Table 1: Clinical trials of probiotics for prevention of NEC and sepsis in neonates.

StudyGA (wk)
BW (g)
Probiotic usedDose and durationPrimary outcomeComments

Kitajima et al. 1997, Japan [25]<1500
BB once daily from first feed for 28 daysGut colonization by BBNo difference in sepsis
Dani et al. 2002, Italy [26]<33
<1500
LGG  CFU once daily from first feeds till dischargeUrinary tract infection, bacterial sepsis, NECNo difference in all three outcomes
Costalos et al. 2003, Greece [27]28–32
SB109/kg twice daily from first feed for 30 daysGut function and stool colonizationNo difference in sepsis
Lin et al. 2005, Taiwan [28]<1500
LA, BI
LA: 1004356 BI: 1015697 twice daily from day 7 until dischargeNEC NEC and sepsis rate in probiotic group (12.2% versus 19.3%)
Bin-Nun et al. 2005 Israel [29]≤1500
BI, ST, BBBI:  CFU
ST:  CFU
BB:  CFU once daily from first feed to 36 wks
NEC NEC in probiotic group.
No difference in sepsis (43% versus 33%)
Manzoni et al. 2006, Italy [30]<1500
LBC  CFU once daily from third day of life to 6 wks or discharge from NICUGut colonization by CandidaNo difference in sepsis
Stratiki et al. 2007, Greece [31]27–37
BLPreterm formula  CFU/g started within 48 h. Intestinal permeabilityNo difference in sepsis
Lin et al. 2008, Taiwan [32]<34
<1500
BB, LA  CFU/day for 6 weeksNEC or death NEC and mortality.
↑ sepsis risk in probiotic
(19.8% versus 11.5%), but nonsignificant
Samanta et al. 2009, India [33]<32
<1500
BI, BB, BL, LA  CFU/day till dischargeNEC, feed tolerance Sepsis in probiotic group (14.3% versus 29.5%)
Rougé et al. 2009 France [34]<32
<1500
BL, LGG  CFU per day until dischargeEnteral feed intake at day 14No difference in sepsis (33.3% versus 26.5%)
Awad et al. 2010, Egypt [35]All neonate
LA  (live and killed)  CFU twice daily from day 1 till dischargedSepsis and NEC sepsis rate in probiotic groups
Mihatsch et al. 2010, Germany [36]<30 and
<1500
BL  CFU/Kg/day for 6 weeksIncidence density of nosocomial infectionNo difference in sepsis
Romeo et al. 2011, Italy [37]<37
<2500
LR
LGG
LR:  CFU daily
LGG:  CFU daily from first 72 hrs to 6 wks or until discharge
Gut fungal colonization and late onset sepsisProbiotics effective in prevention of gut colonization by Candida.
No difference in sepsis
Braga et al. 2011, Brazil [38]<1500
LC, BBr  CFU
Starting from day 2 till 30 days of life
NECNo difference in sepsis (33.6% versus 37.5%)
Sari et al. 2011, Turkey [39]<33
<1500
LS till dischargedNEC, and mortalityNo difference in sepsis (26.4% versus 23.4%)
Fernández-Carrocera et al. 2013, Mexico [40]<1500
LA, LGG,
LC, LP,
BI, ST
Multispecies probiotics 1 g/day
NECNo difference in NEC and sepsis rate (56% versus 58.7%)

BB: Bifidobacterium bifidus; BL: Bifidobacteruim lactis; LB: Bifidobacterium breve; LGG: Lactobacillus rhamnosus GG; LS: Lactobacillus sporogenes; SB: Saccharomyces boulardii; BBr: Bifidobacteria breve; BLo: Bifidobacterium longum; LC: Lactobacillus casei; NEC: necrotizing enterocolitis; ST: Streptococcus thermophillus; BI: Bifidobacterium infantis; CFU: colony forming units; LP: Lactobacillus plantarum; LR: Lactobacillus reuteri.