Necrotising enterocolitis (NEC)

Overview

Saccharomyces boulardii (WA 68; medium effect size, high evidence, high trust) has the strongest evidence in this condition, with medium ratings across ten reviewed studies. Oral S. boulardii in preterm infants may reduce NEC risk by about 44% and improve feeding tolerance and hospital stay, though it did not reduce deaths or infections. Regulatory opinions on probiotic use in preterm infants differ.

Lutein, Algal Oil, Vitamin A, and Zeaxanthin (WA 32; very low effect size, low evidence, medium trust) showed no clear NEC prevention in available trials. The heatmap and evidence reviews below compare individual studies.

Effect graph

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Relevant supplements

Relevant supplements sorted by DEX Score.


Saccharomyces boulardii	★★★★★	Medium
Vitamin A	★★★★★	Low
Zeaxanthin	★★★★★	Very Low / None
Lutein	★★★★★	Very Low / None
Algal Oil	★★★★★	Very Low / None

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Studies

Find individual evidence reviews for supplements sorted by DEX Score.

5 supplements for , and rated at least stars. All purchase bands. No minimum star filter.

Saccharomyces boulardiiView supplement →

Consider purchase★★★★★

How we scored this

Effect SizeMediumEvidenceHighTrustHigh

Evidence Review

Taking Saccharomyces boulardii by mouth may lower the risk of necrotizing enterocolitis (NEC), a serious intestinal condition in preterm babies.
A recent review of ten studies found that S. boulardii, taken at 100–200 mg per kilogram of body weight daily starting in the first week after birth, reduced NEC risk by 44%. It also improved feeding tolerance and shortened hospital stays. However, it did not reduce deaths or infections.
Opinions differ among health authorities. The FDA warns that probiotics can sometimes cause serious infections in very small or premature babies, especially those weighing under 1000 grams. The American Academy of Pediatrics does not recommend probiotics for these infants due to safety concerns. Some international groups, including Canadian and European organizations, say probiotics may help prevent NEC in larger preterm babies (over 1000 grams), but Saccharomyces boulardii is not specifically recommended.

Browse 6 studies1 meta-analysis

Using probiotics in paediatric populations2022

A pediatric position statement noted probiotics may reduce necrotizing enterocolitis mortality in preterm infants, though strain and dosing guidance remain limited.

Effect: Benefit
Population: Children/adolescents

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RCTUse of Probiotics in Preterm Infants2021

A review cautioned that U.S. probiotic supplements lack FDA drug approval and should not be marketed to prevent NEC or sepsis in preterm infants.

Effect: Benefit
Population: Infants

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AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders2020

AGA clinical practice guidelines concluded most probiotics lack sufficient evidence for GI disorders and should not be routinely recommended outside selected cases.

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GuideProbiotics and Preterm Infants: A Position Paper by the European Society for Paediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition and the European Society for Paediatric Gastroenterology Hepatology and Nutrition Working Group for Probiotics and Prebiotics2020

A European position paper noted probiotics may reduce NEC and sepsis in preterm infants, but optimal strain, dose, and duration remain undefined.

Effect: Benefit
Population: Infants

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MetaMultiple strains probiotics appear to be the most effective probiotics in the prevention of necrotizing enterocolitis and mortality: An updated meta-analysis2017n=7,345

A meta-analysis found multi-strain probiotics more effective than single-strain products for preventing NEC in very low birth weight infants.

Effect: Benefit
Duration: ≥14 days
Population: Infants
Participants: 7,345

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MetaProbiotics for prevention of necrotizing enterocolitis in preterm infants2014

A Cochrane review found probiotic prophylaxis may reduce severe NEC and sepsis in preterm infants, though strain-specific evidence varied.

Effect: Benefit
Population: Children/adolescents
Ages: <37 weeks

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Vitamin AView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceMediumTrustMedium

Hospital IV/IM therapy — not an oral supplement

Evidence Review

Giving very small premature babies vitamin A by injection does not seem to prevent a serious bowel condition called necrotizing enterocolitis.
Small studies found no difference between babies who got vitamin A shots and those who did not.

