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Larner College of Medicine Neonatologist Roger Soll, M.D., professor of pediatrics, and epidemiologist Erika Edwards, Ph.D., M.P.H., research associate professor of pediatrics, wrote an editorial to accompany a Canadian retrospective cohort showing that giving neonates probiotics decreased mortality in preterm and low-birth-weight infants even though it did not lower rates of conditions that often kill such babies, according to Inside Precision Medicine.

“The reported effectiveness of probiotic supplementation in infants less than 1,000 g birth weight and the rare cases of probiotic sepsis give some comfort to those choosing to use available probiotic agents,” Soll and Edwards wrote, “however, the exact species of probiotic and the role of breastfeeding (and possible improvements in how we obtain and feed breast milk to critically ill preterm infants) require further research … The evidence that we have made little if any improvement in the rates of [necrotizing enterocolitis] over the past decade adds urgency to the effort to find an effective product that will meet regulatory standards.”

Previous meta-analyses have shown reductions in necrotizing enterocolitis, mortality, and late-onset sepsis in very preterm infants given probiotics. However, the adoption of probiotics among neonatal intensive care units (NICUs) varies because of a lack of pharmaceutical-grade products, low to moderate certainty on efficacy, and potential for harm in the form of probiotic sepsis.