A description of probiotic use in preterm infants in England and Wales 2016-2022
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective: To describe the use of probiotics among preterm infants in neonatal units and explore factors that influence exposure.
Design: Observational study using prospectively recorded health data
Setting: England and Wales
Patients: 48,048 infants born at < 32weeks gestational age (GA) and admitted to a neonatal unit between January 1st 2016 and December 31st 2022.
Main Outcome Measures: Measures of probiotic use (number and proportion of infants exposed to probiotics, postnatal age of first probiotic exposure and discontinuation).
Results: The proportion of infants who received probiotics increased from 9% to 54% over the study period. Median GA of infants given probiotics was 29+3 (IQR 27+3-30+6). Probiotics were started on median day five (IQR 2-8), earlier for those born at >28 weeks GA (median day 4, IQR 2-7), most frequently after enteral feeds (66% of exposed infants), and were usually discontinued between 32 and 36 weeks post menstrual age (PMA) (47% 32+0- 33+6 weeks PMA, 33% 34+0 - 35+6 weeks). Amongst infants cared for in probiotic neonatal intensive care units (defined as units where 50% or more infants born < 32 weeks gestation were exposed to probiotics), 23% were never given probiotics. Infants from whom probiotics were withheld had a lower gestional age, lower birthweight z score and higher illness severity score or were more mature.
Conclusions: By 2022, over half of infants born at < 32 weeks GA were exposed to probiotics, but almost one quarter did not receive them despite being in a probiotic unit. Our findings help inform the interpretation of observational data and the design of future studies addressing the continued uncertainty around safety and efficacy of probiotics.
Design: Observational study using prospectively recorded health data
Setting: England and Wales
Patients: 48,048 infants born at < 32weeks gestational age (GA) and admitted to a neonatal unit between January 1st 2016 and December 31st 2022.
Main Outcome Measures: Measures of probiotic use (number and proportion of infants exposed to probiotics, postnatal age of first probiotic exposure and discontinuation).
Results: The proportion of infants who received probiotics increased from 9% to 54% over the study period. Median GA of infants given probiotics was 29+3 (IQR 27+3-30+6). Probiotics were started on median day five (IQR 2-8), earlier for those born at >28 weeks GA (median day 4, IQR 2-7), most frequently after enteral feeds (66% of exposed infants), and were usually discontinued between 32 and 36 weeks post menstrual age (PMA) (47% 32+0- 33+6 weeks PMA, 33% 34+0 - 35+6 weeks). Amongst infants cared for in probiotic neonatal intensive care units (defined as units where 50% or more infants born < 32 weeks gestation were exposed to probiotics), 23% were never given probiotics. Infants from whom probiotics were withheld had a lower gestional age, lower birthweight z score and higher illness severity score or were more mature.
Conclusions: By 2022, over half of infants born at < 32 weeks GA were exposed to probiotics, but almost one quarter did not receive them despite being in a probiotic unit. Our findings help inform the interpretation of observational data and the design of future studies addressing the continued uncertainty around safety and efficacy of probiotics.
Date Issued
2025-07-24
Date Acceptance
2025-06-29
Citation
BMJ Paediatrics Open, 2025, 9 (1)
ISSN
2399-9772
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Paediatrics Open
Volume
9
Issue
1
Copyright Statement
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
License URL
Identifier
10.1136/bmjpo-2025-003605
Subjects
England
Infant, Premature
Probiotics
Publication Status
Published
Article Number
ARTN e00360
Date Publish Online
2025-07-24