Fortunately Pubmed speaks both English and American, if you search on Pubmed for necrotizing enterocolitis it also gives you articles about correctly spelt gut diseases in preterm infants as well. As a North American transplant my spelling has become a bit haphazard, so sometimes its hemoglobin sometimes haem…

This fascinating new article has examined the development of the stool microbiome in preterm sets of multiples. I was delighted to read that the stool was ‘salvaged directly from the nappy’ from 12 sets of twins and 1 set of triplets from birth until discharge.  Stewart CJ, Marrs ECL, Nelson A, Lanyon C, Perry JD, Embleton ND, Cummings SP, Berrington JE: Development of the preterm gut microbiome in twins at risk of necrotising enterocolitis and sepsis. PLoS ONE 2013, 8(8):e73465 (free access). Basically the authors took the stool, (and also some breast milk) extracted DNA, amplified the 16S rRNA gene and then figured out what kind of bugs were present; on a subset of samples they did pyrosequencing to get more detail (if that sounds like I know what I am talking about, I do a bit. We are currently collaborating with Kelly Grzywacz, a fellow in peds GI, and doing some similar stuff in a lactoferrin trial, we do unfortunately have to use diapers, we couldn’t get any nappies. More on that study when we get to publishing our results).

Twins had intestinal colonization that was more like their co-twin than the unrelated babies. They were also more like their own mother’s breast milk microbiome than other breast milk. One of the babies developed NEC, and 5 days before that the microbial diversity became much less, and was then significantly less diverse than the co-twin. The co-twin also had an episode of getting antibiotics, which led to a smaller reduction in diversity which then recovered.

There have been other studies showing similar things in the past as noted in a review article last year, although not all the studies have shown the same thing. They consistently show changes in the microbiome prior to development of NEC.  Wang Y, et al. (16s rrna gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitis. ISME J 2009, 3(8):944-954.) also showed a reduction in bacterial diversity. Whereas Josef Neu’s group showed a change in bacterial patterns and the appearance of a new potential pathogen, but no loss of diversity.

It seems from this new study that a baby’s gut colonization is strongly affected by the mother’s microbiome, particularly the microbiome of her milk, more than the environment of the NICU, but then we can really mess that up with antibiotics.