title: [Probiotics and necrotizing enterocolitis in preterm infants: to NEC or not to NEC?, this is the question].
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is the most commonly acquired neonatal intraabdominal emergency and causes significant morbidity and mortality. A proposed strategy for the prevention of NEC in preterm infants is the administration of oral probiotics. The objective of the study is to analyze the efficacy and safety of oral probiotics in preterm infants to try to answer the following question: oral probiotics in Neonatology, yes or no?.
  
  
  METHODS
  A scheme of work based on the five standard steps of medicine based on scientific evidence (EBM) was used: 1) question, 2) search, 3) valuation, 4) applicability and 5) adequacy. Electronic searches were performed on international (Tripdatabase, Cochrane Collaboration, National Guideline Clearinghouse, GuiaSalud, INHATA, Medline, SciELO) and national (Índice Médico Español, Índice Bibliográfico Español en Ciencias de la Salud y MEDES) database.
  
  
  RESULTS
  we selected 8 systematic reviews (SR) that answered our clinical question, published between 2007 and 2012, and which included the best available information (randomised clinical trials). Risk of death was significantly reduced in probiotic groups in all SR, with relative risk (RR) 0,40 to 0,56. Risk of NEC was significantly reduced in probiotic groups in all SR, with RR 0,32 to 0,36. Risk of sepsis did not differ significantly between groups.
  
  
  CONCLUSIONS
  The findings of the 8 SR show potential prevention of oral probiotics in mortality and morbidity secondary to NEC. However, they must be interpreted with caution because the beneficial effects of probiotics seem to be strain specific, thus, pooling data from different strains may result in misleading conclusions. We found two groups of investigation in this field ("yes, of course" and "no, be careful") and there is encouraging data which justifies further and definitive clinical trial regarding the efficacy and safety of specific probiotics in circumstances of high local incidence of severe NEC.
authors: Servicio de Pediatría. Unidad de Cuidados Intensivos Neonatales. Hospital General Universitario de Alicante. Departamento de Pediatría. Universidad Miguel Hernández. Alicante.. javier.gonzalezdedios@gmail.com.
authors: Javier
authors: J
authors: González de Dios
authors: Facultad de Medicina y Odontología. Universidad de Valencia. Valencia. España..
authors: María
authors: M
authors: González Muñoz
mesh_terms: D020345:Enterocolitis, Necrotizing / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D019936:Probiotics / Q000627:therapeutic use*