早产儿坏死性小肠结肠炎的危险因素受营养策略和肠道菌群影响
在法国针对3161名24-31孕周后出生的早产儿（其中106名出现坏死性小肠结肠炎）进行的NEC风险因素研究，结果很明确指向出生后的喂养策略和肠道菌群可能与NEC的风险关系密切。很值得一读，特别推荐！
论文摘要
Necrotizing enterocolitis (NEC) is one of the most dreaded diseases in neonatal intensive care units (NICUs) (1, 2). The pathophysiology of NEC remains enigmatic (3). Its etiology is clearly multifactorial, with contributions from genetic predisposition, intestinal immaturity, hemodynamic instability, and intestinal microbial ecology (1–3).
A wide range of incidence of NEC from 2% to 20% has been reported (4–6). Evidence supports that feeding formula rather than human milk increases the risk of developing NEC (7). Other differences in enteral feeding, such as the timing of the introduction of feedings, the size of the daily volume of the increments, and the type of nutrients may also contribute to inter-NICU variation in the incidence of NEC. Moreover, implementation of the quality-improvement initiative reduced the NEC rate (8).
Several studies suggested that NEC is associated with both unusual intestinal microbial species and an overall reduction in the diversity of the microbiota (9–14). Fecal microbiota diversity in preterm infants born at a gestational age of <32 wk, who are at the highest risk of NEC, increases much more slowly than in more mature infants, and composition is dominated by staphylococci, enterobacteria, and enterococci, with a very low abundance of anaerobes except clostridia (15). To date, there is no consensus as to which specific bacterial strains are causally associated with NEC development. Several studies reported a dysbiosis with the phylum Proteobacteria highly represented before NEC onset (10, 11, 16). In addition, the presence of clostridia, in particular Clostridium perfringens, C. butyricum, and C. neonatale, has been reported either by culture (17–19) or by culture independent methods (19–23).
EPIPAGE 2 (Etude Epidémiologique sur les Petits Ages Gestationnels), a nation-wide population-based prospective cohort study (24), provided a unique opportunity to assess the role of nutritional strategies and microbiota as risk factors for NEC. We hypothesized 1) that nutritional strategies are associated with risk of NEC and 2) based on our previous clinical (21) and experimental (25) observations that clostridia colonization would differ between NEC cases and controls.
实验综述
① 开展基于全法国人群的前瞻性研究，评估喂养策略和肠道菌群与坏死性小肠结肠炎（NEC）的关系；
② 在2011年，针对3161名24-31孕周后出生的早产儿，评估出生后的个体特征，并在出生后第7天进行NEC风险评估；
③ 106名出现NEC，缓慢及中等的肠道喂养进展速率、较少及中等的直接母乳喂养策略与NEC高风险相关；
④ 通过比较16个患儿和78个对照组婴儿的肠道菌群，发现梭状芽孢杆菌和金黄色葡萄球菌与NEC相关。