Neonatal necrotizing enterocolitis (NEC) is one of few diseases for which probiotics have appeared to have clear benefit in clinical trials, however safety concerns persist. Clinical trials of probiotics have preceded our understanding of the effect of probiotics on the developing gut and microbial colonization patterns of the preterm infant. Colonization of the preterm intestine begins with the birthing process and is then influenced by the neonatal intensive care unit and iatrogenic manipulations. Resulting altered microbiota may have significant implications for the immature preterm gut and susceptibility to NEC.
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