{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:52:33Z","timestamp":1792785153409,"version":"4.5.0"},"reference-count":119,"publisher":"Georg Thieme Verlag KG","issue":"13","funder":[{"name":"U.S. Department of Health and Human Services, National Institutes of Health","id":[{"id":"https:\/\/ror.org\/033jnv181","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute of General Medical Sciences","award":["U54GM115428"],"award-info":[{"award-number":["U54GM115428"]}],"id":[{"id":"https:\/\/ror.org\/04q48ey07","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>Prevailing evidence underscores the critical influence of infant gut microbiota on systemic immune responses and intestinal health. The role of functional programming of effector immune cells at extra-intestinal mucosal sites is increasing in interest. Common connections between development of gut and lung microbiomes and reciprocal signaling between the two organ systems has reinforced the concept of a \u201cgut\u2013lung axis.\u201d Narrative review of existing literature evaluating mechanistic evidence linking microbial dysbiosis and necrotizing enterocolitis (NEC) to development of preterm acute lung injury and subsequent progression to chronic lung disease or bronchopulmonary dysplasia (BPD). Evidence across animal and human studies indicates that gut-derived microbial ligands and metabolites are foundational in programming respiratory immunity. Conversely, primary pulmonary insults appear to trigger reciprocal shifts in gut microbiome function. This bidirectional signaling likely drives the clinical association between NEC-associated systemic inflammation and the subsequent increased risk of BPD. By focusing on mediators involved in this gut\u2013lung crosstalk, we seek to highlight avenues such as microbiome modulation or targeted anti-inflammatory signaling to prevent or reduce the severity of two of the major morbidities of prematurity.<\/jats:p>","DOI":"10.1055\/a-2821-3458","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:42:31Z","timestamp":1772152951000},"page":"1714-1722","source":"Crossref","is-referenced-by-count":2,"title":["NEC-Associated Bronchopulmonary Dysplasia and the Gut\u2013Lung Axis in Preterm Infants"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5430-848X","authenticated-orcid":false,"given":"Nilima","family":"Jawale","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, SUNY Upstate Medical University, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Shenberger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash K.","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Infectious Disease, Wake Forest University School of Medicine, Winston Salem, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1263-1822","authenticated-orcid":false,"given":"Vignesh","family":"Gunasekaran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, West Virginia University School of Medicine, Martinsburg, West Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvesh M.","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Neonatology, Wake Forest University, Winston Salem, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"6791","DOI":"10.3390\/ijms23126791","article-title":"Respiratory and intestinal microbiota in pediatric lung diseases\u2014current evidence of the gut-lung axis","volume":"23","author":"S Stricker","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"2910","DOI":"10.3389\/fimmu.2019.02910","article-title":"Gut and lung microbiota in preterm infants: immunological modulation and implication in neonatal outcomes","volume":"10","author":"C Tirone","year":"2019","journal-title":"Front Immunol"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1038\/pr.2017.111","article-title":"The importance of appropriate initial bacterial colonization of the intestine in newborn, child, and adult health","volume":"82","author":"W A Walker","year":"2017","journal-title":"Pediatr Res"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"1241303","DOI":"10.3389\/fnut.2023.1241303","article-title":"Early-life gut microbiota and neurodevelopment in preterm infants: a narrative review","volume":"10","author":"I Beghetti","year":"2023","journal-title":"Front Nutr"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1002\/kjm2.12878","article-title":"The impact of gut microbiota on morbidities in preterm infants","volume":"40","author":"M Y Lai","year":"2024","journal-title":"Kaohsiung J Med Sci"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1177\/19345798251353777","article-title":"Distinct microbiota profiles in non-survivors in preterm infants with surgical necrotizing enterocolitis: Insights from FFPE intestinal tissue analysis","volume":"18","author":"P Zhang","year":"2025","journal-title":"J Neonatal Perinatal Med"},{"issue":"06","key":"ref7","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.jpedsurg.2020.02.046","article-title":"Trends