The microbiome, guard or threat to infant health.

Despite improvements in survival for very low birthweight (VLBW) premature infants, there continues to be significant morbidity for these infants at remarkable cost to the healthcare system. Concurrent development of the preterm infant intestine alongside the gut microbiome in the clinical setting rather than in the protected in utero environment where it would usually occur creates significant vulnerabilities for the infant's immature intestine and immune system, resulting in devastating illness and neurological injury. However, the microbiome also has the capacity to promote healthy development. Studies of parallel gut microbiome and preterm infant development have given key insight into the impact of the microbiome on intestinal as well as neural development and may provide potential therapeutic targets to prevent preterm infant morbidities. Development of the microbiome, intestine, and brain occurs in parallel in preterm infants. The microbiome of preterm infants is distinct from that of full term infants, and may be important for normal development. The microbiome of preterm infants follows a distinct pattern of development, divergence from which is seen in necrotizing enterocolitis (NEC) patients prior to disease onset. This may be an opportune window for therapeutic intervention. Microbiome research in preterm infants, has been limited by small cohorts and focused on disease states. Studies from larger populations focused on normal development, including long-term neurodevelopmental outcomes, are key to identification of predictive biomarkers of health as well as at-risk preterm infants. [ABSTRACT FROM AUTHOR]