Advances in Pediatric Research
Open Access

Metabolic and Microbial Disruptions in Preterm Infants with Respiratory Distress Syndrome

Smith Tian^{* *}Correspondence: Smith Tian, Department of Pediatric Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA, Email:

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Description

In 2020, approximately 13.4 million preterm births were recorded globally, with preterm birth rates remaining consistent over the past decade. Preterm Infants (PTIs), born between 22 and 37 weeks of gestation, require extensive care in Neonatal Intensive Care Units (NICUs). These infants are at high risk for severe conditions such as Neonatal Respiratory Distress Syndrome (NRDS), Necrotizing Enterocolitis (NEC) and hypoxic-ischemic encephalopathy. NRDS, a critical respiratory disorder in PTIs, is characterized by worsening breathing difficulties and respiratory failure hours after birth, posing significant risks to neonatal survival. This condition primarily arises due to underdeveloped lungs and insufficient Pulmonary Surfactant (PS), leading to the collapse of alveoli. Various factors, including maternal diabetes, cesarean section, multiple pregnancies and genetic predispositions, can influence the prevalence of NRDS. While endotracheal PS therapy has improved survival rates, the long-term impact of NRDS on neonatal development, particularly in relation to gut microbiota composition, remains largely unexplored.

The neonatal gut microbiota plays a vital role in immune and cognitive development, contributing to the establishment of a balanced host-microbe relationship. Unlike the stable gut microbiota seen in adults, the composition of the neonatal microbiome, especially in PTIs, is influenced by a range of medical, environmental and dietary factors. Gestational Age (GA) is a key determinant, with PTIs showing less diversity in their meconium compared to term infants, often with higher levels of Enterobacteriaceae and Staphylococcus. Additionally, factors such as delivery method, hospital environment, enteral feeding practices and antibiotic exposure all affect the neonatal gut microbiota. For example, Faecalibacterium generates short-chain fatty acids and indole compounds, which modulate immune responses by influencing the differentiation and function of immune cells. However, the interactions between gut bacteria and host metabolites are not yet fully understood. Ultra-Performance Liquid Chromatography–Mass Spectrometry (UPLC-MS) is a powerful tool for identifying metabolic changes associated with neonatal health. Research has shown that metabolomics can provide valuable insights into neonatal conditions like prematurity, sepsis and NEC. For instance, increased N-acetylation of glycoproteins has been observed in the blood of PTIs, along with altered levels of both essential and non-essential amino acids.

Infants with NRDS experience significant physiological stress at birth, which likely impacts both their metabolic profiles and gut microbiota composition during early development. In this study, we hypothesize that NRDS influences the shaping of neonatal serum metabolites and gut microbiota, with lasting effects throughout early development. To investigate this, we collected peripheral blood and fecal samples from NRDS and PTI newborns from birth to 4 weeks of age.

Conclusion

Neonates with NRDS experience significant birth-related stress, leading to mitochondrial dysfunction and disruptions in the endocrine system, particularly the HPA axis, which regulates stress responses and metabolism. While acute symptoms like respiratory distress may resolve with treatment, the long-term effects of NRDS can impact growth, immune function and neurodevelopment. Additionally, as the infant recovers, changes in the gut microbiome-such as an increase in Blautia, a probiotic genus involved in tryptophan metabolism and melatonin production-may further influence development. These factors highlight the need for ongoing monitoring to support the infant’s long-term health and well-being. We analyzed the metabolic and gut microbiota profiles and identified dysregulated host-microbe interactions during this early developmental period.