Probiotic use in French NICUs remains limited and practice patterns are heterogeneous, with minimal adherence to ESPGHAN recommendations, though probiotic exposure was associated with significantly lower mortality in very preterm infants.
Key Findings
Results
The overall rate of probiotic exposure in very preterm infants admitted to French NICUs was 14.3%, and this rate significantly decreased over the study period.
Study included 18,146 infants born at less than 32 weeks of gestation admitted between January 2019 and December 2023
Probiotic exposure rate declined from 16.2% to 12.7% over the study period
Data were collected from NICUs using the same Computer Prescribing Order Entry-Clinical Decision Support system, Logipren®
This was a retrospective multicentre nationwide study
Results
Prescribing practices for probiotics were highly heterogeneous across centers in terms of strain choice, timing of initiation, duration of treatment, dosing regimens, and pharmaceutical formulations.
Limosilactobacillus reuteri DSM 17938 was the most frequently used strain at 65.6%
Lacticaseibacillus rhamnosus lcr35 was the second most used at 30.0%
L. rhamnosus GG ATCC 53103 was used in 4.5% of cases
Only one center prescribed the ESPGHAN-recommended combination of Bifidobacterium infantis Bb-02, B. lactis Bb-12, and Streptococcus thermophilus TH-4
Variability was observed across all prescription parameters including timing, duration, dose, and formulation
Results
Mortality was significantly lower in very preterm infants who received probiotics compared to those who did not.
Mortality rate was 5.2% in the probiotic group versus 7.4% in the non-probiotic group
Adjusted odds ratio for mortality was 0.20 (95% confidence interval: 0.15–0.26)
Analysis was adjusted for sex, gestational age, intrauterine growth restriction, and center-specific effects
Association was identified through multivariate logistic regression analysis
Results
Adherence to ESPGHAN recommendations for probiotic use in preterm infants was minimal across French NICUs.
ESPGHAN recommends the combination of Bifidobacterium infantis Bb-02, B. lactis Bb-12, and Streptococcus thermophilus TH-4
Only one center out of the nationwide cohort prescribed this ESPGHAN-recommended combination
The most commonly used strains (L. reuteri DSM 17938 and L. rhamnosus lcr35) are not part of the ESPGHAN-recommended combination
Authors conclude these results underscore the need for standardized national guidelines and prospective trials
What This Means
This research examined how probiotics (beneficial bacteria) are used in French neonatal intensive care units (NICUs) for very premature babies — those born before 32 weeks of pregnancy. Looking at over 18,000 premature infants cared for between 2019 and 2023, the researchers found that only about 1 in 7 babies (14.3%) received probiotics, and this rate actually declined over the study period. When probiotics were given, there was no consistency: different hospitals used different bacterial strains, started treatment at different times, gave different doses, and used different product formulations. Almost no hospitals followed the international guidelines (from a European expert organization called ESPGHAN) that recommend a specific combination of probiotic strains for premature babies.
Despite the low and inconsistent use, the study found that babies who did receive probiotics had notably lower mortality rates — about 5.2% compared to 7.4% in those who did not receive probiotics. After accounting for other factors like how premature the babies were and which hospital they were in, babies receiving probiotics were statistically much less likely to die during their NICU stay.
This research suggests there is a significant gap between the evidence supporting probiotic use in premature infants and actual clinical practice in France. The wide variation between hospitals and the low overall use — particularly the near-complete disregard for evidence-based strain recommendations — highlight that France currently lacks standardized national guidelines for this practice. The authors call for both clearer national policies and future prospective studies to better understand which specific probiotics work best for premature babies.
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Perazzi C, Lorrain S, Bonsante F, Gouyon B, Lapillonne A, Mitha A, et al.. (2026). Probiotic use in French neonatal intensive care units: A nationwide analysis of practice patterns and clinical outcomes.. Journal of pediatric gastroenterology and nutrition. https://doi.org/10.1002/jpn3.70429