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Bacterial translocation preceding necrotising enterocolitis and sepsis in infants below 31 weeks gestational age

Presented at the Neonatal Society 2012 Autumn Meeting.

Fleming PF, Panton N, Wilks M, Millar M, Costeloe KL

Blizard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, Whitechapel E12AT; Homerton University Hospital, Homerton Row, E96SR, Royal London Hospital, Whitechapel E1 1BB, UK

Background: Loss of the protective barrier function of the intestinal wall with associated invasion and perhaps translocation by bacteria, are regularly cited to be involved in the pathogenesis of necrotising enterocolitis (NEC) and septicaemias in preterm infants (1).In the case of NEC, whether such bacterial invasion occurs in association with the inflammation that characterises the clinical onset of the disease, or whether it may precede symptoms is not known. In vivo studies investigating this concept are limited and constrained because of paucity of data preceding the onset of symptoms. Hypothesis: That bacterial translocation of the intestinal wall may occur in asymptomatic preterm infants and precede the clinical onset of NEC.

Methods: After informed written consent (HREC 10/H0802/40), infants <31 weeks of gestation, were enrolled during the second week into a study of intestinal permeability. Circulating bacterial material was detected using 16S rDNA. Blood samples were collected weekly starting at 14 days (+/- 2 days) for 4 weeks and frozen at – 80ºC within 4 hours. 16S detection was performed using a probe-based real-time PCR assay (Nadkarni et al 2002). Suitable controls were included in each run. Clinical outcomes were recorded.

Results: 213 samples were collected from 61 infants (33 male and 28 female), mean (SD) birth weight 913g (213) and median (range) gestation 26 weeks (23-30). 8 infants (13%) developed NEC (≥Bells Stage II) at a median age of 26 days (range 19-72), two infants died from NEC related complications.

Conclusion: We have demonstrated circulating bacterial material in the blood of asymptomatic preterm babies 6 out of 8 of whom went on to become ‘septic’ or to develop NEC. We speculate that in babies who developed NEC, this material entered the blood stream by translocation of the intestinal wall.

Corresponding author: drpaulfleming@gmail.com

References
1. Sherman MP. New concepts of microbial translocation in the neonatal intestine: mechanisms and prevention. Clin Perinatol. 2010 Sep;37(3):565-79.

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