OBJECTIVE To study the effect of synbiotics in reducing incidence and severity of necrotizing enterocolitis (NEC) among preterm neonates. METHODS This randomized controlled trial conducted in a tertiary care teaching hospital, south India, included 220 enterally fed preterm neonates who were randomized to receive either synbiotics or no intervention. The synbiotic contained Lactobacillus, Bifidobacterium and fructo-oligosaccharide. The demographic parameters, risk factors for NEC and outcome including incidence of NEC, its severity, sepsis and mortality were evaluated. RESULTS Multiple pregnancies, preeclampsia and prolonged rupture of membranes were important maternal characteristics. The average birth weight and gestational age of the preterm neonates was 1.4 kg and 31 weeks, respectively. There was a 50% reduction in the incidence of NEC of all stages in preterm infants who received synbiotics compared to the non-intervention group (7.4% versus 14.5%). Administration of synbiotics did not reduce the severity of NEC, sepsis or mortality. CONCLUSIONS Enteral supplementation of synbiotics along with breastmilk results in a tendancy to decrease the incidence of NEC among preterm neonates.