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By Daniella Gray
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A supplement already used in some neonatal units could be linked to a significant reduction in one of the most feared complications facing babies born too soon, according to new research.
Scientists from the Karolinska Institutet, Sweden, examined outcomes among very preterm infants and found that those given probiotics appeared less likely to develop severe bowel disease or die than similar babies who did not receive the supplements.
The study, published in JAMA Network Open, focused on infants born between 28 and 31 weeks' gestation.
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Researchers compared outcomes before and after probiotics were introduced nationally across Swedish neonatal intensive care units (NICUs).
Necrotizing enterocolitis (NEC), a serious condition in which intestinal tissue becomes inflamed and can die, is among the most dangerous complications affecting premature babies.
Severe cases may require surgery and can be fatal.
“The direction of the association was not unexpected, as numerous randomized trials and meta-analyses have shown that probiotics benefit preterm infants,” Ayoub Mitha, MD, PhD, the study's corresponding author, told Newsweek. “What was more striking was the magnitude of the association, particularly for the most severe forms of NEC requiring surgery.”
Only one case of so-called surgical NEC occurred among the 1,571 infants who received probiotics, compared with 40 cases among 3,124 infants who did not.
Mitha said Sweden's long-standing emphasis on breast milk feeding, family-centered care and skin-to-skin contact may have contributed to the positive results.
He also noted that no probiotic-associated sepsis cases were reported among the supplemented infants.
The findings add to a growing body of evidence suggesting probiotics may help support the development of a healthy gut microbiome in babies born prematurely.
However, independent expert Thao (Tina) Ho, associate professor and chief of neonatology at the University of South Florida Morsani College of Medicine, said there are different ways to look at the data.
“I think the comparison with the least potential for bias is between babies who received probiotics and those who did not receive probiotics during the same time period, 2021 to 2024,” Ho told Newsweek.
Using that comparison, the rate of NEC and/or death was 0.8 percent among babies receiving probiotics, compared with 2.9 percent among those who did not.
That translates to roughly 48 babies needing probiotic treatment to prevent one additional case of NEC or death.
Ho described the large sample size and consistent use of a well-characterized probiotic formulation as strengths of the study.
But she said that, because it was observational, it cannot prove probiotics directly caused the improved outcomes.
“Other changes in the care of premature babies between 2017 to 2019 and 2021 to 2024 could also have contributed to the improved outcomes,” she said.
Looking ahead, Mitha said one of the biggest unanswered questions concerns extremely preterm infants born before 28 weeks, who face the greatest risks of NEC and death but were not included in the study.
“This question is currently being addressed in the PEPS trial, a large placebo-controlled randomized trial conducted in Sweden and Denmark, which has so far enrolled 535 infants,” Mitha said.
For parents, Ho said the findings may be worth discussing with their baby's medical team.
“If they do offer probiotics, you should discuss with your baby’s medical team about the risks and benefits so that you can make the decision together,” she said. “Store-bought probiotics are not safe for a preterm baby since they are not tested and regulated like medications.”
Reference
Mitha A, Söderquist Kruth S, Sinervo E, et al. Probiotics and Risk of Death, Necrotizing Enterocolitis, and Sepsis in Very Preterm Infants. JAMA Netw Open. 2026;9(9):e2635560. doi:10.1001/jamanetworkopen.2026.35560
Contact Newsweek editors on this story: Kara Dolman and Emma Lee-Sang
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