Decades of research have failed to define the pathophysiology of necrotizing enterocolitis (NEC), a devastating pediatric gastrointestinal disorder of preterm infants. However, evidence suggests that host-microbiota interactions, in which microbial dysbiosis is followed by loss of barrier integrity, inflammation, and necrosis, are central to NEC development. Thus, greater knowledge of the preterm infant microbiome could accelerate attempts to diagnose, treat, and prevent NEC. In this article, we summarize clinical characteristics of and risk factors for NEC, the structure of the pre-event NEC microbiome, how this community interfaces with host immunology, and microbiome-based approaches that might prevent or lessen the severity of NEC in this very vulnerable population.

Original languageEnglish
Pages (from-to)S257-S263
JournalThe Journal of infectious diseases
Issue number3
StatePublished - Jun 16 2021


  • TLR4
  • metagenomics
  • microbiome
  • microbiota
  • necrotizing enterocolitis
  • preterm birth


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