The Microbiota-Gut Axis in Premature Infants: Physio-Pathological Implications

Abstract

Intriguing evidence is emerging in regard to the influence of gut microbiota composition and function on host health from the very early stages of life. The development of the saprophytic microflora is conditioned by several factors in infants, and peculiarities have been found for babies born prematurely. This population is particularly exposed to a high risk of infection, postnatal antibiotic treatment, feeding difficulties and neurodevelopmental disabilities. To date, there is still a wide gap in understanding all the determinants and the mechanism behind microbiota disruption and its influence in the development of the most common complications of premature infants. A large body of evidence has emerged during the last decades showing the existence of a bidirectional communication axis involving the gut microbiota, the gut and the brain, defined as the microbiota–gut–brain axis. In this context, given that very few data are available to demonstrate the correlation between microbiota dysbiosis and neurodevelopmental disorders in preterm infants, increasing interest has arisen to better understand the impact of the microbiota–gut–brain axis on the clinical outcomes of premature infants and to clarify how this may lead to alternative preventive, diagnostic and therapeutic strategies. In this review, we explored the current evidence regarding microbiota development in premature infants, focusing on the effects of delivery mode, type of feeding, environmental factors and possible influence of the microbiota–gut–brain axis on preterm clinical outcomes during their hospital stay and on their health status later in life.

Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of randomised controlled trials

“…Indeed, a reduction in antibiotic prescriptions has the potential to beneficially protect the infant microbiome and to reduce the development of antibiotic resistance. 30 , 31 …”

Effect of different feeding methods and gut microbiota on premature infants and clinical outcomes

“…Feeding pattern is known to strongly influence the composition of the gut microbiota ( 30 ). In one study, the consecutive appearance of Bacillales , Lactobacillales , Enterobacteriales , Clostridiales , and Bifidobacteriales was found in infants fed with maternal breasts, while formula-fed infants experienced a longer persistence of Bacillales and Lactobacillales ( 15 ).…”

Development of the Gastrointestinal Tract in Newborns as a Challenge for an Appropriate Nutrition: A Narrative Review

“…There are several factors which could have a specific impact on the MGBA development in early life; one of the most relevant might be prematurity, as preterm birth interrupts the physiological growth and development of both the GI tract and the nervous system and leads to a certain degree of microbial dysbiosis. Despite that, at present there are no studies specifically designed to describe the unique features of the MGBA in preterm infants [ 80 ]. In addition, nutrition during sensitive developmental time windows is thought to have a major impact on the microbiota-gut–brain crosstalk [ 81 , 82 ], either through an effect of single nutrients (e.g., milk fat globule membranes [ 83 ], human milk oligosaccharides [ 84 ], or through the well-known benefits of exclusive human milk feeding compared to other feeding sources [ 85 ].…”