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. 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 Bifidobacterium and Lactobacillus. 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 the 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 the 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 proven to be protective against NEC, and probiotic supplementation has reduced both the incidence and severity of necrotizing enterocolitis in preterm neonates. Also, interventions such as surgery, laparotomy, and the use of stem cells in clinical neonatology are therapeutic options with huge potential. With its multifactorial pathogenesis, disease prevention remains a challenge, although probiotic supplementation has reduced both the incidence and severity of necrotizing enterocolitis in preterm neonates.