in incidence and outcomes of necrotizing enterocolitis over the last 12 years: a multicenter cohort analysis","volume":"55","author":"S M Han","year":"2020","journal-title":"J Pediatr Surg"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1080\/15513819709168731","article-title":"Inflammatory cytokine mRNAs in surgical specimens of necrotizing enterocolitis and normal newborn intestine","volume":"17","author":"R M Viscardi","year":"1997","journal-title":"Pediatr Pathol Lab Med"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1542\/peds.2004-0569","article-title":"Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis","volume":"115","author":"S R Hintz","year":"2005","journal-title":"Pediatrics"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1038\/s41390-021-01614-3","article-title":"Brain injury in preterm infants with surgical necrotizing enterocolitis: clinical and bowel pathological correlates","volume":"91","author":"P M Garg","year":"2022","journal-title":"Pediatr Res"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"115243","DOI":"10.1016\/j.biopha.2023.115243","article-title":"Role of the gut-microbiota-metabolite-brain axis in the pathogenesis of preterm brain injury","volume":"165","author":"L Li","year":"2023","journal-title":"Biomed Pharmacother"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1186\/1471-2431-13-127","article-title":"Long term healthcare costs of infants who survived neonatal necrotizing enterocolitis: a retrospective longitudinal study among infants enrolled in Texas Medicaid","volume":"13","author":"V Ganapathy","year":"2013","journal-title":"BMC Pediatr"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00383-024-05918-3","article-title":"Characteristics, progression, management, and outcomes of NEC: a retrospective cohort study","volume":"41","author":"M Shahroor","year":"2024","journal-title":"Pediatr Surg Int"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.jpedsurg.2018.02.087","article-title":"Loss of endothelial nitric oxide synthase exacerbates intestinal and lung injury in experimental necrotizing enterocolitis","volume":"53","author":"N A Drucker","year":"2018","journal-title":"J Pediatr Surg"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1186\/s12887-020-02304-5","article-title":"Intestinal tract and parenteral multi-organ sequential pathological injury caused by necrotizing enterocolitis","volume":"20","author":"F S Wang","year":"2020","journal-title":"BMC Pediatr"},{"issue":"04","key":"ref16","doi-asserted-by":"crossref","first-page":"R422","DOI":"10.1152\/ajpregu.00229.2021","article-title":"A hydrogen-sulfide derivative of mesalamine reduces the severity of intestinal and lung injury in necrotizing enterocolitis through endothelial nitric oxide synthase","volume":"323","author":"B D Hosfield","year":"2022","journal-title":"Am J Physiol Regul Integr Comp Physiol"},{"issue":"10","key":"ref17","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1055\/a-1904-9194","article-title":"Clinical correlates of moderate-to-severe bronchopulmonary dysplasia in preterm infants following surgical necrotizing enterocolitis","volume":"41","author":"P M Garg","year":"2024","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1542\/peds.2008-0526","article-title":"Cytokines associated with bronchopulmonary dysplasia or death in extremely low birth weight infants","volume":"123","author":"N Ambalavanan","year":"2009","journal-title":"Pediatrics"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s13054-024-05006-x","article-title":"Gut-derived immune cells and the gut-lung axis in ARDS","volume":"28","author":"M Ziaka","year":"2024","journal-title":"Crit Care"},{"issue":"S 01","key":"ref20","first-page":"S2","article-title":"Molecular embryology of the foregut","volume":"52","author":"S Faure","year":"2011","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"03","key":"ref21","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.mucimm.2024.12.013","article-title":"Immune crosstalk between respiratory and intestinal mucosal tissues in respiratory infections","volume":"18","author":"M Zhao","year":"2025","journal-title":"Mucosal Immunol"},{"issue":"11","key":"ref22","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.3390\/pathogens13111005","article-title":"The intriguing connection between the gut and lung microbiomes","volume":"13","author":"M Druszczynska","year":"2024","journal-title":"Pathogens"},{"issue":"7402","key":"ref23","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1038\/nature11234","article-title":"Structure, function and diversity of the healthy human microbiome","volume":"486","author":"Human Microbiome Project Consortium","year":"2012","journal-title":"Nature"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"e14266","DOI":"10.1111\/apha.14266","article-title":"The neonate respiratory