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Am J Perinatol
DOI: 10.1055/a-2563-0878
Review Article

Gut–Brain Axis in Preterm Infants with Surgical Necrotizing Enterocolitis

Parvesh M. Garg
1   Department of Pediatrics/Neonatology, Wake Forest University, Winston Salem, North Carolina
,
Jeffrey S. Shenberger
3   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut
,
Mckenzie Ostrander
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Terrie E. Inder
4   Children Hospital of Orange County, University of California, Irvine, Orange, California
,
Padma P. Garg
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
› Author Affiliations
Funding P.M.G. was partially supported by the NIH NIGMS under award number U54GM115428. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The Mississippi Center for Clinical and Translational Research and the Department of Pediatrics at Wake Forest School of Medicine supported the NEC research.
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Abstract

Necrotizing enterocolitis (NEC) affects 5 to 10% of very low-birth-weight infants and remains a leading cause of mortality and long-term morbidity. Preterm infants with NEC, especially those requiring surgery, have higher inflammatory markers in the blood, severe white matter abnormalities on brain imaging, and adverse neurodevelopmental outcomes. This review presents current evidence regarding the clinical factors associated with brain injury in preterm infants with NEC needing surgical intervention. Studies that evaluate neuroprotective strategies to prevent brain injury are greatly needed to improve neurodevelopmental outcomes in high-risk preterm infants with NEC.

Key Points

  • NEC is associated with white matter, grey matter, and cerebellar injury in neonates.

  • Clinical and histopathological factors are associated with gut-associated brain injury in NEC.

  • Neuroprotective strategies and intervention are greatly needed in infants with surgical NEC.

Keywords

necrotizing enterocolitis - brain injury - preterm infant

Authors' Contributions

P.M.G. designed the study. P.M.G., M.O., T.E.I., J.S.S., and P.P.G. wrote the manuscript. All the authors contributed to and approved the manuscript.




Publication History

Received: 24 October 2024

Accepted: 19 March 2025

Accepted Manuscript online:
20 March 2025

Article published online:
12 April 2025

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