Application of Probiotics in Neonatal Diseases

Probiotics have increasingly progressed from laboratory research to clinical application, supported by growing evidence demonstrating their potential benefits across multiple neonatal conditions. In 2023, the Chinese Preventive Medicine Association released an evidence-based guideline on pediatric probiotic use; however, comprehensive summaries dedicated specifically to neonates remain scarce despite rapidly expanding clinical utilization in this population. This narrative review synthesizes current evidence on the role of probiotics in common neonatal disorders and discusses key considerations regarding timing, dosing, and safety. Literature from PubMed and CNKI was examined, prioritizing clinical trials and meta-analyses published in the past five years, with extended inclusion for topics lacking sufficient data. Searches covered probiotics in relation to necrotizing enterocolitis, feeding intolerance, antibiotic-associated diarrhea, neonatal hyperbilirubinemia, sepsis, bronchopulmonary dysplasia, respiratory infection, micronutrient metabolism, safety, and mechanisms. A total of 22 reviews/meta-analyses and 51 clinical studies were included. Overall, Bifidobacterium and Lactobacillus are the most frequently used probiotics in neonatal care, with evidence supporting reductions in necrotizing enterocolitis, feeding intolerance, antibiotic-associated diarrhea, hyperbilirubinemia, and potentially sepsis, alongside possible respiratory and micronutrient-related benefits. Although safety profiles are generally favorable, rare instances of probiotic-related sepsis highlight the need for caution. Considerable heterogeneity in strains, dosing strategies, and intervention durations continues to limit interpretation. Further large-scale, rigorously designed randomized trials are required to refine strain selection, validate efficacy, and ensure safety in this highly vulnerable population.