Rethinking probiotic delivery: new hope for preventing necrotizing enterocolitis

INTRODUCTION: Necrotizing enterocolitis (NEC) is a devastating disease of the gastrointestinal tract that mainly affects premature newborns, with mortality rates exceeding 50% in the most severe cases. Despite decades of research the disease persists, there is no known cure, and treatment consists of supportive care only. Dysbiosis of the gut microbiome has been implicated as a contributing factor to the development of NEC. With a deepening understanding of the therapeutic efficacy of probiotics in reversing intestinal dysbiosis, a potential avenue to prevent this disease has emerged. AREAS COVERED: Through review of the literature related to probiotics in NEC and novel oral delivery methods for probiotics, we will discuss what is known about preventing NEC with commercially available probiotics. We will discuss the challenges imposed on probiotic therapy by the September 2023 FDA warning on probiotic administration to premature babies. We will also examine novel delivery methods for probiotics that can enhance their beneficial capabilities. EXPERT OPINION: By obtaining approval for novel oral probiotic delivery technologies including biofilm formation and prebiotic co-ride, the risk of NEC in premature infants could be significantly decreased.