Do probiotics prevent necrotising enterocolitis in premature babies?

Bottom Line

Given the low to moderate certainty of evidence for the effects of probiotic supplements on the risk of NEC and associated morbidity and mortality for very preterm or very low birth weight (VLBW) infants, and particularly for extremely preterm or extremely low birth weight (ELBW) infants, there is a need for further large, high-quality trials to provide evidence of sufficient validity and applicability to inform policy and practice. Probiotics may reduce the risk of NEC (risk ratio (RR) 0.54, 95% confidence interval (CI) 0.46 to 0.65; I² = 17%; 57 trials, 10,918 infants; low certainty). (S1)

Cochrane (2023) rated this evidence low certainty.

The registry also contains 4 later systematic reviews or guidelines on this question (latest 2025). They are not summarised here; see the full list in Research Rail.

Sources

1. S1 Probiotics to prevent necrotising enterocolitis in very preterm or very low birth weight infants. Sharif S, Meader N, Oddie SJ et al. · 2023 Jul 26 · The Cochrane database of systematic reviews · Systematic review / meta-analysis

This report screened 41 items (39 research or guidance records, 2 community posts); the full list is available in Research Rail.