Disruption of the gut bile acid-microbiota axis precedes severe bronchopulmonary dysplasia in preterm infants

Preterm infants who develop severe BPD exhibit early disruption of the bile acid-microbiota axis, characterized by reduced bile acid levels and enrichment of opportunistic taxa. Integrating these features within interpretable machine-learning models enables accurate early risk stratification and provides mechanistic insights beyond traditional inflammation-based frameworks. Validation in larger, multicenter cohorts is warranted to refine biomarker panels and explore targeted interventions that modulate bile acid signaling or microbial ecology to prevent or attenuate BPD.