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2018 ; 2018
(ä): 7456857
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The Neurodevelopmental Perspective of Surgical Necrotizing Enterocolitis: The
Role of the Gut-Brain Axis
#MMPMID29686534
Moschopoulos C
; Kratimenos P
; Koutroulis I
; Shah BV
; Mowes A
; Bhandari V
Mediators Inflamm
2018[]; 2018
(ä): 7456857
PMID29686534
show ga
This state-of-the-art review article aims to highlight the most recent evidence
about the therapeutic options of surgical necrotizing enterocolitis, focusing on
the molecular basis of the gut-brain axis in relevance to the neurodevelopmental
outcomes of primary peritoneal drainage and primary laparotomy. Current evidence
favors primary laparotomy over primary peritoneal drainage as regards
neurodevelopment in the surgical treatment of necrotizing enterocolitis. The
added exposure to inhalational anesthesia in infants undergoing primary
laparotomy is an additional confounding variable but requires further study. The
concept of the gut-brain axis suggests that bowel injury initiates systemic
inflammation potentially affecting the developing central nervous system. Signals
about microbes in the gut are transduced to the brain and the limbic system via
the enteric nervous system, autonomic nervous system, and hypothalamic-pituitary
axis. Preterm infants with necrotizing enterocolitis have significant differences
in the diversity of the microbiome compared with preterm controls. The gut
bacterial flora changes remarkably prior to the onset of necrotizing
enterocolitis with a predominance of pathogenic organisms. The type of initial
surgical approach correlates with the length of functional gut and microbiome
equilibrium influencing brain development and function through the gut-brain
axis. Existing data favor patients who were treated with primary laparotomy over
those who underwent primary peritoneal drainage in terms of neurodevelopmental
outcomes. We propose that this is due to the sustained injurious effect of the
remaining diseased and necrotic bowel on the developing newborn brain, in
patients treated with primary peritoneal drainage, through the gut-brain axis and
probably not due to the procedure itself.