Intestinal Microbiome Changes in an Infant with Right Atrial Isomerism and Recurrent Necrotizing Enterocolitis: A Case Report and Review of Literature

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2022 Oct 31

PMID 36312470

Authors

Aleksandra Kaplina

Ekaterina Zaikova

Artem Ivanov

Yulia Volkova

Tatiana Alkhova

Vladimir Nikiforov

Alexander Latypov

Marina Khavkina

Tatiana Fedoseeva

Tatiana Pervunina

Yulia Skorobogatova

Svetlana Volkova

Vladimir Ulyantsev

Olga Kalinina

Stanislav Sitkin

Natalia Petrova

Affiliations

Soon will be listed here.

Abstract

Background: Necrotizing enterocolitis (NEC) is a multifactorial disease that predominantly affects premature neonates. Intestinal dysbiosis plays a critical role in NEC pathogenesis in premature neonates. The main risk factor for NEC in term infants is mesenteric hypoperfusion associated with ductal-dependent congenital heart disease (CHD) that eventually leads to intestinal ischemia. The incidence of NEC in neonates with critical CHD is 6.8%-13%. However, the role of the intestinal microbiome in NEC pathogenesis in infants with ductal-dependent CHD remains unclear.

Case Summary: A male term neonate with right atrial isomerism underwent modified Blalock-Taussig shunt placement on the 14 day of life and had persistent mesenteric hypoperfusion after surgery. The patient had episodes of NEC stage IIA on the 1 and 28 days after cardiac surgery. Fecal microbial composition was analyzed before and after cardiac surgery by sequencing region V4 of the 16S rRNA gene. Before surgery, species belonging to genera and and class Gammaproteobacteria were detected, Bifidobacteriaceae showed a low abundance. The first NEC episode was associated with postoperative hemodynamic instability, intestinal ischemia-reperfusion injury during cardiopulmonary bypass, and a high abundance of ) (56.1%). Antibacterial therapy after the first NEC episode resulted in increased abundance of Gammaproteobacteria, decreased abundance of Firmicutes, and low alpha diversity. These changes in the microbial composition promoted the growth of (72.0%) before the second NEC episode.

Conclusion: A high abundance of and mesenteric hypoperfusion may have contributed to NEC in the present case.

Citing Articles

Human Milk Feeding and Direct Breastfeeding Improve Outcomes for Infants With Single Ventricle Congenital Heart Disease: Propensity Score-Matched Analysis of the NPC-QIC Registry.

Elgersma K, Wolfson J, Fulkerson J, Georgieff M, Looman W, Spatz D J Am Heart Assoc. 2023; 12(17):e030756.

PMID: 37642030 PMC: 10547322. DOI: 10.1161/JAHA.123.030756.

Human milk feeding and direct breastfeeding improve outcomes for infants with single ventricle congenital heart disease: Propensity score matched analysis of the NPC-QIC registry.

Elgersma K, Wolfson J, Fulkerson J, Georgieff M, Looman W, Spatz D medRxiv. 2023; .

PMID: 37162951 PMC: 10168482. DOI: 10.1101/2023.04.26.23289126.

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