Authors' conclusion: enteral supplementation of probiotics prevents severe necrotizing enterocolitis and all cause mortality in preterm infants. Our updated review of available evidence supports a change in practice. More studies are needed to assess efficacy in extremely low birth weight infants and assess the most effective formulation and dose to be utilized.
Reviewers' commentary: this systematic review provides high quality evidence with low possibility of future change regarding the strong recommendation for routinely providing probiotics to the premature infants in the neonatal intensive care units for diminishing the risk of severe necrotizing enterocolitis. In any neonatal intensive care unit with a 10% prevalence of necrotizing enterocolitis, 16 premature infants would have to be treated to prevent one death, and 17 to prevent one necrotizing enterocolitis stage II or III. More studies are needed to ascertain specific doses, formulation and effects in those extremely low birth weight infants, as well as economic analyses to determine its cost-effectiveness in different health systems. With current evidence, it should be strongly considered to routinely provide probiotics to premature babies.