Probiotics: Role in Pathophysiology and Prevention in Necrotizing Enterocolitis
Section snippets
Components of the Gut Defense
The fully developed gastrointestinal system possess local nonspecific barrier defenses and cell-specific antigen interactions that function together to protect the gut from colonization and translocation of potentially pathogenic bacteria and antigens.13 The local defenses include gastric acidity and digestive enzymes to destroy ingested pathogens and associated antigens, mucus production to inhibit microbial adherence, active regular peristalsis to prevent bacterial stasis and rapidly
Bacterial Colonization of the Developing Gut
In utero the fetal gut is bathed in sterile amniotic fluid enriched with nutrients, hormones, and growth factors which aid in the development of the intestinal tract.41 At delivery, the newborn leaves this sterile environment and is exposed to environmental organisms, some of which establish residence and colonize the gut. Colonization by nonpathogenic, commensal organisms creates a stable and diverse intestinal flora which is essential for the ongoing development of both intestinal structure
Probiotics and Health
Although the use of probiotics (“for life”) for health benefit has received a fair amount of attention in the past decade, the potential health benefits of nonpathogenic microorganisms have been described centuries ago in the Old Testament and classical Roman literature.69, 70 The term probiotic was first introduced in 1965 and the definition has since undergone many variations.71 In 2001, the Food and Agriculture Organization (FAO) of the United Nations and the World Health Organization (WHO)
Rationale
NEC, an inflammatory bowel disease largely specific to the preterm infant, is characterized by the disruption of intestinal mucosal integrity leading to an acute clinical presentation of feeding intolerance, bloody stools, and pneumointestinalis, and is accompanied by a systemic inflammatory response of cardiorespiratory compromise and severe hemodynamic instability. As reviewed, the preterm infant is especially vulnerable to the development of NEC as a result of inappropriate intestinal
Conclusion
Ongoing development of the gastrointestinal system continues after birth and relies on the establishment of a stable and diverse intestinal microbial population. This symbiotic relationship between commensal organisms and the host enhances the maturity of the intestinal defenses and modulates the inmate immune system and gut inflammation.
The developmental immaturity of the preterm gut and the exposure to the NICU environment and associated treatments promotes inappropriate intestinal
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