Gut microbiota in necrotizing enterocolitis: a bibliometric and visualization analysis

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease affecting neonates, especially preterm and very low birth weight infants. Recent studies highlight the role of the gut microbiota in neonatal health, with microbial dysbiosis linked to NEC onset. However, bibliometric analyses in this field remain relatively scarce. This study aims to conduct a comprehensive analysis of the literature related to gut microbiota and NEC published between 1996 and 2024, to outline the development of this research area, identify emerging trends, and provide insights for future investigations.

Articles and reviews related to gut microbiota and NEC were retrieved through a subject search from Web of Science Core Collection, restricting the document type to articles or reviews and language to English. The relevant literature to be included in the analysis was identified. Subsequently, bibliometric analyses were conducted using Python, CiteSpace, VOSviewer, and the Bibliometrix (R-Tool of R-Studio) software to perform a visualization analysis of basic information and trends regarding journals, countries/regions, influential authors, institutions, keywords, and papers.

A total of 555 relevant articles were published between 1996 and 2024. The number of publications has consistently grown, with a notable surge since 2009. The United States and China are the primary contributors to this body of research, with the United States exerting the greatest influence in this field. Prominent journals include Frontiers in Pediatrics, Nutrients, Frontiers in Microbiology, Pediatric Research, and PLOS One. Influential authors in this area include Sangild PT and Neu J. Key research trends focus on the pathogenesis of the neonatal gut microbiota about NEC, the therapeutic potential of breast milk and probiotics, and the identification of multi-omics biomarkers. Recent literature prominently features keywords such as "premature infants," "pathogenesis," "breast milk," "NEC," "prebiotics," "probiotics," and "gut microbiota," while topics such as "inflammatory bowel disease" and "immune system" highlight a shift in research priorities, with an increasing focus on understanding pathological mechanisms and therapeutic interventions.

Our analysis highlights the role of gut microbiota in NEC in preterm infants, identifying probiotics and breast milk as potential therapeutic targets. It emphasizes the need for further research on microbiota-based interventions and their safety in neonates.

Gut microbiota dysbiosis plays a central role in the pathogenesis of necrotizing enterocolitis (NEC), particularly in preterm and extremely low birth weight infants. Probiotics and breast milk components are emerging as promising therapeutic and preventive strategies to restore microbial balance and strengthen intestinal defenses. This study presents the first comprehensive bibliometric analysis (1996-2024) of NEC-gut microbiota research, systematically mapping key authors, institutions, journals, and global collaborations, and identifying research hotspots such as probiotics, breast milk, the gut-brain axis, and multi-omics, while also highlighting gaps in mechanistic understanding and safety concerns regarding microbiota-based therapies in neonates. By providing a quantitative overview and roadmap of research trends, the findings enable clinicians and researchers to identify priority areas, support the development of targeted microbiota-based interventions and clinical strategies to reduce NEC incidence and improve neonatal outcomes, and encourage future large-scale, multicenter studies and mechanistic research to translate microbiota insights into safe and effective clinical practice.