A multicenter randomized trial in very low birth weight infants studied the use of routine supplementation of enteral feeds with bovine lactoferrin (BLF) and probiotics (lactobacillus rhamnosus GG, LGG). Infants were randomly assigned to one of three arms in the trial: supplementation with bovine lactoferrin alone (BLF group), supplementation with lactoferrin and probiotic (BLF plus LGG group), and control (placebo). Supplementation was started at birth and the main outcome measures were NEC (stage 2 or higher), and NEC or death. The incidence of NEC/death in control infants was 10%, while the incidence in each of the intervention groups was around 4%. NEC alone was also significantly lower in the two intervention groups compared to controls.