microbiome","volume":"241","author":"S Pirr","year":"2025","journal-title":"Acta Physiol (Oxf)"},{"key":"ref25","first-page":"31","article-title":"The lower airway microbiome in paediatric health and chronic disease","volume":"52","author":"S Campbell","year":"2024","journal-title":"Paediatr Respir Rev"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3390\/pathogens13030220","article-title":"Lung microbiota and ventilator-associated pneumonia in the neonatal period","volume":"13","author":"F Garc\u00eda-Mu\u00f1oz Rodrigo","year":"2024","journal-title":"Pathogens"},{"issue":"12","key":"ref28","doi-asserted-by":"crossref","first-page":"e113466","DOI":"10.1371\/journal.pone.0113466","article-title":"Environmentally determined differences in the murine lung microbiota and their relation to alveolar architecture","volume":"9","author":"Y Yun","year":"2014","journal-title":"PLoS One"},{"issue":"S 01","key":"ref29","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/ijpo.12217","article-title":"The prenatal gut microbiome: are we colonized with bacteria in utero?","volume":"12","author":"R W Walker","year":"2017","journal-title":"Pediatr Obes"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"31023","DOI":"10.1038\/srep31023","article-title":"The airway microbiome at birth","volume":"6","author":"C V Lal","year":"2016","journal-title":"Sci Rep"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"469","DOI":"10.3390\/nu12020469","article-title":"Nutrients and microbiota in lung diseases of prematurity: the placenta-gut-lung triangle","volume":"12","author":"F Piersigilli","year":"2020","journal-title":"Nutrients"},{"issue":"08","key":"ref32","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1164\/rccm.201911-2127LE","article-title":"Human fetal lungs harbor a microbiome signature","volume":"201","author":"D Al Alam","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"L407","DOI":"10.1152\/ajplung.00561.2018","article-title":"Perinatal maternal antibiotic exposure augments lung injury in offspring in experimental bronchopulmonary dysplasia","volume":"318","author":"K A Willis","year":"2020","journal-title":"Am J Physiol Lung Cell Mol Physiol"},{"issue":"11","key":"ref34","doi-asserted-by":"crossref","first-page":"2629","DOI":"10.1016\/j.ajpath.2018.07.020","article-title":"Prenatal intra-amniotic endotoxin induces fetal gut and lung immune responses and postnatal systemic inflammation in preterm pigs","volume":"188","author":"D N Nguyen","year":"2018","journal-title":"Am J Pathol"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"e8578","DOI":"10.1371\/journal.pone.0008578","article-title":"Disordered microbial communities in asthmatic airways","volume":"5","author":"M Hilty","year":"2010","journal-title":"PLoS One"},{"issue":"02","key":"ref36","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1073\/pnas.1310750111","article-title":"House dust exposure mediates gut microbiome Lactobacillus enrichment and airway immune defense against allergens and virus infection","volume":"111","author":"K E Fujimura","year":"2014","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"01","key":"ref37","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1186\/s12866-020-01816-5","article-title":"Altered gut microbiota in infants is associated with respiratory syncytial virus disease severity","volume":"20","author":"J N Harding","year":"2020","journal-title":"BMC Microbiol"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"4997","DOI":"10.1038\/s41467-019-13014-7","article-title":"Impact of delivery mode-associated gut microbiota dynamics on health in the first year of life","volume":"10","author":"M Reyman","year":"2019","journal-title":"Nat Commun"},{"issue":"06","key":"ref39","doi-asserted-by":"crossref","first-page":"2102406","DOI":"10.1183\/13993003.02406-2021","article-title":"Neonatal metabolome of caesarean section and risk of childhood asthma","volume":"59","author":"G G\u00fcrdeniz","year":"2022","journal-title":"Eur Respir J"},{"issue":"649","key":"ref40","doi-asserted-by":"crossref","first-page":"eabl3981","DOI":"10.1126\/scitranslmed.abl3981","article-title":"The balance between protective and pathogenic immune responses to pneumonia in the neonatal lung is enforced by gut microbiota","volume":"14","author":"J Stevens","year":"2022","journal-title":"Sci Transl Med"},{"issue":"05","key":"ref41","doi-asserted-by":"crossref","first-page":"e00484-19","DOI":"10.1128\/mSystems.00484-19","article-title":"Changes in the composition of the gut microbiota and the blood transcriptome in preterm infants at less than 29 weeks gestation diagnosed with bronchopulmonary dysplasia","volume":"4","author":"F J Ryan","year":"2019","journal-title":"mSystems"},{"issue":"11","key":"ref42","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1055\/s-0040-1710554","article-title":"Early gut microbiota changes in preterm infants