Role of Intestinal Microflora on Necrotizing Enterocolitis in Preterm Infants

Preterm infants are a vulnerable population at risk of intestinal dysbiosis. The newborn microbiome is dominated by Bifidobacterium species, though abnormal microbial colonization can occur by exogenous factors such as mode of delivery, formula feeding, and exposure to antibiotics. Therefore, preterm infants are predisposed to sepsis and necrotizing enterocolitis (NEC), a fatal gastrointestinal disorder, due to an impaired intestinal barrier, immature immunity, and a dysbiotic gut microbiome. Properties of human milk serve as protection in the prevention of NEC. Human milk oligosaccharides (HMOs) and the microbiome of breast milk are immunomodulatory components that provide intestinal homeostasis through regulation of the microbiome and protection of the intestinal barrier. Enteral probiotic supplements have been trialed to evaluate their impact on establishing intestinal homeostasis. Here, we review the protective role of HMOs, probiotics, and synbiotic combinations in protecting a vulnerable population from the pathogenic features associated with necrotizing enterocolitis.

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The Role of Probiotics in the Prevention of Necrotizing Enterocolitis

Current Pediatric Reviews ◽

10.2174/1573396315666181224123223 ◽

2019 ◽

Vol 15 (2) ◽

pp. 88-91 ◽

Cited By ~ 1

Author(s):

Ivana Trivić ◽

Ana Savić Mlakar ◽

Iva Hojsak

Keyword(s):

Gastrointestinal Tract ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Preventive Strategies ◽

Life Threatening ◽

Probiotic Strains ◽

Considerable Benefit ◽

Nutritional Strategies

Necrotizing enterocolitis (NEC) is a frequent and severe life-threatening disease affecting the gastrointestinal tract of preterm infants. Given that NEC occurs in a well-defined population of patients, there might be a considerable benefit in identifying specific pharmacological and nutritional preventive strategies, that could reduce the incidence of NEC. Amongst nutritional strategies emphasis has been put on the use of probiotics. Therefore, the aim of this review is to summarize currently available evidence on the role of probiotics in general, as well as the role of specific probiotic strains or their combinations, in the prevention of NEC.

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The Role of Dietary Fats in the Development and Prevention of Necrotizing Enterocolitis

Nutrients ◽

10.3390/nu14010145 ◽

2021 ◽

Vol 14 (1) ◽

pp. 145

Author(s):

Belal N. Alshaikh ◽

Adriana Reyes Loredo ◽

Megan Knauff ◽

Sarfaraz Momin ◽

Shirin Moossavi

Keyword(s):

Fatty Acids ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Postnatal Period ◽

Dietary Fats ◽

Microbial Colonization ◽

Intestinal Development ◽

Limited Effect ◽

Mortality And Morbidity

Necrotizing enterocolitis (NEC) is a significant cause of mortality and morbidity in preterm infants. The pathogenesis of NEC is not completely understood; however, intestinal immaturity and excessive immunoreactivity of intestinal mucosa to intraluminal microbes and nutrients appear to have critical roles. Dietary fats are not only the main source of energy for preterm infants, but also exert potent effects on intestinal development, intestinal microbial colonization, immune function, and inflammatory response. Preterm infants have a relatively low capacity to digest and absorb triglyceride fat. Fat may thereby accumulate in the ileum and contribute to the development of NEC by inducing oxidative stress and inflammation. Some fat components, such as long-chain polyunsaturated fatty acids (LC-PUFAs), also exert immunomodulatory roles during the early postnatal period when the immune system is rapidly developing. LC-PUFAs may have the ability to modulate the inflammatory process of NEC, particularly when the balance between n3 and n6 LC-PUFAs derivatives is maintained. Supplementation with n3 LC-PUFAs alone may have limited effect on NEC prevention. In this review, we describe how various fatty acids play different roles in the pathogenesis of NEC in preterm infants.

