Necrotising enterocolitis: is there a relationship to specific pathogens?

Peter, Corinna; Feuerhahn, Michael; Bohnhorst, Bettina; Schlaud, Martin; Ziesing, Stefan; Hardt, H. von der; Poets, Christian F.

doi:10.1007/s004310051012

Cited by 82 publications

(56 citation statements)

References 23 publications

(35 reference statements)

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“…Some studies have found an association between various bacterial species and NEC (15)(16)(17)(18)(19)(20), whereas others did not observe any association between NEC and any specific bacterial species (8,21).…”

Section: Discussionmentioning

confidence: 99%

“…It is suspected that abnormal colonization of the gastrointestinal tract or an unfavorable balance between commensal and pathogenic bacteria is part of the pathogenesis of NEC (4)(5)(6). It has been suggested that the ability of microflora to invade the epithelium and ferment unabsorbed nutrients (7), and the colonization by various bacterial pathogens in a sufficiently vulnerable host (8) could promote the development of NEC. Bacterial colonization of the neonatal gut is influenced by factors such as gestational age, feeding, medication, and diverse environmental flora (9).…”

mentioning

confidence: 99%

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Investigation of the early intestinal microflora in premature infants with/without necrotizing enterocolitis using two different methods

et al. 2011

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Investigation of the early intestinal microflora in premature infants with/without necrotizing enterocolitis using two different methods

et al. 2011

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“…The pathogenesis of disease implies delayed gut colonisation with a limited number of bacterial species, which tend to be virulent (Dai & Walker, 1998). Although colonisation with potential pathogens appears to be a prerequisite for development of NEC, no speci®c bacteria have been associated with the condition (Peter et al 1999). Animal models of NEC have implicated Clostridium spp.…”

Section: Neonatal Necrotising Enterocolitismentioning

confidence: 99%

Perspectives on the role of the human gut microbiota and its modulation by pro- and prebiotics

et al. 2000

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One of the most topical areas of human nutrition is the role of the gut in health and disease. Specifically, this involves interactions between the resident microbiota and dietary ingredients that support their activities. Currently, it is accepted that the gut microflora contains pathogenic, benign and beneficial components. Some microbially induced disease states such as acute gastroenteritis and pseudomembranous colitis have a defined aetiological agent(s). Speculation on the role of microbiota components in disorders such as irritable bowel syndrome, bowel cancer, neonatal necrotising enterocolitis and ulcerative colitis are less well defined, but many studies are convincing. It is evident that the gut microflora composition can be altered through diet. Because of their perceived health-promoting status, bifidobacteria and lactobacilli are the commonest targets. Probiotics involve the use of live micro-organisms in food; prebiotics are carbohydrates selectively metabolized by desirable moieties of the indigenous flora; synbiotics combine the two approaches. Dietary intervention of the human gut microbiota is feasible and has been proven as efficacious in volunteer trials. The health bonuses of such approaches offer the potential to manage many gut disorders prophylactically. However, it is imperative that the best methodologies available are applied to this area of nutritional sciences. This will undoubtedly involve a genomic application to the research and is already under way through molecular tracking of microbiota changes to diet in controlled human trials.

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“…Additionally, studies in fetal and germ-free preterm pigs, and in quails, show that the initial bacterial colonization is a prerequisite for the development of NEC (5,53,68). Regardless, no specific pathogen has been identified as the primary cause of NEC (47,69) although bacterial overgrowth may be a key element in the etiology of NEC (37). Bacterial overgrowth may result from factors such as intestinal dysmotility, reduced digestive function, and immature immunological responses to microbial colonization, all of which are characteristics of the premature gut (3,37).…”

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confidence: 99%

Antibiotics modulate intestinal immunity and prevent necrotizing enterocolitis in preterm neonatal piglets

Jensen

Thymann

Cilieborg

et al. 2014

American Journal of Physiology-Gastrointestinal and Liver Physi

103

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Preterm birth, bacterial colonization, and formula feeding predispose to necrotizing enterocolitis (NEC). Antibiotics are commonly administered to prevent sepsis in preterm infants, but it is not known whether this affects intestinal immunity and NEC resistance. We hypothesized that broad-spectrum antibiotic treatment improves NEC resistance and intestinal structure, function, and immunity in neonates. Caesarean-delivered preterm pigs were fed 3 days of parenteral nutrition followed by 2 days of enteral formula. Immediately after birth, they were assigned to receive either antibiotics (oral and parenteral doses of gentamycin, ampicillin, and metronidazole, ANTI, n ϭ 11) or saline in the control group (CON, n ϭ 13), given twice daily. NEC lesions and intestinal structure, function, microbiology, and immunity markers were recorded. None of the ANTI but 85% of the CON pigs developed NEC lesions by day 5 (0/11 vs. 11/13, P Ͻ 0.05). ANTI pigs had higher intestinal villi (ϩ60%), digestive enzyme activities (ϩ53-73%), and goblet cell densities (ϩ110%) and lower myeloperoxidase (Ϫ51%) and colonic microbial density (10 5 vs. 10 10 colony-forming units, all P Ͻ 0.05). Microarray transcriptomics showed strong downregulation of genes related to inflammation and innate immune response to microbiota and marked upregulation of genes related to amino acid metabolism, in particular threonine, glucose transport systems, and cell cycle in 5-day-old ANTI pigs. In a follow-up experiment, 5 days of antibiotics prevented NEC at least until day 10. Neonatal prophylactic antibiotics effectively reduced gut bacterial load, prevented NEC, intestinal atrophy, dysfunction, and inflammation and enhanced expression of genes related to gut metabolism and immunity in preterm pigs.

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Necrotising enterocolitis: is there a relationship to specific pathogens?

Abstract: Although gut colonisation with potential pathogens appeared to be a prerequisite for the development of NEC, there were no specific bacteria associated with this disease if data from infants with NEC were compared with those from time- and gestational age-matched controls.

Cited by 82 publications

References 23 publications

Investigation of the early intestinal microflora in premature infants with/without necrotizing enterocolitis using two different methods

Investigation of the early intestinal microflora in premature infants with/without necrotizing enterocolitis using two different methods

Perspectives on the role of the human gut microbiota and its modulation by pro- and prebiotics

Antibiotics modulate intestinal immunity and prevent necrotizing enterocolitis in preterm neonatal piglets

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