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Types, Frequency, Duration, and Dosage of Probiotics to Prevent Necrotizing Enterocolitis in Preterm Infants Among Countries

Kutylowksi, Julie, MS, RD, CNSC; Yahia, Najat, PhD, RD, LD

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000605
Clinical Issues in Neonatal Care

Background: Probiotic use in the neonatal intensive care unit (NICU) has been linked to reduced rates of necrotizing enterocolitis in preterm infants. Currently, in the United States, probiotic use within the NICU is limited despite being commonly used in other countries.

Purpose: To provide an overview of the current practices of using probiotics in preterm infants for the prevention of NEC in the NICU in preselected countries.

Methods: A comprehensive literature search was conducted on PubMed and Also, studies from 2 recent meta-analyses on the topic were reviewed for inclusion. Selection criteria were as follows: studies involving preterm infants using probiotics in the NICU, reporting on the impact of probiotic use on the incidence of necrotizing enterocolitis, published within the last 10 years and in the English language, and originating from the United States, Canada, or any European country.

Results: Twenty-three studies were selected. The most common types of probiotics used were Bifidobacterium infantis and Lactobacillus rhamnosus. The most common frequency of administration was daily or twice day. Duration ranged from 10 days to the entire NICU stay. The dosage was commonly 1 billion colony-forming units daily but ranged from 12 million daily to 12 billion per kilogram daily.

Implications for Practice: Examining the current practices of probiotic use in the NICU provides useful information as this adjunctive therapy rises in popularity.

Implications for Research: Refining methods of probiotic research for necrotizing enterocolitis prevention will improve safety and effectiveness and provide a framework for future clinical trials.

Department of Human Environmental Studies, Central Michigan University, Mount Pleasant.

Correspondence: Julie Kutylowksi, MS, RD, CNSC, Department of Human Environmental Studies, Central Michigan University, 108 Wightman Hall, Mt Pleasant, MI 48859 (

The authors declare no conflicts of interest.

© 2019 by The National Association of Neonatal Nurses