This presentation explored the future of probiotic supplementation in preterm neonates. Patole reviews the evidence for prophylactic probiotics in the prevention of necrotizing enterocolitis (NEC). In preterm, very low birth weight infants, NEC causes devastating consequences. In particular, infants with NEC often have long-term neurodevelopmental impairments. Pre- and postnatal disturbances of gut perfusion, altered intestinal structure and function, altered gut flora and increased metabolic demands of enteral feeds, all contribute to an increased risk of NEC and feed intolerance in preterm neonates with intrauterine growth restriction. The benefits of probiotic prophylaxis require further research. Robust evidence that demonstrate the efficacy of probiotics in the prevention of NEC is required before this could be introduced into routine clinical care. It is also important to ensure the safety and quality of probiotic formulations for clinical use. This calls for collaborations between regulatory authorities and the industry.