The Role of Bacteria in Necrotizing Enterocolitis: Understanding the Forest for the Trees

McElroy, Steven J.

doi:10.1159/000437205

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…NEC continues to confuse the medical world because no unique bacterium has been identified as the causative pathogen for its development, although a dysbiosis of the intestinal microbiota is involved .…”

Section: Discussionmentioning

confidence: 99%

Preterm infants with necrotising enterocolitis demonstrate an unbalanced gut microbiota

et al. 2017

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Aim: This Lebanese study tested the hypothesis that differences would exist in the gut microbiota of preterm infants with and without necrotising enterocolitis (NEC), as reported in Western countries.Methods: This study compared 11 infants with NEC and 11 controls, all born at 27-35 weeks, in three neonatal intensive care units between January 2013 and March 2015. Faecal samples were collected at key time points, and microbiota was analysed by culture, quantitative PCR (qPCR) and temperature temporal gel electrophoresis (TTGE). Results:The cultures revealed that all preterm infants were poorly colonised and harboured no more than seven species. Prior to NEC diagnosis, significant differences were observed by qPCR with a higher colonisation by staphylococci (p = 0.034) and lower colonisations by enterococci (p = 0.039) and lactobacilli (p = 0.048) in the NEC group compared to the healthy controls. Throughout the study, virtually all of the infants were colonised by Enterobacteriaceae at high levels. TTGE analysis revealed no particular clusterisation, showing high interindividual variability. Conclusion:The NEC infants were poorly colonised with no more than seven species, and the controls had a more diversified and balanced gut microbiota. Understanding NEC aetiology better could lead to more effective prophylactic interventions and a reduced incidence.

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Section: Discussionmentioning

confidence: 99%

Preterm infants with necrotising enterocolitis demonstrate an unbalanced gut microbiota

et al. 2017

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“…Despite multiple reports of NEC outbreaks associated with certain bacteria, identification of a specific pathogen as the main aetiological factor remains elusive 108,115 . Several studies have shown that there is decreased diversity in the gut microbiota of infants diagnosed with NEC when compared with age-matched controls, although without a unified pattern except for the overabundance of strict anaerobes 108,118,119 .…”

Section: Pathogenesis Of Necmentioning

confidence: 99%

Necrotizing enterocolitis: new insights into pathogenesis and mechanisms

Niño

Sodhi

Hackam

2016

Nat Rev Gastroenterol Hepatol

397

384

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Necrotizing enterocolitis (NEC) is the most frequent and lethal disease of the gastrointestinal tract of preterm infants. At present, NEC is thought to develop in the premature host in the setting of bacterial colonization, often after administration of non-breast milk feeds, and disease onset is thought to be due in part to a baseline increased reactivity of the premature intestinal mucosa to microbial ligands as compared with the full-term intestinal mucosa. The increased reactivity leads to mucosal destruction and impaired mesenteric perfusion and partly reflects an increased expression of the bacterial receptor Toll-like receptor 4 (TLR4) in the premature gut, as well as other factors that predispose the intestine to a hyper-reactive state in response to colonizing microorganisms. The increased expression of TLR4 in the premature gut reflects a surprising role for this molecule in the regulation of normal intestinal development through its effects on the Notch signalling pathway. This Review will examine the current approach to the diagnosis and treatment of NEC, provide an overview of our current knowledge regarding its molecular underpinnings and highlight advances made within the past decade towards the development of specific preventive and treatment strategies for this devastating disease.

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“…Pathogens such as enterococci and Enterobacteriaceae causing late-onset bloodstream infection are in a dominant or near-dominant proportion within the intestinal microbiome at diagnosis [29]. Although the emerging evidence suggests that NEC is also strongly related to the intestinal microbiomic structure, there is insufficient evidence at present to determine whether any specific bacteria or fungi are causally associated with development of NEC [30]. …”

Section: Prebiotics and Probioticsmentioning

confidence: 99%

Immunonutrition for Preterm Infants

Walsh

McGuire²

2019

Neonatology

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Care and outcomes for very preterm infants continue to improve, but important causes of mortality and acute and long-term morbidity associated with prolonged hospitalisation remain. Necrotising enterocolitis (NEC) and late-onset infection have emerged as the major causes of death beyond the early neonatal period and of neurodisability in very preterm infants. Although the pathogenesis of these conditions is incompletely understood, it appears to be related to the content and mode of delivery of the enteral diet, particularly the impact of immunonutrients from human breast milk on the microbial and metabolic balance within the immature intestine. Evidence exists to support investment in measures to help mothers to express breast milk as the primary source of nutrition for their very preterm infants. In the absence of maternal milk, pasteurised donor breast milk provides protection against NEC, but its nutritive adequacy is not clear and its cost-effectiveness is uncertain. Supplementation with individual immunonutrients, including immunoglobulins and lactoferrin, has not been shown to be effective in preventing NEC or infection in randomised controlled trials. The evidence base for prebiotics and probiotics is stronger, but concerns exist about the choice, safety and availability of formulations. Other strategies – including avoidance of drugs such as gastric acid suppressants that compromise innate immunity, as well as evidence-based progressive feeding strategies that reduce exposure to invasive interventions – are emerging as key components of care packages to reduce the burden of NEC, infection and associated growth and developmental faltering for very preterm infants.

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The Role of Bacteria in Necrotizing Enterocolitis: Understanding the Forest for the Trees

Cited by 7 publications

References 22 publications

Preterm infants with necrotising enterocolitis demonstrate an unbalanced gut microbiota

Preterm infants with necrotising enterocolitis demonstrate an unbalanced gut microbiota

Necrotizing enterocolitis: new insights into pathogenesis and mechanisms

Immunonutrition for Preterm Infants

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