Mikrobiom von risikoneugeborenen und präventive modifikation

Background. Approximately 100,000 newborn infants are admitted each year to pediatric hospitals in Germany. Hence, many infants are exposed to a variety of microbiome-disturbing factors in the early developmental phase in life. There is an increasing body of evidence that alterations of the microbiome can impair short-term and long-term health. Objective. This article illuminates the complex interplay between the microbiome and host immunity at the beginning of life. The focus lies on the specific vulnerability of newborns at risk, diagnostic challenges and options for preventive modifications of the microbiome. Materials and methods. Selective literature review. Results. The molecular analysis of complex gut communities enables a better understanding of the delicate interplay between host immunity and microbiome early in life. This is of particular importance in preterm infants, who are highly vulnerable for infections but also for term infants who have to “integrate” potential pathogens, such as group B streptococci into their gut community. The microbiome is unstable in the first weeks of life. The immune system is characterized by a variety of transient events that allow for theestablishmentofthemicrobiomeasa complex ecosystem. Conclusion. The targeted modification of the microbiome requires the characterization of disturbances, risk profiles and an overall better understanding of the co-development of the microbiome and immunity over time (window of opportunity). Potential modifiers, such as prebiotics and probiotics need to be investigated in randomized controlled trials. Newborn infants can be expected to benefit from the implementation of antibiotic stewardship programs, which are already effective in the prenatal period.