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Am J Perinatol
DOI: 10.1055/a-2549-6551
Review Article

The Nonbacterial Infant Microbiome and Necrotizing Enterocolitis

Nilima Jawale 
1   Department of Pediatrics/Neonatology, SUNY Upstate Medical University, New York, New York
,
Jeffrey S. Shenberger
2   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut
,
Ricardo J. Rodriguez
3   Department of Pediatrics/Neonatology, Wake Forest University, Winston Salem, North Carolina
,
Avinash K. Shetty
4   Department of Pediatrics/Infectious Disease, Wake Forest University, Winston Salem, North Carolina
,
Parvesh M. Garg
3   Department of Pediatrics/Neonatology, Wake Forest University, Winston Salem, North Carolina
› Author Affiliations
Funding P.M.G. is partially supported by the NIGMS of the NIH under award number U54GM115428. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Abstract

Necrotizing enterocolitis (NEC) is among the most devastating neonatal illnesses of premature infants. Although it is a disease of multifactorial etiology associated with bacterial dysbiosis, several reports of viral and some fungal infections associated with NEC have been published. Despite the abundance of viruses—primarily bacteriophages, and “virus-like particles” in the normal infant gut flora, there is limited understanding of the contribution of these elements to newborn gut health and disease. This study aims to review existing evidence on normal newborn virome and mycobiome development and present insights into the complex inter-kingdom interactions between gut bacteria, viruses, and fungi in the intestinal ecosystem, exploring their potential role in predisposing the preterm infant to NEC.

Key Points

  • We have reviewed a number of viral and fungal infections reported in association with NEC-like illnesses.

  • Bacteriophages play a crucial role in the gut microbiome development, but their role in pathogenesis of NEC and potential for therapeutic use is unknown.

  • Development of next-gen metagenomic tools are needed to enhance our understanding of viral diversity, bacteriophages, and the gut virome in the context of neonatal health and disease.

Keywords

necrotizing enterocolitis - bacterial dysbiosis - viruses - bacteriophages - fungi - microbiome

Authors' Contributions

P.M.G. and N.J. designed the study. P.M.G., N.J., A.S., J.S.S., and R.J.R. wrote the manuscript. All the authors contributed to and approved the manuscript.




Publication History

Received: 03 January 2025

Accepted: 03 March 2025

Accepted Manuscript online:
04 March 2025

Article published online:
16 April 2025

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