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.