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Probiotics for Preterm Infants: Confounding Features Warrant Caution

We read with interest the recent controversial debate on probiotics for preterm infants sparked by the meta-analysis by Deshpande et al1 and associated commentaries by distinguished authors.2,3 Although we are supportive of the therapeutic potential of probiotics for exclusively formula-fed, very low birth weight neonates, none of the meta-analyses published to date have extracted data in relation to extremely preterm, extremely low birth weight infants or those exclusively fed breast milk. As such, we would be cautious about encouraging widespread use.

We offer the following evidence base regarding associated confounders.

1. Feed regimen: Infants exclusively fed maternal or donor breast milk have a significantly lower incidence of necrotizing enterocolitis in comparison with those who are formula fed.4,5 However, published trials to date and the recent meta-analysis failed to provide sufficient information …