Neonatal intestinal dysbiosis in necrotizing enterocolitis

Abstract

Necrotizing Enterocolitis (NEC) is one of the most devastating gastrointestinal diseases in neonates, particularly among preterm infants in whom surgical NEC is the leading cause of morbidity. NEC pathophysiology occurs in the hyper-reactive milieu of the premature gut after bacterial colonization. The resultant activation of the TLR4 pathway appears to be a strongly contributing factor. Advancements in metagenomics may yield new clarity to the relationship between the neonatal intestinal microbiome and the development of NEC. After a century without effective directed treatments, microbiome manipulation offers a promising therapeutic target for the prevention and treatment of this devastating disease.

Keywords: Inflammation; Intestinal failure; Microbiome; Neonatal sepsis; Prematurity.

Fig. 1

Clinical findings of Necrotizing Enterocolitis. a Abdominal distension and erythema frequently seen in an infant with necrotizing enterocolitis. b Necrotic bowel found upon surgical exploration for necrotizing enterocolitis. c Abdominal radiograph demonstrating portal venous gas and pneumatosis intestinalis

Fig. 2

Factors that Predispose the Immature Gut to Necrotizing Enterocolitis. Pictorial representation of factors contributing to the propensity of the immature gut to develop necrotizing enterocolitis

Fig. 3

Factors Impacting the Neonatal Gut Microbiome. Factors contributing to the development of the neonatal microbiome include both prenatal factors such as the maternal microbiome, the microbiome of the amniotic fluid, the degree of prematurity and the mode of delivery, and postnatal exposures including antibiotics, diet, and acid suppressing medications