Decembrino Nunzia, Scuderi Maria Grazia, Betta Pasqua Maria, Leonardi Roberta, Bartolone Agnese, Marsiglia Riccardo, Marangelo Chiara, Pane Stefania, De Rose Domenico Umberto, Salvatori Guglielmo, Grosso Giuseppe, Di Domenico Federica Martina, Dotta Andrea, Putignani Lorenza, Capolupo Irma, Di Benedetto Vincenzo
Neonatal Intensive Care Unit, AOU Policlinico G. Rodolico San Marco, University of Catania, 95123 Catania, Italy.
Pediatric Surgery Unit, Department of Medical and Surgical Sciences and Advanced Technologies, G. F. Ingrassia, AOU Policlinico G. Rodolico San Marco, University of Catania, 95123 Catania, Italy.
Nutrients. 2025 Jul 5;17(13):2234. doi: 10.3390/nu17132234.
The gut microbiota (GM) is pivotal for immune regulation, metabolism, and neurodevelopment. Infants undergoing surgery for congenital gastrointestinal anomalies are especially prone to microbial imbalances, with a paucity of beneficial bacteria (e.g., Bifidobacteria and Bacteroides) and diminished short-chain fatty acid production. Dysbiosis has been associated with severe complications, including necrotizing enterocolitis, sepsis, and feeding intolerance. This narrative review aims to critically examine strategies for microbiota modulation in this high-risk cohort. An extensive literature analysis was performed to compare the evolution of GM in healthy neonates versus those requiring gastrointestinal surgery, synthetizing strategies to maintain eubiosis, such as early nutritional interventions-particularly the use of human milk-along with antibiotic management and supplementary treatments including probiotics, prebiotics, postbiotics, and lactoferrin. Emerging techniques in metagenomic and metabolomic analysis were also evaluated for their potential to elucidate microbial dynamics in these patients. Neonates undergoing gastrointestinal surgery exhibit significant alterations in microbial communities, characterized by reduced levels of eubiotic bacteria and an overrepresentation of opportunistic pathogens. Early initiation of enteral feeding with human milk and careful antibiotic stewardship are linked to improved microbial balance. Adjunctive therapies, such as the administration of probiotics and lactoferrin, show potential in enhancing gut barrier function and immune modulation, although confirmation through larger-scale studies remains necessary. Modulating the GM emerges as a promising strategy to ameliorate outcome in neonates with congenital gastrointestinal surgical conditions. Future research should focus on the development of standardized therapeutic protocols and the execution of rigorous multicenter trials to validate the efficacy and safety of these interventions.
肠道微生物群（GM）对免疫调节、新陈代谢和神经发育至关重要。接受先天性胃肠道畸形手术的婴儿尤其容易出现微生物失衡，有益细菌（如双歧杆菌和拟杆菌）数量不足，短链脂肪酸生成减少。生态失调与严重并发症有关，包括坏死性小肠结肠炎、败血症和喂养不耐受。本叙述性综述旨在严格审视针对这一高危人群的微生物群调节策略。进行了广泛的文献分析，以比较健康新生儿与需要进行胃肠道手术的新生儿的GM演变情况，综合维持微生态平衡的策略，如早期营养干预——特别是使用母乳——以及抗生素管理和包括益生菌、益生元、后生元及乳铁蛋白在内的补充治疗。还评估了宏基因组学和代谢组学分析中的新兴技术在阐明这些患者微生物动态方面的潜力。接受胃肠道手术的新生儿的微生物群落表现出显著变化，其特征是有益菌水平降低，机会性病原体占比过高。早期开始母乳喂养和谨慎使用抗生素与改善微生物平衡有关。辅助治疗，如给予益生菌和乳铁蛋白，在增强肠道屏障功能和免疫调节方面显示出潜力，不过仍需通过大规模研究加以证实。调节GM成为改善患有先天性胃肠道手术疾病新生儿预后的一种有前景的策略。未来的研究应侧重于制定标准化治疗方案以及开展严格的多中心试验，以验证这些干预措施的有效性和安全性。
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