Preemies Benefit From Probiotics: Prevent Necrotising Enterocolitis

Researchers have investigated the benefits of lactobacillus and other probiotics for preemies.  Image by Bob Blaylock

Researchers have investigated the benefits of lactobacillus (shown here) and other probiotics for preemies. Image by Bob Blaylock

3-10% of premature infants develop necrotising entercolitis (NEC), which starts out as inflammation of the gastrointestinal wall, and leads to decreased blood flow and subsequently could severely damage the intestinal walls. Researchers have found that probiotics may be the answer for babies with NEC.

Probiotics are cultures of ‘friendly’ bacteria, normally found in human digestive systems, which help to maintain a good balance of microflora in the gut. Probiotics use what is natural to the body, i.e. bacteria, to treat bodily disorders, so they are effective in restoring the normal balance.

What Causes Necrotising Enterocolitis?

Researchers believe that low birth weight, premature birth, frequent enteral (tube) feeding, use of high calorie formula, use of antibiotics, and compromised immunity of infants are responsible for NEC.

Unfortunately, while full-term infants have a normal composition of microflora in their gut, preemies possess distinct, and an incomplete set, of beneficial microflora, which renders them more prone to developing NEC.
Several groups of researchers have tested out different strains of bacteria, mainly Lactobacillus and Bifidobacterium, in an effort to prevent the occurrence of NEC in the premature infants.  The goal is to help the premature infants establish intestinal flora similar to full-term infants, with the administration of probiotics.
Pre-term infants with NEC exhibit delayed development, have low tolerance to subsequent enteral feedings, have decreased growth and nutritional deficiencies. The use of antibiotics in prolonged hospital stays only makes the cases more challenging to treat.

Probiotics in Pre-term Infants: Testing

Several studies have shown that probiotics, when given to premature infants within the first 24 hrs, are very beneficial: The colonization of intestine with friendly bacteria happens sooner, and the infants are able to feed better. All previous studies have worked on different strains of the good bacteria, so more studies are required to find a common unifying regimen for administering the right probiotics.

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In this current study, Mr. Underwood and his group have compared the effects of two strains of Bifidobacterium, B. infantis and B. lactis. The B. infantis strain possesses the enzymes to process the products of human milk derived diets, while the B. lactis cannot.

Power of Mother’s Milk to Infants

Dr. Underwood told Decoded Pregnancy that B. infantis was more effective than B. lactis in increasing the colonization of microflora in both formula-fed and mother’s milk-fed infants. The positive effect of probiotics was more pronounced in breast milk-fed infants, demonstrated by an increase in good fecal bacteria and a decrease in the bad bacteria like g-proteobacteria.

The great benefits of human breast milk just seem to be piling up. All the more reason for advocating breastfeeding for all infants, the lactation consultants would say.

Future of Probiotics in NEC

Having proven in this preliminary study, that B. infantis shows promise in prevention of NEC, Dr. Underwood hopes to follow this up with an extensive multi-center trial of testing out B. infantis and placebo controls in NEC. This current study has its limitations: small sample size that could not take into account the confounding effects of antibiotic administration, delivery mode, start of feeding or skin-to-skin time.

Preemies and Probiotics: More Research Necessary

In premature infants, who are most delicate and precious, probiotic use could reduce NEC and improve the health of the preemies. For these babies, probiotics are all about the right proportions: Dose, combination, formulation of bacterial strains and delivery mode work together to improve intestinal health.


Underwood MA, Kalanetra KM, Bokulich NA, Lewis ZT, Ryazantseva M, Mirmiran M, Tancredi DJ and Mills DA. A comparison or two probiotic strains of bifidobacteria in premature infants. (2013). Pediatrics. Accessed October 21, 2013.

Anderson T, Lord A, Shotkoski N and O’Keefe C. The use of probiotics for the preventions of NEC in the premature infant. (2009). ICAN: Infant, Child and Adolescent nutrition. 2009. 1: 246. Accessed October 21, 2013.

Song D, Ibrahim S and Hayek S. Recent application of probiotics in food and agricultural science. (2012). Intech. Accessed October 21, 2013.

Niekerk V. Probiotics in premature infants: focus on necrotizing enterocolitis. [PDF] (2011). South African Journal of Clinical Nutrition. Accessed October 21, 2013.

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