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Probiotics, Prebiotics, and Synbiotics for the Prevention of Necrotizing Enterocolitis

Frontiers in Nutrition ◽

10.3389/fnut.2021.667188 ◽

2021 ◽

Vol 8 ◽

Author(s):

Kiera Murphy ◽

R. Paul Ross ◽

C. Anthony Ryan ◽

Eugene M. Dempsey ◽

Catherine Stanton

Keyword(s):

Gut Microbiota ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Early Life ◽

Observational Studies ◽

Meta Analysis ◽

Randomized Controlled ◽

Routine Administration ◽

Gut Microbiota Composition

Necrotizing enterocolitis (NEC) is a major cause of morbidity and mortality in preterm infants. The exact mechanism by which NEC develops is poorly understood however there is growing evidence to suggest that perturbations in the early-life gut microbiota composition increase the risk for NEC. Modulation of the gut microbiota with probiotics, prebiotics, or in combination (synbiotics) is an area which has attracted intense interest in recent years. In this narrative review, we present an overview of the role of the gut microbiota in the pathogenesis of NEC. We also examine the evidence currently available from randomized controlled trials, observational studies, systematic reviews, and meta-analysis examining the role of probiotics, prebiotics, and synbiotics in reducing the risk of or preventing NEC. Current clinical practice guidelines with recommendations on the routine administration of probiotics to preterm infants for NEC are also explored.

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Probiotics for Preventing Necrotizing Enterocolitis in Preterm Infants: A Network Meta-Analysis

Nutrients ◽

10.3390/nu13010192 ◽

2021 ◽

Vol 13 (1) ◽

pp. 192

Author(s):

Isadora Beghetti ◽

Davide Panizza ◽

Jacopo Lenzi ◽

Davide Gori ◽

Silvia Martini ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Subgroup Analysis ◽

Meta Analysis ◽

Relative Effect ◽

Outcome Data ◽

Feeding Type ◽

Credible Intervals ◽

Meta Analyses

Background: Recent evidence supports a role of probiotics in preventing necrotizing enterocolitis (NEC) in preterm infants. Methods: A systematic review and network meta-analysis of randomized controlled trials (RCTs) on the role of probiotics in preventing NEC in preterm infants, focusing on the differential effect of type of feeding, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used; a subgroup analysis on exclusively human milk (HM)-fed infants vs. infants receiving formula (alone or with HM) was performed. Results: Fifty-one trials were included (10,664 infants, 29 probiotic interventions); 31 studies (19 different probiotic regimens) were suitable for subgroup analysis according to feeding. In the overall analysis, Lactobacillus acidophilus LB revealed the most promising effect for reducing NEC risk (odds ratio (OR), 0.03; 95% credible intervals (CrIs), 0.00–0.21). The subgroup analysis showed that Bifidobacterium lactis Bb-12/B94 was associated with a reduced risk of NEC stage ≥2 in both feeding type populations, with a discrepancy in the relative effect size in favour of exclusively HM-fed infants (OR 0.04; 95% CrIs <0.01–0.49 vs. OR 0.32; 95% CrIs 0.10–0.36). Conclusions: B. lactis Bb-12/B94 could reduce NEC risk with a different size effect according to feeding type. Of note, most probiotic strains are evaluated in few trials and relatively small populations, and outcome data according to feeding type are not available for all RCTs. Further trials are needed to confirm the present findings.

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Oxidative Stress and Necrotizing Enterocolitis: Pathogenetic Mechanisms, Opportunities for Intervention, and Role of Human Milk

Oxidative Medicine and Cellular Longevity ◽

10.1155/2018/7397659 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 19

Author(s):

Arianna Aceti ◽

Isadora Beghetti ◽

Silvia Martini ◽

Giacomo Faldella ◽

Luigi Corvaglia

Keyword(s):

Oxidative Stress ◽

Human Milk ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Antioxidant Status ◽

Antioxidant Properties ◽

Nutritional Intervention ◽

Antioxidant Defenses ◽

Antioxidant Compounds

This review will examine the role of oxidative stress (OS) in the pathogenesis of necrotizing enterocolitis (NEC) and explore potential preventive and therapeutic antioxidant strategies. Preterm infants are particularly exposed to OS as a result of several perinatal stimuli and constitutive defective antioxidant defenses. For this reason, OS damage represents a contributing factor to several complications of prematurity, including necrotizing enterocolitis (NEC). Being NEC a multifactorial disease, OS may act as downstream component of the pathogenetic cascade. To counteract OS in preterm infants with NEC, several antioxidant strategies have been proposed and different antioxidant compounds have been experimented. It is well known that human milk (HM) is an important source of antioxidants. At the same time, the role of an exclusive HM diet is well recognized in the prevention of NEC. However, donor HM (DHM) processing may impair antioxidant properties. As DHM is becoming a common nutritional intervention for high risk PI, the antioxidant status of preterm and DHM and potential ways to preserve its antioxidant capacity may merit further investigation.

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