Probiotics for prevention of necrotizing enterocolitis: a systematic review of current evidences

Results We analyzed 20 manuscripts (13 Randomized clinical trial and 7 Meta-analysis) that were published from 2005 to 2014 and that analyze 3025 neonates. Analysis of the best evidences revealed that probiotics may have beneficial effects in the prevention of NEC, however current studies have failed to control for numerous confounding variables such as breast feeding rates, antibiotic exposure, feeding practices, and environmental crosscontamination. The incidence of NEC (stage > 2) was significantly lowered only in infants weighing 1001 to 1500 g. Thus, there is not enough evidence to support the efficacy of probiotics in extremely low birth-weight infants, and future well-designed studies are needed. Trials performed at institutions with high NEC rates have observed significant benefit from probiotics, while those institutions with low NEC rates have shown limited effects. Multistrain probiotics may be more effective than single-strain products. Currently, data from about 3000 neonates indicates that significant adverse effects of probiotics are rare.