Intestinal microbiome changes in an infant with right atrial isomerism and recurrent necrotizing enterocolitis: A case report and review of literature

Abstract

BACKGROUND Necrotizing enterocolitis (NEC) is a multifactorial disease that predominantly affects premature neonates. Intestinal dysbiosis plays a critical role in NEC pathogenesis in premature neonates. The main risk factor for NEC in term infants is mesenteric hypoperfusion associated with ductal-dependent congenital heart disease (CHD) that eventually leads to intestinal ischemia. The incidence of NEC in neonates with critical CHD is 6.8%-13%. However, the role of the intestinal microbiome in NEC pathogenesis in infants with ductal-dependent CHD remains unclear. CASE SUMMARY A male term neonate with right atrial isomerism underwent modified Blalock-Taussig shunt placement on the 14 th day of life and had persistent mesenteric hypoperfusion after surgery. The patient had episodes of NEC stage IIA on the 1 st and 28 th days after cardiac surgery. Fecal microbial composition was analyzed before and after cardiac surgery by sequencing region V4 of the 16S rRNA gene. Before surgery, species belonging to genera Veillonella and Clostridia and class Gammaproteobacteria were detected, Bifidobacteriaceae showed a low abundance. The first NEC episode was associated with postoperative hemodynamic instability, intestinal ischemia-reperfusion injury during cardiopulmonary bypass, and a high abundance of Clostridium paraputrificum (Clostridium sensu stricto I ) (56.1%). Antibacterial therapy after the first NEC episode resulted in increased abundance of Gammaproteobacteria, decreased abundance of Firmicutes, and low alpha diversity. These changes in the microbial composition promoted the growth of Clostridium sensu stricto I (72.0%) before the second NEC episode. CONCLUSION A high abundance of Clostridium sensu stricto I and mesenteric hypoperfusion may have contributed to NEC in the present case.

Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score‐Matched Analysis of the NPC‐QIC Registry

“…Knowledge about the gut microbiome of infants with CHD is only beginning to emerge, 62 , 63 , 64 , 65 , 66 , 67 and there has been no investigation into HM composition in the context of CHD. A 2022 study by Huang et al 62 provided the first comprehensive evidence on the gut microbiome of neonates with critical CHD, reporting dysbiosis characterized by increased pathogens (eg, Enterococcaceae , Enterobacteriaceae ) and decreased beneficial organisms (eg, Bifidobacterium , Lactobacillus ), a profile that shares similarities with the gut microbiome of very‐low‐birth‐weight infants, 58 with consequent inflammatory and immune imbalances potentially contributing to poor clinical outcomes, including NEC.…”

“… 62 The authors propose Bifidobacterium and oligosaccharide supplementation for infants with critical CHD but stop short of recommending improved lactation support for these infants and their families as a mechanism to promote intestinal homeostasis. Of the remaining abstracts, 67 studies, 63 , 65 , 66 or reviews 64 identified on the topic of the gut microbiome in patients with CHD, only 1 briefly mentions HM/breastfeeding, 66 and none discuss HM/breastfeeding as a therapeutic intervention for gut dysbiosis.…”

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry

“…Knowledge about the gut microbiome of infants with CHD is only beginning to emerge, [64][65][66][67][68][69] and there has been no investigation into HM composition in the context of CHD. A 2022 study by Huang et al.…”

“…64 The authors propose Bifidobacterium and oligosaccharide supplementation for infants with critical CHD, but stop short of recommending improved lactation support for these infants and their families as a mechanism to promote intestinal homeostasis. Of the remaining abstracts, 69 studies, 65,67,68 or reviews 66 identified on the topic of the gut microbiome in patients with CHD, only one briefly mentions HM/BF 68 and none discuss HM/BF as a therapeutic intervention for gut dysbiosis.…”