Introduction and aims Necrotising Enterocolitis predominantly affects premature infants, and it is the commonest and most severe gastrointestinal emergency in this patient group. Enterally fed probiotics are a promising new approach to the prevention of NEC, as they may help normalise the intestinal microflora colonisation in preterm infants.

The purpose of this survey was to establish the current trend with regard to the use of probiotics in preterm infants in England and Wales. It also aimed to ascertain the number of neonatal units in England and Wales that exclusively used breast milk, and implemented a standardised feeding protocol.

Methods The survey, as well as an invitation to participate containing information about the survey, was emailed to the lead neonatologist at 160 of 176 neonatal units in England and Wales. This was done after ethical approval from both the University’s College of Human and Health Sciences and ABMU Joint Scientific Review Committee was attained.

Results 59 Neonatal units responded to the survey; this included 11 Level 1 units, 24 Level 2 units, 11 Level 3 units and 13 Level 3 + neonatal surgery units. Of these 59, ten percent (6/59) utilised probiotics, while the remaining 90 percent (53/59) did not. The six units using probiotics included 12.5 percent of the Level 2 units (3/21) and 23% of the Level 3 + neonatal surgery units (3/13). Infloran was most commonly used, with 83% of the units utilising it (5/6). All the units using probiotics implemented a standardised feeding protocol, while only 33% of them exclusively used breast milk.

Of the 53 units not using probiotics, 92% used a standardised feeding protocol, while only 42% exclusively used breast milk.

Conclusion Use of probiotics in preterm babies at risk for NEC remains low in the United Kingdom. Poor evidence of effectiveness below 1000 grams and the lack of a reliable pharmaceutical product with the associated safely concerns might explain this trend. The low levels of exclusive breast milk use in this high-risk population remain a concern and should be targeted for quality improvement.