Background: Necrotizing Enterocolitis (NEC) is the most devastating gastrointestinal emergency in preterm and very low birth weight infants. Despite preferential use of breastmilk, donor human milk, early treatment of sepsis, and a cautious approach to enteral feeding, the overall incidence of NEC remains high in Canada (1.5% to 9.3%) (2015 Canadian Neonatal Network). Probiotics, which are thought to prevent NEC by promoting colonization of the gut with beneficial organisms, have been drawing increasing attention worldwide. Expert bodies, including The Cochrane Collaboration, have indicated that a change in practice is warranted.

Objectives: To assess the impact of an evidence-based practice change on multiple outcomes of an affected population; specifically, the impact of an enteral probiotic protocol on the rate of NEC in neonates born less than 33 weeks gestational age and/or less than 1500gm.

Methods: We conducted a retrospective cohort study with historical controls. Our NICU underwent an evidence-based change of practice in September 2014 with the implementation of a protocol for enteral administration of probiotics to infants born less than 33 weeks gestational age and/or less than 1500gm. The infants were provided with 0.5g of Florababy™, PO/NG/OG daily, starting with the first feed, and continued until discharge/transfer from hospital. We compared outcomes among infants admitted during the first 12 months of the practice change, to infants admitted 24 months prior.

Results:

Conclusion: Daily, enteral supplementation with probiotics (Florababy™) to eligible infants showed a reduction in NEC. Although this finding did not reach statistical significance due to power, this result remains clinically significant considering the devastating effects of NEC.