Bugs and the barrier: A review of the gut microbiome and intestinal barrier in necrotizing enterocolitis |
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| Affiliation: | 1. Division of Pediatric Surgery, Oklahoma Children''s Hospital, 1200 Everett Drive, ET NP 2320 Oklahoma City, OK 73104, United States;2. The University of Oklahoma Health Sciences Center, Department of Surgery, 800 Research Parkway, Suite 449, Oklahoma City, OK 73104, United States;1. Division of Pediatric Surgery, Primary Children''s Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA;2. Department of Surgery, Norton Children''s Hospital, University of Louisville, Louisville, KY, USA;3. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA;4. Department of Anesthesia, Boston Children''s Hospital, Harvard Medical School, Boston, MA, USA;5. Nemours Children''s Hospital Orlando, University of Central Florida, Orlando, FL, USA;6. Cincinnati Children''s Hospital, Cincinnati, OH, USA;7. Medical College of Wisconsin, Children''s Hospital Wisconsin, Milwaukee, WI, USA;1. Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children''s Hospital of Chicago, Chicago, Illinois, USA;2. Northwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA;3. Department of Obstetrics and Gynecology, Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA;4. Division of Pediatric Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA;1. Division of Pediatric Surgery, Washington University, St. Louis, MO, USA;2. Division of Pediatric Surgery, University of Utah, Salt Lake City, UT, USA;3. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA;4. Division of Pediatric Orthopedic Surgery, Carolinas Medical Center, Wake Forest School of Medicine, Charlotte, NC, USA;5. Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children''s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;6. Pediatric Surgery, Connecticut Children''s, Hartford, CT, USA;7. Department of Pediatric Surgery, Nationwide Children''s Hospital and Ohio State University, Columbus, OH, USA;8. Department of Pediatric Otolaryngology, Nationwide Children''s Hospital and Ohio State University, Columbus, OH, USA;10. Division of Pediatric Urology, Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA;111. Division of Pediatric Surgery, Department of Surgery, Shawn Jenkins Children''s Hospital, The Medical University of South Carolina, Charleston, SC, USA;11. Division of Plastic, Maxillofacial and Oral Surgery, Department of Surgery and Department of Population Health Sciences, Duke University, Durham, NC, USA;12. Department of Pediatric Anesthesiology and Perioperative Medicine, Nemours Children''s Hospital Delaware, Thomas Jefferson University, Philadelphia, USA;13. Department of Anesthesia & Critical Care Medicine, St. Louis University, St. Louis, MO, USA;14. Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children''s Hospital of Chicago, Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;15. Division of Urology, Ann & Robert H. Lurie Children''s Hospital of Chicago, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA;16. Division of Pediatric Surgery, Children''s Hospital of the King''s Daughters, Eastern Virginia Medical School, Norfolk, VA, USA;17. Independent Statistical Consultant, Phoenixville, PA, USA;18. Department of Surgery, Washington University St. Louis School of Medicine and BJC Healthcare, St. Louis, MO, USA;110. Department of Surgery, Boston Children''s Hospital, Boston, MA, USA;1. Dayton Children''s Hospital, Dayton, OH, USA;2. University Hospitals Cleveland Medical Center/ Rainbow Babies and Children''s Hospital, Cleveland, OH, USA;3. Boston Children''s Hospital, Boston, MA, USA;4. University of Louisville School of Medicine/ Norton Children''s Hospital, Louisville, KY, USA |
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| Abstract: | Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disease that affects premature neonates. It frequently results in significant morbidity and mortality for those affected. Years of research into the pathophysiology of NEC have revealed it to be a variable and multifactorial disease. However, there are risk factors associated with NEC including low birth weight, prematurity, intestinal immaturity, alterations in microbial colonization, and history of rapid or formula based enteral feeds (Fig. 1).1, 2, 3 An accepted generalization of the pathogenesis of NEC includes a hyperresponsive immune reaction to insults such as ischemia, starting formula feeds, or alterations in the microbiome with pathologic bacterial colonization and translocation. This reaction causes a hyperinflammatory response disrupting the normal intestinal barrier, allowing abnormal bacterial translocation and ultimately sepsis.1,2,4 This review will focus specifically on the interactions with the microbiome and intestinal barrier function in NEC. |
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