Probiotic supplementation reduces neonatal jaundice and respiratory distress syndrome risk in preterm infantsProbiotics may reduce jaundice and breathing issues in preterm infants

IntroductionPrematurity remains a major contributor to neonatal morbidity and mortality worldwide, with neonatal jaundice and respiratory distress syndrome (RDS) representing two of the most common complications associated with immature hepatic and pulmonary development. Increasing evidence suggests that probiotic supplementation may improve neonatal outcomes through modulation of the gut microbiome, gut–liver axis, and gut–lung axis; however, published findings remain inconsistent. The meta-analysis evaluated the effects of probiotic supplementation on prematurity-related morbidity, with particular emphasis on neonatal jaundice and RDS.MethodsThe study was conducted according to PRISMA 2020 guidelines, and a comprehensive literature search of PubMed, Scopus, Web of Science, and the Cochrane Library identified 18 eligible studies comprising 2,587 preterm infants. Methodological quality was assessed using the Cochrane Risk of Bias 2 tool and Newcastle–Ottawa Scale, and pooled effect estimates were calculated using random-effects models.ResultsProbiotic supplementation significantly reduced the incidence of neonatal jaundice (RR = 0.72, 95% CI: 0.61–0.84; p < 0.001), peak total serum bilirubin levels (MD = −1.84 mg/dL, 95% CI: −2.47 to −1.21), and phototherapy requirements (RR = 0.68, 95% CI: 0.55–0.82; p < 0.001). The incidence of RDS was significantly reduced (RR = 0.79, 95% CI: 0.66–0.95; p = 0.012), accompanied by a shorter duration of respiratory support (MD = −1.9 days, 95% CI: −2.8 to −1.0). Moderate heterogeneity was observed across pooled analyses (I² = 42–57%). Exploratory meta-regression suggested that probiotic formulation, early initiation (