Prevention of Necrotizing Enterocolitis Through Manipulation of the Intestinal Microbiota of the Premature Infant

Abstract

In spite of four decades of research, necrotizing enterocolitis (NEC) remains the most common gastrointestinal complication in premature infants with high mortality and long-term morbidity. The composition of the intestinal microbiota of the premature infant differs dramatically from that of the healthy term infant and appears to be an important risk factor for NEC. Promising NEC prevention strategies that alter the intestinal microbiota include probiotics, prebiotics, synbiotics, lacteroferrin, and human milk feeding.

Necrotizing enterocolitis: new insights into pathogenesis and mechanisms

“…An important factor to consider in the context of NEC is that colonization of the gut in the early neonatal period happens in two waves 105 . The first wave, which is similar in both term and preterm infants, is predominantly dependent upon the mode of childbirth 105,106 .…”

“…An important factor to consider in the context of NEC is that colonization of the gut in the early neonatal period happens in two waves 105 . The first wave, which is similar in both term and preterm infants, is predominantly dependent upon the mode of childbirth 105,106 . The second wave of colonization in term infants is determined by feeding type, namely breastfeeding, which is rich in bifidobacteria and Bacteroides , or formula-feeding, which predominantly comprises streptococci, staphylococci and lactobacilli 106 .…”

“…The second wave of colonization in term infants is determined by feeding type, namely breastfeeding, which is rich in bifidobacteria and Bacteroides , or formula-feeding, which predominantly comprises streptococci, staphylococci and lactobacilli 106 . In the case of preterm infants the second wave of colonization is less influenced by the type of feeding and is characterized by high numbers of Clostridiaceae and Enterobacteriaceae and very low relative numbers of bifidobacteria and Bacteroidetes, in contrast with term infants 105 . In fact, 16S ribosomal RNA gene pyrosequencing has shown that the single most important determinant factor of the composition of the premature gut microbiota is the degree of prematurity 107 .…”

Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

“…The results of meta-analyses of prospective randomized clinical trials related to the role of probiotics in preventing NEC also support the importance of the gut microbiota in the pathogenesis of disease (28). Recent studies support the importance of the gut microbiome and suggest that maintaining environmental homeostasis (microbial, immune balance) could prove beneficial for preventing NEC in preterm infants (29).…”

New Frontiers of Necrotizing Enterocolitis: From Pathophysiology to Treatment

“…These agents have been shown to protect against NEC and reduce disease severity and overall mortality in premature infants [82] [83]. The finding that a degree of perturbation in the normal gut microbial flora exists in patients with NEC supports a rationale of using probiotics to treat and prevent this disease [84] [85] [86]. Considering the vulnerability of premature infants, routine administration of probiotic agents has elicited substantial controversy regarding the type of agent to be used, dosing and timing [83] [87].…”