Contemporary use of prophylactic probiotics in NICUs in the United States: a survey update

Abstract

Objective: In 2015, 14.0% of US NICUs administered probiotics to very low birth weight infants. Current probiotic use prior to and after the Fall of 2023 (when FDA warnings were issued) remains unknown. Study design: A survey was distributed to the American Academy of Pediatrics Section on Neonatal and Perinatal Medicine (August–November/2022) and Neonatology Solutions’ Level III/IV NICUs (January–April/2023). Probiotic administration practices were investigated. Results: In total, 289 unique NICUs and 406 providers responded to the survey. Of those, 29.1% of NICUs administered prophylactic probiotics to premature neonates, however, this decreased considerably after FDA warnings were issued. Additionally, 71.4% of providers stated willingness to administer probiotics to premature infants if there was an FDA-approved formulation. Conclusions: Probiotic use in US NICUs increased between 2015 and the Fall of 2023 and then dropped dramatically following warning letters from the FDA. The introduction of an FDA-approved probiotic may further expand administration.