Elsevier

Clinics in Perinatology

Volume 37, Issue 3, September 2010, Pages 565-579
Clinics in Perinatology

New Concepts of Microbial Translocation in the Neonatal Intestine: Mechanisms and Prevention

https://doi.org/10.1016/j.clp.2010.05.006Get rights and content

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General Principles

Healthy term infants stay with their mothers, breastfeed, and acquire intestinal microflora from the mother that is genetically compatible. This theory, espoused by Hooper and colleagues,8 holds that proper postnatal acquisition of genetically compatible gut microbiota improves nutrition and fortifies the gut's epithelial barrier. In contrast, VLBW infants are almost always separated from their mothers and are cared for in a neonatal ICU containing resistant and invasive pathogens. Although

Gut epithelia and protection against bacterial translocation

The mechanisms used by goblet cells, enterocytes, and Paneth cells to protect VLBW infants from BT are summarized in Table 1.46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66

General Principles

During the third trimester of pregnancy, the fetus swallows nutrient-, growth factor-, and antibiotic peptide–rich amniotic fluid.69 Human milk is even more complex than amniotic fluid, and it continues to enhance intestinal development after birth.70 In addition to its nutrient composition, human milk contains hormones, growth factors, cytokines, immunomodulators, natural peptide antibiotics, sIgA, and probiotic bacteria.70, 71, 72, 73, 74, 75, 76 sIgA in milk is the end result of crosstalk

Summary

Bacterial translocation from the GI tract is an important pathway initiating late-onset sepsis and necrotizing enterocolitis in very low-birth-weight infants. The emerging intestinal microbiota, nascent intestinal epithelia, naive immunity, and suboptimal nutrition (lack of breast milk) have roles in facilitating bacterial translocation. Feeding lactoferrin, probiotics, or prebiotics has presented exciting possibilities to prevent bacterial translocation in preterm infants, and clinical trials

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    This research was supported by NIH grant R44 HD057744 and a Gerber Foundation grant.

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