Nutrients. 2022 Nov 6;14(21):4691. doi: 10.3390/nu14214691.

Tomás Cerdó ¹, José Antonio García-Santos ^2 3 4, Anna Rodríguez-Pöhnlein ^2 3 4, María García-Ricobaraza ^2 3 4, Ana Nieto-Ruíz ^2 3 4, Mercedes G Bermúdez ^2 3 4, Cristina Campoy ^2 3 4 5

Author information

¹Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, 14004 Córdoba, Spain.

²EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, 18016 Granada, Spain.

³Department of Paediatrics, School of Medicine, University of Granada, Avda. Investigación 11, 18016 Granada, Spain.

⁴Instituto de Investigación Biosanitaria Ibs-GRANADA, Health Sciences Technological Park, 18012 Granada, Spain.

⁵Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada's Node, Carlos III Health Institute, Avda. Monforte de Lemos 5, 28028 Madrid, Spain.

Abstract

Parenteral nutrition (PN) is a life-saving therapy providing nutritional support in patients with digestive tract complications, particularly in preterm neonates due to their gut immaturity during the first postnatal weeks. Despite this, PN can also result in several gastrointestinal complications that are the cause or consequence of gut mucosal atrophy and gut microbiota dysbiosis, which may further aggravate gastrointestinal disorders. Consequently, the use of PN presents many unique challenges, notably in terms of the potential role of the gut microbiota on the functional and clinical outcomes associated with the long-term use of PN. In this review, we synthesize the current evidence on the effects of PN on gut microbiome in infants and children suffering from diverse gastrointestinal diseases, including necrotizing enterocolitis (NEC), short bowel syndrome (SBS) and subsequent intestinal failure, liver disease and inflammatory bowel disease (IBD). Moreover, we discuss the potential use of pre-, pro- and/or synbiotics as promising therapeutic strategies to reduce the risk of severe gastrointestinal disorders and mortality. The findings discussed here highlight the need for more well-designed studies, and harmonize the methods and its interpretation, which are critical to better understand the role of the gut microbiota in PN-related diseases and the development of efficient and personalized approaches based on pro- and/or prebiotics.

Keywords: TPN-associated mucosal atrophy; gut microbiota dysbiosis; inflammatory bowel disease (IBD); intestinal failure (IF); necrotizing enterocolitis (NEC); parenteral nutrition-associated liver disease (PNAD); pediatric population; postbiotics; short bowel syndrome (SBS); total parenteral nutrition (TPN).