Infant gut microbiota restoration: state of the art

Abstract

The gut microbiota has a central role in the programming of the host's metabolism and immune function, with both immediate and long-term health consequences. Recent years have witnessed an accumulation of understanding of the process of the colonization and development of the gut microbiota in infants. The natural gut microbiota colonization during birth is frequently disrupted due to C-section birth or intrapartum or postpartum antibiotic exposure, and consequently aberrant gut microbiota development is common. On a positive note, research has shown that restoration of normal gut microbiota development is feasible. We discuss here the current understanding of the infant microbiota, provide an overview of the sources of disturbances, and critically evaluate the evidence on early life gut microbiota restoration for improved health outcomes by analyzing published data from infant gut microbiota restoration studies.

Keywords: Intrapartum antibiotics; birth mode; breastfeeding; cesarean section; fecal microbiota transplant; lactic acid bacteria and bifidobacteria; vaginal seeding.

Figure 1.

Gut microbiota development and its effects on current and later-life health.

Figure 2.

Differences in gut microbiota composition between groups of infants stratified by birth mode and treatment. (a) scores on the first principal component, (b) relative abundance of bifidobacteriaceae, (c) relative abundance of bacteroidaceae. lighter colors refer to 1-month samples and darker colors to 3-month samples. asterisks indicate the significance of the difference from the vaginally born (“V”) group (blue) and the C-section born (“CS”) group (red), data from refs 4, 50, 82, 85, 86. statistical tests were conducted separately within each age group.

Figure 3.

Efficacy of restoration of the microbial families that were significantly different between vaginally born and C-section born untreated infants. – indicates unsuccessful restoration (relative abundance is significantly different from the vaginally born), + indicates moderately successful restoration (no statistically significant difference in relative abundance from the vaginally born group, but difference in mean abundance > 25%), and ++ indicates full restoration (difference in mean relative abundance < 25%, p > .05).