Use of Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Survey of Current Practices Among Indian Neonatologists

Objective: Probiotics are known to reduce the risk of necrotizing enterocolitis (NEC≥ Stage II) significantly, as well as all-cause mortality, late-onset sepsis (LOS), and feeding intolerance in preterm infants. Probiotics have been reported to have comparable benefits in high- and low-middle-income countries (LMICs). We aimed to assess the current practices of neonatologists in India for using probiotics in preterm infants.

Material and methods: A questionnaire created using Survey Monkey's web-based tool was sent to neonatologists in India. Survey forms automatically converted responses into Excel files (Microsoft® Corp., Redmond, WA). Data were analyzed using SPSS (IBM Corp., Armonk, NY).

Results: A total of 615 responses were received from various neonatal intensive care units (NICUs) in India (Level I: 43 (7%), II: 124 (20.8%), III: 448 (72.8%)). Around 431 (70%) of the units had either National Neonatology Forum (NNF) accreditation or IAP fellowships or were affiliated with private or government medical colleges. The remaining 184 (30%) were in private setups. Routine probiotic supplementation (RPS) was provided in 241 (39.1%) of the responding units; 179 (48%) quoted inadequate evidence as the reason for not providing RPS, 125 (33.43%) quoted difficulty in sourcing safe and effective products, whereas others were concerned about adverse effects. Most centers provided RPS for preterm infants <32 weeks and 1500 g at birth. The clinical practice was influenced by the judgment of the attending clinician. Significant variation was noticed in the protocol for RPS.

Conclusion: Findings of the survey suggest that approximately 39% of the participating neonatologists in India currently offer RPS for preterm infants. A significant variation exists in the selection of probiotic strains, products, dose, and duration of supplementation. Despite limitations, our findings are useful in guiding clinical practice and further research to optimize the safety and efficacy of RPS for preterm infants.