Probiotics Reduce Necrotizing Enterocolitis Severity in HIV-exposed Premature Infants.

Single-center randomized placebo-controlled study in premature very low birth weight infants in a South African neonatal unit. Active-arm data are reported separately for HIV-exposed infants (probiotic arm N=37 randomized) and HIV-unexposed infants (probiotic arm N=54 randomized); all infants were exclusively breast milk fed.

Pro-B2 probiotic was given daily as five drops mixed with breast milk and administered orally or via orogastric tube. Each daily dose supplied Lactobacillus rhamnosus GG 0.35 × 10^9 CFU and Bifidobacterium infantis 0.35 × 10^9 CFU. Supplementation started when enteral feeds began and continued for 4 weeks (28 days).

Overall, probiotic supplementation reduced necrotizing enterocolitis in the cohort, and in HIV-exposed infants it was associated more with reduced severity than with clear prevention of severe disease. In the HIV-exposed probiotic arm, all stages of NEC occurred in 3 (3%) versus 6 (6%) in placebo (p=0.029), with Bell's I in 2 (5%) versus 0 (p=0.045) and Bell's III in 0 versus 2 (5%) (p=0.36). In HIV-unexposed infants, time to full feeding was shorter with probiotics: 9.63 ± 2.42 vs 11.14 ± 4.15 days (p=0.022).

Findings come from a single neonatal unit with small HIV-exposed and HIV-unexposed subgroup sample sizes, limiting precision and generalizability. The intervention lasted only 28 days, and the main outcomes were focused on NEC and feeding, so broader clinical effects were not assessed. Subgroup results should be interpreted cautiously because power for between-group comparisons was likely limited.