Intestinal microbiome changes in an infant with right atrial isomerism and recurrent necrotizing enterocolitis:A case report and review of literature  

作　　者：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 

机构地区：[1]Research Laboratory of Physiology and Diseases of Newborns,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [2]Research Laboratory of Autoimmune and Autoinflammatory Diseases,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [3]Vladimir Ulyantsev,International Laboratory of Computer Technologies,ITMO University,St.Petersburg 197101,Russia [4]Department of Cardiovascular Surgery for Children,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [5]Department of Neonatal Physiology with an ICU Ward,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [6]Pediatric Cardiac Intensive Care Unit,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [7]Neonatal and Preterm Special Care Unit(2nd Stage Care),Almazov National Medical Research Centre,St.Petersburg 197341,Russia [8]Institute of Perinatology and Pediatrics,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [9]Express Laboratory of Perinatal Centre,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [10]Clinical Diagnostic Laboratory,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [11]Epigenetics and Metagenomics Group,Institute of Perinatology and Pediatrics,Almazov National Medical Research Centre,St.Petersburg 197341,Russia [12]Department of Internal Diseases,Gastroenterology and Dietetics,North-Western State Medical University named after I.I.Mechnikov,St.Petersburg 191015,Russia

出　　处：《World Journal of Clinical Cases》2022年第29期10583-10599,共17页世界临床病例杂志

基　　金：Supported by the Russian Science Foundation,No.22-25-00484。

摘　　要：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 ductaldependent 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^(th)day of life and had persistent mesenteric hypoperfusion after surgery.The patient had episodes of NEC stageⅡA on the 1^(st)and 28^(th)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 Veillonella and Clostridia and class Gammaproteobacteria were detected,Bifidobacteriaceae showed a low abundance.The first NEC episode was associated with postoperative hemodynamic instability,intestinal ischemiareperfusion injury during cardiopulmonary bypass,and a high abundance of Clostridium paraputrificum(Clostridium sensu stricto I)(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 Clostridium sensu strictoⅠ(72.0%)before the second NEC episode.CONCLUSION A high abundance of Clostridium sensu strictoⅠand mesenteric hypoperfusion may have contributed to NEC in the present case.

关 键 词：Necrotizing enterocolitis Congenital heart disease Ivemark syndrome HETEROTAXY Right atrial isomerism Intestinal microbiome Case report 

分 类 号：R725.7[医药卫生—儿科]