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Objective Necrotizing enterocolitis (NEC) is one of the most common acquired diseases of the gastrointestinal tract in preterm infants.In past several years, several randomized, controlled trials (RCTs) have indicated probiotics could lower mortality and the incidence of necrotizing enterocolitis (NEC).But meanwhile some researchers also hold a contrary opinion.In addition, the influence on normal growth and related safety concern of probiotics remains unclear.In view of this situation, we performed an updated meta-analysis of all relevant RCTs to assess the benefits of probiotic supplementation for preterm infants.Methods We searched in PubMed, Embase,Cochrane databases for English references, and in Wanfang, VIP, Cnki databases for Chinese references (All last launched on 2013/03/18).Finally 27 RCTs (including 9Chinese articles) were finally incorporated into this meta-analysis.Incidence and relative risk (RR) were calculated using a random-effects or fixed-effects model depending on the heterogeneity of the included studies.Results A total of 6655preterm infants, including the probiotics group (n=3298) and the control group(n=3357), were eligible for inclusion in this meta-analysis.(1) As to the main index,the risk for NEC (Bell level> Ⅰ) was significantly lower with probiotic supplement in preterm infants (Gestational age< 37 weeks) (RR =0.35; 95% confidence interval [CI]=0.27-0.44; P<0.00001).Thereinto, The risk for NEC (Bell level> Ⅱ) also showed a significant lower tendency in probiotics group (RR =0.34, 95% [CI]=0.25-0.48,P<0.00001).And in early preterm infants (Gestational age< 34 weeks), the risk of NEC (Bell level> Ⅰ) was lower as well in probiotics group (RR =0.39, 95%confidence interval [CI]=0.27-0.56, P<0.00001).(2) As to the complications, risk of death was also significantly reduced in the probiotic group (RR =0.58; 95% CI=0.46-0.75; P <0.0001).In contrast, no significant difference was reported in the risk for sepsis (RR =0.94; 95% CI=0.83-1.06; P=0.31).(3) As to the normal feeding and growth, there was no difference in the time of age reaching full feeds between two groups (WMD =-1.66; 95% CI=-3.6-0.27; P=0.09).In contrast, in probiotics group weight gain seemed greater than the control group (WMD =1.33; 95% CI=0.76-1.91;P <0.00001).Conclusions: Despite the gestational age and NEC stage, we demonstrated that probiotics supplement could significantly lower the risk of NEC in preterm infants.Besides, our meta-analysis showed that its application didn't increase the risk of incidence of sepsis and mortality.Finally, we proved that probiotics supplement have no adverse effect on normal feeding and growth.