Probiotics, Prebiotics, and Synbiotics for Preterm Neonates

Abstract

Probiotics have been extensively studied in neonates over the past several decades. Multiple meta-analyses have found probiotics to be effective at decreasing the number of necrotizing enterocolitis incidents. While relatively few NICUs in the United States are routinely using probiotics, many NICUs around the world have been doing so for more than a decade. The barriers to the routine use of probiotics include safety concerns and the lack of a clear consensus on the preferred formulation, dosage, and duration. Further research must be done to determine the safest and most effective formulation. This article discusses the history of probiotics, mechanisms of protection, available clinical evidence, and barriers to the use of probiotics in neonates. This review also addresses the current state of evidence regarding the naturally occurring substances called prebiotics, which can be added to formulas in the form of a supplement to promote intestinal colonization with commensal organisms, and synbiotics, which are combination products containing both probiotic cultures and prebiotic substrates.