Browse 1 study1 meta-analysis

MetaVitamin A supplementation prevents the bronchopulmonary dysplasia in premature infants: A systematic review and meta-analysis2021n=1,409

A meta-analysis of 9 RCTs (1,409 preterm infants) found vitamin A supplementation reduced BPD incidence (OR 0.67, 95% CI 0.52–0.88) without affecting mortality, ROP, or NEC.

Effect: Benefit
Population: Infants
Participants: 1,409

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Algal OilView supplement →

Do not purchase★★★★★

How we scored this

Effect SizeVery Low / NoneEvidenceLowTrustMedium

Evidence Review

Giving breastfeeding mothers DHA-enriched algal oil after very premature birth does not appear to lower the risk of a serious intestinal disease called necrotizing enterocolitis (NEC) in their babies.

Browse 1 study

RCTEffect of Maternal Docosahexaenoic Acid Supplementation on Bronchopulmonary Dysplasia-Free Survival in Breastfed Preterm Infants: A Randomized Clinical Trial2020n=528

An RCT in 528 breastfed preterm infants found maternal DHA 1.2 g/day did not improve bronchopulmonary dysplasia-free survival at 36 weeks; BPD was actually more common in the DHA group (41.7% vs 31.4%).

Effect: No Benefit
Duration: 36 weeks postmenstrual age
Dose: 1.2 g/day
Population: Women
Participants: 528

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LuteinView supplement →

Do not purchase★★★★★

How we scored this

Effect SizeVery Low / NoneEvidenceLowTrustMedium

Evidence Review

Studies show that giving preterm and low birth weight babies a daily supplement (LUTEINofta, containing small amounts of lutein and zeaxanthin) from birth until they reach 36 weeks corrected age does not lower the risk of developing necrotizing enterocolitis.

Browse 1 study

RCTLutein and zeaxanthin supplementation in preterm very low-birth-weight neonates in neonatal intensive care units: a multicenter randomized controlled trial2013n=229

In a multicenter RCT in preterm infants, lutein/zeaxanthin supplementation did not significantly reduce retinopathy of prematurity, NEC, or BPD versus placebo.

Effect: No Benefit
Dose: 0.14 mg lutein + 0.0006 mg zeaxanthin/day
Population: Infants
Participants: 229

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ZeaxanthinView supplement →

Do not purchase★★★★★

How we scored this

Effect SizeVery Low / NoneEvidenceLowTrustMedium

Evidence Review

It is not known if taking zeaxanthin alone helps prevent necrotizing enterocolitis, a serious intestinal condition in premature babies.
Giving a supplement with very small amounts of zeaxanthin and lutein daily from birth to about 36 weeks did not lower the chance of NEC compared to placebo.

Browse 1 study

RCTLutein and zeaxanthin supplementation in preterm very low-birth-weight neonates in neonatal intensive care units: a multicenter randomized controlled trial2013n=229

In a multicenter RCT in preterm infants, lutein/zeaxanthin supplementation did not significantly reduce retinopathy of prematurity, NEC, or BPD versus placebo.

Effect: No Benefit
Dose: 0.14 mg lutein + 0.0006 mg zeaxanthin/day
Population: Infants
Participants: 229

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Evidence visualised

Same ratings as above, aggregated so you can see coverage and imbalance.

Purchase-guidance distribution

How many supplements fall in each purchase band

Effect-size distribution

How large the reported benefits tend to be

Study distribution across 5 supplements for necrotising enterocolitis (10 studies total).
Supplement	DEX	Studies	Meta-analyses	Share
Saccharomyces boulardii	★★★★★68%	6	1	60%
Algal Oil	★★★★★32%	1	0	10%
Lutein	★★★★★32%	1	0	10%
Vitamin A	★★★★★48%	1	1	10%
Zeaxanthin	★★★★★32%	1	0	10%

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Necrotising enterocolitis (NEC)

Overview

Effect graph

Relevant supplements

Studies

Evidence visualised

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