiotic prophylaxis. These studies reported a marked reduction in the incidence and severity of NEC, along with secondary benefits such as lower mortality, reduced sepsis, faster achievement of full enteral feeding, and shorter hospital stays. The most consistent positive outcomes were associated with formulations containing Bifidobacterium species (e.g., B. infantis, B. lactis), alone or in combination with Lactobacillus acidophilus. In contrast, two trials found no significant reduction in NEC incidence with Lactobacillus sporogenes or Saccharomyces boulardii, indicating that the benefits are likely strain-specific. Conclusion: The current evidence suggests that prophylactic supplementation with specific probiotics, particularly Bifidobacterium-based formulations, is effective in reducing the incidence and severity of NEC in preterm and VLBW infants. However, efficacy is not universal across all probiotic strains. Future research should focus on standardizing optimal strains, dosages, and treatment protocols, and include long-term safety and outcome assessments to guide definitive clinical practice recommendations.