A new study from the German Neonatal Network Database compares the incidence of NEC between centers that used probiotics, centers that did not use probiotics, and centers that changed their practice part way through the data collection period from being non-users to users. They all seem to have chosen the same probiotic combination (Infloran), and they only report the cases of surgical NEC (and separately surgery for other neonatal acute intestinal complications), the data base includes babies under 1500 grams who are between 23 and 32 weeks gestation.
I think its safe to assume that the diagnostic variability in stage 3, surgical, NEC is less than in stage 2 disease, although it probably isn’t perfect, and the precise indications for surgery may differ from one center to the next, also it isn’t clear if an infant who perforated, but was not considered a candidate for surgery, would be included as a case or not (but that would likely be a very small proportion).
The authors of the paper (Hartel C, Pagel J, Rupp J, Bendiks M, Guthmann F, Rieger-Fackeldey E, et al. Prophylactic Use of Lactobacillus acidophilus/Bifidobacterium infantis Probiotics and Outcome in Very Low Birth Weight Infants. The Journal of pediatrics. 2014) found that centers using probiotics had a percentage of surgical NEC in their babies of 2.6% compared to 4.2% in those with no probiotics. Centers that changed during the course of the study showed a reduction after the introduction of probiotics from 6.2 to 4.0%.
In the logistic regression analysis, the use of probiotics gave an Odds Ratio for surgical NEC of 0.58, and for death or surgical NEC of 0.43.
Not surprisingly, probiotics reduce the incidence of NEC in Germany, just as they do elsewhere. Infloran seems to be an effective mixture, even though its formulation has changed slightly it was one of the mixtures used in randomized controlled trials, it is widely available in many countries.
Rather than another polemic about the moral necessity to routinely use probiotics in at-risk preterm infants, I will simply refer you to my several previous posts, which you can find using the search function if you wish,