Background Probiotics may protect from necrotizing enterocolitis (NEC). Former studies in Asian populations have shown that Infloran^® - a mixture of Lactobacillus acidophilus and Bifidobacterium infantis - decreases NEC by 80% in very low birth weight (VLBW) infants. Therefore, we implemented Infloran^® at our department in 2010. The objectives of our study were to determine the influence of the probiotic Infloran^® on NEC incidence, NEC severity and the influence of enteral nutrition in a Caucasian population compared to a historic control group.

Material and methods Since 2010, VLBW infants born

Results 230 infants were included (mean gestational age: 27+2, birth weight: 900g) and compared with 233 controls (28+5, 980g). After implementation of Infloran^® NEC decreased by 32% (10.3% before vs. 7% after implementation of probiotics, p = 0.092 – corrected for confounding variables birth weight and gestational age). Probiotics had no influence on NEC severity. A NEC reduction was shown in breast fed infants only and not in formula fed infants.

Discussion The effect of Infloran^® was less effective in our Caucasian population than expected. Interestingly, NEC incidence was not reduced in exclusively formula fed infants. The inefficacy in this subgroup is alarming. Therefore, the impact of enteral nutrition on probiotic effects should be explored in further prospective randomised controlled trials.