Abstract
<jats:p>This chapter covers the spectrum of probiotics use in neonatal medicine. It discusses the scientific evidence, controversies, expert panel recommendations, author’s personal experience of introducing probiotics in his neonatal unit in the United Kingdom (UK), guidelines, and parental information. For over three decades, the use of probiotics in neonates has been extensively studied. In the late 1990s, randomized controlled trials reported outcomes of reduced necrotizing enterocolitis (NEC) in babies receiving probiotics. NEC remains a devastating disease in preterm infants, with high mortality and morbidity, and it is still poorly understood. The evidence from the most recent Cochrane database of systematic reviews concludes that probiotics may reduce the risk of NEC (risk ratio [RR] = 0.54, 95% confidence interval [CI] = 0.46 to 0.65; = 17%; 57 trials, 10,918 infants; low certainty). The number needed to treat for an additional beneficial outcome (NNTB) was 33 (95% CI = 25 to 50). The current use of probiotics in neonatal medicine across the world and reasons for the varied uptake is discussed. It also details the results from the first-ever comprehensive survey of the use of probiotics in neonatal units in the UK, conducted by the author and his team in 2022–23. Probiotics use in neonatal medicine will continue to be an exciting topic of discussion. Further research, clinical trials, and analysis of outcomes from neonatal units will bring more clarity and a consensus of views on the use of probiotics in neonates across the world.</jats:p>