The pathophysiology of necrotizing enterocolitis in preterm infants: New insights in the interaction between the gut and its microbiota

Fardou Hadewych Heida

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    Necrotizing enterocolitis (NEC) is a severe gastrointestinal disorder affecting the preterm infant. The underlying cause of NEC is partly unknown. This thesis studied the gut flora, the intestinal barrier function, and the intestinal bloodcirculation contributing to NEC.
    We observed NEC-associated bacteria (Clostridium perfringens and Bacteroides dorei) within the first baby poop after birth (meconium). These bacteria might predispose the intestine to an early inflammatory reaction. We also observed an increase of immune competent Paneth cells, the guardians of the deepest regions of the gut (crypts), from a gestational age of 29 weeks onwards, which is the same postmenstrual age when NEC commonly develops.
    This combination of NEC-associated bacteria and the increase of Paneth cells probably stimulates the inflammatory reaction, which damages the surrounding intestinal cells and sometimes leads to necrosis of the bowel wall. Thereby, the preterm infant often has a diminished intestinal bloodcirculation (e.g. due to low blood pressure). The diminshed intestinal bloodcirculation decreases the amount of oxygen reaching the intestinal cells which further stimulates damage of these cells and could again lead to necrosis. Indeed, we observed a diminished intestinal bloodcirculation during NEC (measured via near-infrared spectroscopy (NIRS)). Damage of the bowel wall (measured via the marker I-FABP) was related to (the severity of) NEC, the severity of diminishing of intestinal bloodcirculation, and the length of intestinal necrosis in (surgical) NEC.
    The occurrence of NEC thus seems to be a complex interplay between local inflammation of the intestines, NEC-associated bacteria, and a diminished intestinal bloodcirculation.
    Originele taal-2English
    KwalificatieDoctor of Philosophy
    Toekennende instantie
    • Rijksuniversiteit Groningen
    Begeleider(s)/adviseur
    • Bos, Arie, Supervisor
    • Hulscher, Jan, Co-supervisor
    • Harmsen, Hermie J.M. , Co-supervisor
    Datum van toekenning29-jun-2016
    Plaats van publicatie[Groningen]
    Uitgever
    Gedrukte ISBN's978-90-367-8878-6
    Elektronische ISBN's978-90-367-8877-9
    StatusPublished - 2016

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