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The “pro” and “con” of probiotics, regulation and preterm infant health

Pediatric Research volume 97, pages 455–458 (2025)Cite this article

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Necrotizing Enterocolitis (NEC) is among the most devastating complications of preterm birth, with ~25% mortality among very low birthweight (VLBW) infants.1,2,3 Among survivors, the condition can impart long-term negative health effects, occurring both before and after the index neonatal hospitalization.1,2,3 Babies born at extremely low birthweight (ELBW) are more vulnerable, and mortality surpasses 40% for infants in need of surgery.4,5,6 Survivors of NEC require significant resources to meet ongoing healthcare needs, as afflicted infants are at risk for short gut syndrome, liver disease and intestinal failure.5,6,7,8,9 Beyond the neonatal period, infants with NEC exhibit double the odds of neurodevelopmental impairment, independent of additional risk conferred by intraventricular hemorrhage and periventricular leukomalacia.10,11 This care is costly, and NEC remains a major source of healthcare utilization. Direct costs of NEC alone are estimated from $300,000–$600,000 per case of surgical NEC.12,13,14 Surgical NEC is the costliest diagnosis in children’s hospitals, with even higher costs associated with lower gestational age at time of diagnosis.15 Total annual spending on NEC approaches $1 Billion.4

Despite its devastating impact, treatment for NEC has not dramatically changed in decades. Bowel rest, antibiotics and supportive care remain mainstays of treatment. Though the mechanism of NEC is not fully known, greater progress has been made in prevention among VLBW infants. Receipt of antenatal steroids, along with postnatal strategies such as early enteral feeding, reductions in early and prolonged antibiotic exposure, use of standardized feeding protocols, promotion of skin-to-skin contact and human milk diets are all associated with reductions in NEC.16,17,18,19,20

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  1. Division of Neonatology, Department of Pediatrics, Maria Fareri Children’s Hospital, New York Medical College, Valhalla, NY, USA

    Shetal Shah

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Shah, S. The “pro” and “con” of probiotics, regulation and preterm infant health. Pediatr Res 97, 455–458 (2025). https://doi.org/10.1038/s41390-024-03766-4

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