LIMITATIONS Heterogeneity of organisms and dosing regimens studied prevent a species-specific treatment recommendation from being made .
CONCLUSIONS Preterm infants benefit from probiotics to prevent severe NEC and death
CONTEXT Necrotizing enterocolitis ( NEC ) is the most frequent gastrointestinal emergency in neonates .
The microbiome of the preterm gut may regulate the integrity of the intestinal mucosa .
Probiotics may positively contribute to mucosal integrity , potentially reducing the risk of NEC in neonates .
OBJECTIVE To perform an up date d systematic review and meta- analysis on the efficacy and safety of probiotics for the prevention of NEC in premature infants .
Role of probiotics VSL#3 in prevention of suspected sepsis in low birthweight infants in India: a randomised controlled trial
Objectives To assess the effect of the probiotic VSL#3 in prevention of neonatal sepsis in low birthweight ( LBW ) infants . Design R and omised , double-blind , placebo-controlled trial . Setting Community setting in rural India . Participants LBW infants aged 3–7 days . Interventions Infants were r and omised to receive probiotic ( VSL#3 , 10 billion colony-forming units ( cfu ) ) or placebo for 30 days , and were followed up for 2 months . Main outcome measure Possible serious bacterial infection ( PSBI ) as per the Integrated Management of Neonatal Childhood Illnesses algorithm , as diagnosed by fieldworkers/physicians . Results 668 infants were r and omised to VSL#3 and 672 to placebo .  By intention-to-treat analysis , the risk of PSBI among infants in the overall population of LBW infants was not statistically significant ( RR 0.79 ( 95 % CI 0.56 to 1.03 ) ) . Probiotics  reduced median days of hospitalisation ( 6 days vs 3 days in probiotics ) ( p=0.018 ) but not the risk of hospitalisation ( RR 0.66 ( 95 % CI 0.42 to 1.04 ) . The onset of PSBI in 10 % of infants occurred on the 40th day in the probiotics arm versus the 25th day in the control arm ( p=0.063 ) . Conclusions Daily supplementation of LBW infants with probiotics VSL#3 ( 10 billion cfu ) for 30 days led to a non-significant 21 % reduction in risk of neonatal sepsis . A larger study with sufficient power and a more specific primary end point is warranted to confirm the preventive effect of VSL#3 on neonatal sepsis in LBW infants . Trial registration number The study is registered at the Clinical Trial Registry of India ( CTRI/2008/091/000049 )
LIMITATIONS Heterogeneity of organisms and dosing regimens studied prevent a species-specific treatment recommendation from being made .
CONCLUSIONS Preterm infants benefit from probiotics to prevent severe NEC and death
CONTEXT Necrotizing enterocolitis ( NEC ) is the most frequent gastrointestinal emergency in neonates .
The microbiome of the preterm gut may regulate the integrity of the intestinal mucosa .
Probiotics may positively contribute to mucosal integrity , potentially reducing the risk of NEC in neonates .
OBJECTIVE To perform an up date d systematic review and meta- analysis on the efficacy and safety of probiotics for the prevention of NEC in premature infants .