Despite these very encouraging results, the presence of
clinical heterogeneity, heterogeneity of probiotic strains,
reproducibility of results in different set-ups, and crosscontamination,
have all been cited as the reasons for not
introducing the routine use of probiotics at this stage in
preterm neonates. However, given the health burden of
NEC and the fact that many level III neonatal nurseries in
Finland, Italy and Japan have been using probiotics
routinely for over a decade and have not reported any
significant adverse effects, and based on the current evidence
and in comparison to other effective interventions in
neonatal medicine, such as hypothermia in hypoxic
ischemic encephalopathy, parents of preterm infants
should be informed of the current evidence; probiotics
should be offered routinely if safe and clinically effective
products are available at each unit.