# Gut Microbiota and Short-Chain Fatty Acids in the Pathogenesis of Necrotizing Enterocolitis in Very Preterm Infants

## TL;DR

This paper reviews how gut bacteria and short-chain fatty acids affect the risk of a serious intestinal disease in very preterm infants.

## Contribution

The paper highlights the potential of SCFAs as diagnostic markers and therapeutic targets for NEC in preterm infants.

## Key findings

- Very preterm infants with NEC have lower levels of short-chain fatty acids.
- Gut microbiota instability and Gram-negative bacteria are linked to NEC risk.
- Multi-center studies are needed to explore SCFAs' role in NEC and develop probiotic treatments.

## Abstract

The development of a symbiotic gut ecosystem is a crucial step in
postnatal adaptation. The gut microbiome of very preterm infants is
characterized by an overall instability, reduced microbial diversity, and a
predominance of Gram-negative Proteobacteria, all factors associated with an
increased risk of necrotizing enterocolitis (NEC). Short-chain fatty acids
(SCFAs) are the key bacterial metabolites that are essential for maintaining
intestinal homeostasis, supporting immune development, enhancing intestinal
barrier integrity, and reducing inflammation. This review examines the role of
gut microbiota and SCFAs in neonatal NEC, with a focus on potential diagnostic
and therapeutic strategies. Clinical studies have consistently demonstrated a
significant decrease in total SCFA levels and individual bacterial metabolites
in preterm infants with NEC. This finding has been corroborated by various
experimental models. Clarification of the role of SCFAs in NEC pathogenesis,
determination of their diagnostic utility, and assessment of the feasibility of
developing comprehensive pro- and postbiotic formulations require multi-center,
multi-omics investigations that include a large cohort of very preterm infants.