A 27-week preterm neonate weighing 980 g is admitted to the NICU. The unit follows a protocol for prophylactic therapy to reduce the incidence of necrotizing enterocolitis. Which of the following is the MOST evidence-based intervention for this purpose?

• A Early initiation of trophic feeds with maternal breast milk
• B Oral gentamicin prophylaxis for the first 14 days
• C Empiric intravenous piperacillin-tazobactam for 72 hours
• D Probiotic supplementation with Lactobacillus rhamnosus GG ✓

Explanation

Multiple Cochrane reviews show that probiotic supplementation significantly reduces the incidence of NEC and mortality in preterm neonates. While trophic feeds with breast milk are beneficial, probiotics have the strongest specific evidence for NEC prevention. Neither oral gentamicin nor empiric antibiotics are recommended for NEC prophylaxis.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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