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Open Access Highly Accessed Open Badges Correspondence

Evidence-based guidelines for use of probiotics in preterm neonates

Girish C Deshpande12, Shripada C Rao345, Anthony D Keil36 and Sanjay K Patole35*

Author Affiliations

1 Department of Neonatal Paediatrics, Nepean Hospital Sydney, Sydney, Australia

2 University of Sydney, Australia Sydney, Australia

3 Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia

4 Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Australia

5 University of Western Australia, Perth, Australia

6 PathWest Laboratory Medicine, WA, USA

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BMC Medicine 2011, 9:92  doi:10.1186/1741-7015-9-92

Published: 2 August 2011



Current evidence indicates that probiotic supplementation significantly reduces all-cause mortality and definite necrotising enterocolitis without significant adverse effects in preterm neonates. As the debate about the pros and cons of routine probiotic supplementation continues, many institutions are satisfied with the current evidence and wish to use probiotics routinely. Because of the lack of detail on many practical aspects of probiotic supplementation, clinician-friendly guidelines are urgently needed to optimise use of probiotics in preterm neonates.


To develop evidence-based guidelines for probiotic supplementation in preterm neonates.


To develop core guidelines on use of probiotics, including strain selection, dose and duration of supplementation, we primarily used the data from our recent updated systematic review of randomised controlled trials. For equally important issues including strain identification, monitoring for adverse effects, product format, storage and transport, and regulatory hurdles, a comprehensive literature search, covering the period 1966-2010 without restriction on the study design, was conducted, using the databases PubMed and EMBASE, and the proceedings of scientific conferences; these data were used in our updated systematic review.


In this review, we present guidelines, including level of evidence, for the practical aspects (for example, strain selection, dose, duration, clinical and laboratory surveillance) of probiotic supplementation, and for dealing with non-clinical but important issues (for example, regulatory requirements, product format). Evidence was inadequate in some areas, and these should be a target for further research.


We hope that these evidence-based guidelines will help to optimise the use of probiotics in preterm neonates. Continued research is essential to provide answers to the current gaps in knowledge about probiotics.