Abstract
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.
Highlights
Necrotizing enterocolitis (NEC) affects the gastrointestinal tract of preterm infants and remains a leading cause of morbidity and mortality in neonatal intensive care units
As Human milk oligosaccharides (HMOs) and probiotics have been separately identified to have a benefit in the infant gut microbiome, reduced risk of morbidities such as NEC, and long-term impact on neurodevelopment, recent studies have examined the synergistic effects of these agents when supplemented in combination
Preterm infants are vulnerable to intestinal dysbiosis and an immature intestinal barrier that predisposes them to morbidities such as sepsis and NEC
Summary
Necrotizing enterocolitis (NEC) affects the gastrointestinal tract of preterm infants and remains a leading cause of morbidity and mortality in neonatal intensive care units. While the exact pathogenesis of NEC remains an intense area of investigation, it is known that breast fed infants are largely protected from developing NEC, strongly suggesting components present in breast milk are protective. Observations of infants with NEC have shown evidence of intestinal bacterial dysbiosis when compared to healthy infants, which has led to the hypothesis that inappropriate gut bacterial colonization serves as a contributing feature in the development of NEC [3,4,5]. A variety of exogenous and endogenous therapeutic strategies have been investigated to strengthen gut barrier function and prevent intestinal dysbiosis related to prematurity. We discuss the benefits of prebiotics, human milk oligosaccharides, and enteral probiotic supplements in premature infants and their protective role on the intestinal epithelial barrier, the gut microbiome, and prevention against morbidities and mortalities associated with preterm birth
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