A Clinical Review of Diagnostic Biomarkers and the Role of the Gut Microbiota in Preterm Infants With Necrotizing Enterocolitis

Abstract

The purpose of this work is to clarify the latest opinions of clinicians about the pathogenesis, diagnosis and treatment of necrotic enterocolitis, as well as the role of microflora in the pathogenesis of this pathology. Material and methods. Search Strategy: A literature search was conducted in the following electronic databases: PubMed, Web of Science (Thomson Reuters), Scopus, Cochrane Library, SpringerLink, and EBSCOhost ScienceDirect. The search spanned 20 years, from 2000 to 2020. In this review, we included 39 articles on this topic, which were available in full text and analyzed through critical evaluation. Results.According to the literature, necrotizing enterocolitis is primarily attributed to prematurity, compounded by the disruption of intestinal microflora composition due to artificial feeding, leading to an inflammatory reaction in the immature intestine. Delayed detection of the initial signs of necrotizing enterocolitis exacerbates treatment outcomes. In clinical practice, two main dilemmas in necrotizing enterocolitis diagnosis arise. Firstly, distinguishing early necrotizing enterocolitis from sepsis can be challenging, resulting in delayed diagnosis and treatment. Secondly, the optimal timing for surgical intervention remains unclear. Conclusion. There is a need to elucidate the latest opinions of clinicians regarding the pathogenesis, diagnosis, and treatment of necrotizing enterocolitis, including the role of microflora in its pathogenesis. Treatment strategies should integrate various models of clinical prognosis and biomarkers to accurately diagnose and tailor therapy for necrotizing enterocolitis.