Pathogenesis of Necrotising Enterocolitis Associated with Faecal Microbiome among Preterm Infants: A Review

Abstract

Necrotizing enterocolitis (NEC) is primarily a disease process of the gastrointestinal (GI) tract of premature neonates that results in inflammation and bacterial invasion of the bowel wall. It is the most common gastrointestinal (GI) emergency in neonatal intensive care units (NICUs), making it one of the leading causes of long-term disability in preterm infants. Despite advances in the care of premature infants, NEC remains one of the leading causes of morbidity and mortality in this population. It occurs in 1-5% of all neonatal intensive care admissions and 5-10% of all very low birth weight (<1500 g) infants. Necrotizing enterocolitis (NEC) is primarily a disease of premature infants, but may also be present in 10% of term and near term babies. Preterm infants show delayed colonization by "healthy commensal" organisms, especially bifidobacteria and lactobacilli. Data suggest that low colonization of Bifidobacterium and Lactobacillus in preterm Very Low Birth Weight (VLBW) infants may serve as a predisposing factor in microbial infection and NEC. The presence of a higher proportion of Proteobacteria has an association with faecal microbiome among preterm infants. Thus, the focus of this review is to provide an in-depth summary of the current knowledge regarding its association with faecal microbiome among preterm infants. Different search engines were carefully employed in analyzing scientific articles, journals, and online published data. Preventing NEC is instrumental in decreasing the morbidity and mortality from this gastrointestinal emergency. Human milk (breastfeeding) has been proved to be protective against NEC likewise probiotic supplementation has reduced both incidence and severity of necrotising enterocolitis in preterm neonates. Also, the intervention of surgery, laparotomy andthe use of stem cells in clinical neonatology is therapeutic options with huge potential.With its multifactorial pathogenesis, disease prevention remains a challenge, although, probiotic supplementation has reduced both incidence and severity of necrotising enterocolitis in preterm neonates.