Gut microbiota as a risk and protective factor in neonatal necrotizing enterocolitis: An integrative review

Necrotizing enterocolitis (NEC) is characterized by inflammation of the gastrointestinal tract and intestinal necrosis, primarily affecting premature neonates. It is one of the leading causes of morbidity and mortality in this population. This article aims to analyze, based on recent scientific literature, the relationship between intestinal microbiota and the development of NEC in premature neonates, highlighting the main pathophysiological mechanisms and prevention strategies. We conducted an integrative literature review, with search in the Virtual Health Library (VHL) and Pubmed databases, applying the Patient, Intervention, Comparison and Outcomes (PICO) strategy. A total of 178 articles were initially identified, with the application of validated tools to assess the methodological quality of the studies. The final sample included 13 international articles. The main findings show intestinal dysbiosis, activation of immune pathways and metabolic alterations as key elements in the pathogenesis of NEC. On the other hand, the use of probiotics and enrichment of breast milk were associated with beneficial effects. In conclusion, NEC is a multifactorial disease associated with intestinal dysbiosis, with an increase in pathogenic bacteria and a reduction in beneficial bacteria such as Bifidobacterium spp. The activation of pro-inflammatory TLR4 receptors by bacterial LPS favors intestinal damage. Factors such as prematurity, use of antimicrobials, and changes in the composition of breast milk favor microbiota imbalance. Probiotics and breastfeeding are promising strategies for preventing this situation. Therefore, this article gathers pertinent information that can help in understanding the factors involved in NEC.