Multi-strain Probiotics to Prevent Necrotizing Enterocolitis in Very Preterm Infants

Researchers will compare outcomes between two phases:

Control Phase: No probiotics will be administered, and outcomes will be recorded to establish baseline NEC rates.

Intervention Phase: Participants will receive a daily multi-strain probiotic combination (0.5 g sachet) starting within 24 hours of enteral feeding initiation.

Participants will be:

* Preterm infants born at \<32 weeks' gestation and \<1500 g birth weight.

The study uses a stepped-wedge cluster randomized trial (SW-CRT) design, where neonatal intensive care units (NICUs) transition from the control phase to the intervention phase at pre-specified intervals. Individual consent will be obtained for probiotic administration and data collection during the intervention phase, and data collection-only consent will be sought during the control phase.

This trial is designed to provide high-quality evidence on the efficacy and safety of probiotics in preventing NEC in preterm infants.

• Survival [Срок оценки: From date of randomization until the date of 34 weeks corrected gestational age]
• Late-onset sepsis [Срок оценки: From date of randomization until the date of 34 weeks corrected gestational age or or date of death from any cause, whichever came first]
• Growth anthropometrics at 36 weeks corrected gestation [Срок оценки: at 36 weeks corrected age or discharge from level III NICU whichever occure first.]
• Time to achieve full enteral feed [Срок оценки: From date of randomization until the date of 34 weeks corrected gestational age or or date of death from any cause, whichever came first]