From dysbiosis to disease: Tracing gut microbiota's role in neonatal sepsis

Introduction: Neonatal sepsis remains a critical health issue, contributing significantly to morbidity and mortality among preterm infants. Dysbiosis, an imbalance in gut microbiota, is increasingly recognized as a key factor influencing the susceptibility to sepsis. This study aims to elucidate these associations by tracing gut microbiota development in preterm neonates. Method: ology: A prospective cohort study was conducted at a tertiary care hospital in Karnataka, India, involving 182 preterm neonates (gestational age <37 weeks, birth weight <1500 g) from January 2021 to September 2023. Two cohorts were defined: Cohort 1 (Healthy neonates) and Cohort 2 (Neonates with sepsis). Stool samples were collected on day 4 and day 14 for microbiological analysis. Conventional culture techniques were used to identify bacterial isolates. Results: The study included 182 neonates, equally divided between two cohorts. On Day 4, Cohort 1 had 45 % E. coli and 44 % Klebsiella pneumoniae, which decreased to 40.7 % and 40.7 % by Day 14, respectively. Conversely, Bifidobacterium spp. increased from 30.8 % to 52.7 %. Cohort 2 exhibited higher persistence of pathogenic bacteria, with Klebsiella pneumoniae increasing from 70.3 % to 74.7 % and E. coli from 38.5 % to 51.6 %. Mode of delivery significantly influenced gut flora, with NVD linked to higher beneficial bacteria prevalence (Enterococcus faecalis and Bifidobacterium spp.). Conclusion: The study highlights significant differences in gut microbial patterns between healthy and sepsis neonates, emphasizing the role of initial gut colonization in neonatal health outcomes. Factors such as delivery mode and prenatal antibiotic exposure significantly impact gut microbiota composition, influencing infection susceptibility.