Necrotising Enterocolitis and the Preterm Microbiome

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Abstract

Necrotising enterocolitis (NEC) is a devastating inflammatory condition of the gut that primarily affects preterm infants. Whilst the aetiology varies from case to case, recent data show that the onset of NEC is closely associated with the pattern of gut microbiota, especially in the few days prior to NEC onset. Recent studies suggest Human Milk Oligosaccharides (HMOs) may be a key component of breast milk associated with reductions in NEC.

3 min read
Reference

Dr Nicholas Embleton

Content

Prior to birth, the fetus is not completely sterile but is only colonized with low levels of bacteria. However, following delivery both term and preterm infants become rapidly colonised depending on a range of factors, including delivery mode and the immediate environment. Preterm infants experience an abnormal environment with limited or absent contact with the mother, they may have been delivered by caesarian section, and are frequently exposed to antibiotics. In addition, early enteral feeding takes time to establish, and there are key differences between infants who receive human breast milk and those who do not. The gut microbiota in preterm infants are therefore very different from that of a healthy breast fed infant, and appear linked to a range of health and disease outcomes. Necrotising enterocolitis (NEC) is a devastating inflammatory condition of the gut that primarily affects preterm infants. Whilst the aetiology varies from case to case, recent data show that the onset of NEC is closely associated with the pattern of gut microbiota, especially in the few days prior to NEC onset. Changes in the pattern of gut microbes are mirrored by changes in a range of stool metabolites such as short chain fatty acids. Whether these changes are causal in the pathogenesis of NEC, or whether they reflect other processes is uncertain. The continual interaction between diet and microbes suggest that dietary factors are important in NEC, especially the well-studied observation that NEC is lower in infants fed breast milk. Recent studies suggest Human Milk Oligosaccharides (HMOs) may be a key component of breast milk associated with reductions in NEC. In preterm infants, the specific pattern of HMO concentrations is linked with the development of NEC, suggesting future therapeutic possibilities for specific individual HMOs.

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