The use of probiotics in the Neonatal Unit

What are probiotics?

Normally, our intestines are full of ‘friendly’ bacteria, which help to keep the bowel healthy. When infants are born prematurely, they do not have the same quantity or range of ‘friendly’ bacteria. This can lead to the multiplication of less ‘friendly’ bacteria within the bowel (intestines), which, in turn, can put them at risk of developing a disease called necrotising enterocolitis (NEC).

NEC is a condition that mainly affects premature infants. It affects the intestines and, when severe, can be life threatening. There are many factors involved in its development, but we know that the type of bacteria in the intestines plays a key role.

Probiotics are live, ‘friendly’ bacteria, given to babies to grow in their intestines. This helps to stop more ‘unfriendly’ bacteria from growing out of control.

Research studies have shown that giving probiotics to premature infants can reduce their risk of developing NEC. They may also help prevent other bloodstream infections and improve overall survival.

Probiotics are not medicines; under the UK law they are classed as food supplements. However, the probiotic preparation used in the Rosie neonatal intensive care unit (NICU) is produced under the same standards as medicines to ensure its safety and quality.

Are there any side effects?

Multiple clinical trials have shown that probiotics are safe to use in preterm infants. There is a very small risk that the use of probiotics may cause an infection in some preterm infants; however, if this happens, the infection can be treated with antibiotics.

It is important to understand that the risk of infection from the use of probiotics is much smaller than the risks associated with the development of NEC. In other words, the benefits of giving probiotics outweigh the risks.

How and when are probiotics given?

We will start probiotics when your baby is ready to commence feeding and continue until they are around 34 weeks corrected age, by which point the risk of NEC is much reduced and there is little further benefit of giving probiotics. The dose comes in a powder form, is mixed with a small amount of water and given via your baby’s nasogastric tube once a day.

Can I decline the use of probiotics?

Yes, you can choose not to allow your baby to receive probiotics, and you can change your mind at any time.

Will my baby not receive friendly bacteria from their milk feeds?

Breastmilk can help to provide ‘friendly’ bacteria and this is one of the reasons why we encourage mothers to try to express breast milk if possible. The benefits of probiotics are in addition to the known benefits of breastmilk. Preterm formulas do not contain probiotics.

What if I have further questions?

If you have any further questions, please ask a member of staff.

References/sources of evidence

Probiotics for Preterm Infants: ESPGHAN Committee Position Paper, JPGN Volume 70, Number 5, May 2020