Background and Aim It is previously claimed that probiotic and prebiotic use in premature infants prevents pathogenic bacterial colonization in the intestine and reduces morbidity and mortality. In this study, the effect of synbiotic (probiotic+prebiotic) use on morbidity and mortality in very low birth weight (VLBW) infants is evaluated.

Methods Thirty-four VLBW infants were randomly assigned to receive either synbiotic [probiotic: Bifidobacterium lactis, 5x10 colony forming unit, 30mg + prebiotic: Chicory inulin, 900 mg (1 sachet/day Maflor®, Cidex), n=17] (Group-1) or placebo (n=17) (Group-2) from the first enteral feeding and throughout the hospitalization period.

Results There was no significant difference regarding the sociodemographic features between groups. The time interval to reach enteral nutrition to 50 cc/kg/day was similar in both groups, whereas it took shorter time in Group-1 to reach 100/cc/day (p=0.02). Increased gastric residual (former feeding >50%) occurred less in Group-1 (p=0.002). There was no significant difference between groups in the rate of early clinical or culture proven sepsis, however late clinical sepsis rate and late culture proven sepsis in Group-1 was significantly lower (p=0.001, p=0.04). Synbiotic use reduced the risk of sepsis independently from gestational age and gender (p=0.03). Necrotizing enterocolitis (stage≥2) was significantly higher in Group-2 (p=0.001). The rate of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) were lower in Group-1 (p=0.04, p=0.03). No difference was identified regarding mortality, actual weight during hospitalization and discharge between groups.

Conclusion Introduction of synbiotics with the first enteral feeding can help to reduce feeding intolerance and morbidity in VLBW infants.