Fecal Microbial Community in Preterm Infants

The gastrointestinal tract of a healthy fetus is sterile. In full term infants, the bacterial colonization of the gastrointestinal tract has been extensively studied if not entirely understood. During the birth process and rapidly thereafter, microbes from the mother and the surrounding environment colonize the gastrointestinal tract until a dense and complex bacterial community is established. In vaginally delivered neonates, bacteria appear in the stools during the first day of life, with usually Escherichia coli and Enterococcus spp. , among the first, followed within the first 5 days by Bifidobacterium spp. Because, at this stage, the composition of the gut bacterial community is strongly influenced by the diet, a shift in the bacterial composition can be observed. By 10 days of age, most healthy full term neonates are colonized with a heterogeneous bacterial flora, with bifidobacteria dominant in breast-fed infants and a more diversified flora in formula-fed infants (1). A dynamic balance exists between the bacterial community, the host physiology, and the diet: all of them influence initial acquisition, subsequent development and eventual stability of the gut ecosystem (2). In contrast, in preterm infants, especially extremely low birth weight preterm infants (weighting less than 1,000 g at birth), bacterial colonization and its consequences on health have not been extensively studied. Many factors influence the biodiversity of the intestinal flora and may increase the risk of gastrointestinal disease such as necrotizing enterocolitis (NEC): immaturity of the main vital functions, the characteristics of the medical environment, from delivery to hospital discharge, the developmental stage of gastrointestinal and immune functions, the mode and environment of delivery, the feeding regimen, the kind of drug therapy (such as antibiotics, corticoids, etc.), or of other therapy (such as oxygenation). In adults, the human cecal flora differs quantitatively and qualitatively from the fecal flora. Facultative anaerobes represented 25% of total bacteria in the cecum versus 1% in the feces (3). So, the biodiversity of the bacterial community should be studied at these different levels of the gastrointestinal tract. For obvious reasons, most of the studies were performed on stool samples. In recent years, the use of ribosomal RNA, in particular, sequences of the 16S rRNA genes, has greatly facilitated the study of gastrointestinal tract ecology because it allows a culture-independent analysis of the fecal microbial community. In adult fecal samples, molecular tools have indicated that 60% to 80% of the total human microflora has not been cultivated (4). Techniques such as polymerase chain reaction, gene sequencing, in situ hybridization, and denaturing gradient gel electrophoresis are routinely used to study gut microbial ecology and have been recently reviewed by Suau (5). So far, only three studies inspected the microbial composition of premature infants using molecular methods (6–8). Thus, the aim of the present review is to describe the composition of fecal microbial community in preterm infants from the colonization of sterile gut, to present the different factors that contribute to its alterations, and to link the gut microflora to diseases such as NEC. This review is essentially based on data collected using traditional bacterial culture from fecal samples.