with bronchopulmonary dysplasia: a pilot case-control study","volume":"38","author":"S M Chen","year":"2021","journal-title":"Am J Perinatol"},{"issue":"01","key":"ref43","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s12967-021-02794-6","article-title":"Effect of antibiotic-induced intestinal dysbacteriosis on bronchopulmonary dysplasia and related mechanisms","volume":"19","author":"X Ran","year":"2021","journal-title":"J Transl Med"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jpeds.2022.09.029","article-title":"Early empirical antibiotics and adverse clinical outcomes in infants born very preterm: a population-based cohort","volume":"253","author":"A Vatne","year":"2023","journal-title":"J Pediatr"},{"issue":"07","key":"ref45","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/INF.0000000000000239","article-title":"Association between pulmonary Ureaplasma colonization and bronchopulmonary dysplasia in preterm infants: updated systematic review and meta-analysis","volume":"33","author":"J Lowe","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"ref46","doi-asserted-by":"crossref","first-page":"1632412","DOI":"10.3389\/fmicb.2025.1632412","article-title":"Intestinal microbiota changes in early life of very preterm infants with bronchopulmonary dysplasia: a nested case-control study","volume":"16","author":"T Ning","year":"2025","journal-title":"Front Microbiol"},{"issue":"12","key":"ref47","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1097\/01.inf.0000190632.31565.83","article-title":"Critical appraisal of the role of Ureaplasma in the development of bronchopulmonary dysplasia with metaanalytic techniques","volume":"24","author":"R L Schelonka","year":"2005","journal-title":"Pediatr Infect Dis J"},{"issue":"08","key":"ref48","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/S2213-2600(24)00079-1","article-title":"Azithromycin therapy for prevention of chronic lung disease of prematurity (AZTEC): a multicentre, double-blind, randomised, placebo-controlled trial","volume":"12","author":"J Lowe","year":"2024","journal-title":"Lancet Respir Med"},{"key":"ref49","doi-asserted-by":"crossref","first-page":"564","DOI":"10.3389\/fped.2019.00564","article-title":"Predicting BPD: lessons learned from the airway microbiome of preterm infants","volume":"7","author":"S J Gentle","year":"2020","journal-title":"Front Pediatr"},{"issue":"10","key":"ref50","doi-asserted-by":"crossref","first-page":"e110027","DOI":"10.1371\/journal.pone.0110027","article-title":"Soluble factors from Lactobacillus reuteri CRL1098 have anti-inflammatory effects in acute lung injury induced by lipopolysaccharide in mice","volume":"9","author":"M Griet","year":"2014","journal-title":"PLoS One"},{"issue":"10","key":"ref51","doi-asserted-by":"crossref","first-page":"16113","DOI":"10.1038\/nmicrobiol.2016.113","article-title":"Enrichment of the lung microbiome with gut bacteria in sepsis and the acute respiratory distress syndrome","volume":"1","author":"R P Dickson","year":"2016","journal-title":"Nat Microbiol"},{"key":"ref52","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.jpeds.2016.11.002","article-title":"Antibiotic exposure and risk for death or bronchopulmonary dysplasia in very low birth weight infants","volume":"181","author":"J B Cantey","year":"2017","journal-title":"J Pediatr"},{"key":"ref54","doi-asserted-by":"crossref","first-page":"3020","DOI":"10.3389\/fmicb.2019.03020","article-title":"Different effects of premature infant formula and breast milk on intestinal microecological development in premature infants","volume":"10","author":"C Chen","year":"2020","journal-title":"Front Microbiol"},{"issue":"01","key":"ref55","doi-asserted-by":"crossref","first-page":"L65","DOI":"10.1152\/ajplung.00421.2020","article-title":"Lung immune tone via gut-lung axis: gut-derived LPS and short-chain fatty acids' immunometabolic regulation of lung IL-1\u03b2, FFAR2, and FFAR3 expression","volume":"321","author":"Q Liu","year":"2021","journal-title":"Am J Physiol Lung Cell Mol Physiol"},{"key":"ref56","doi-asserted-by":"crossref","first-page":"628453","DOI":"10.3389\/fimmu.2021.628453","article-title":"Butyrate shapes immune cell fate and function in allergic asthma","volume":"12","author":"W Yip","year":"2021","journal-title":"Front Immunol"},{"key":"ref57","doi-asserted-by":"crossref","first-page":"1434687","DOI":"10.3389\/fcimb.2024.1434687","article-title":"The emerging roles of microbiome and short-chain fatty acids in the pathogenesis of bronchopulmonary dysplasia","volume":"14","author":"Y Gao","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"issue":"03","key":"ref58","doi-asserted-by":"crossref","first-page":"e14092","DOI":"10.1111\/apha.14092","article-title":"The gut-lung axis and asthma susceptibility in early life","volume":"240","author":"F G Kahhaleh","year":"2024","journal-title":"Acta Physiol (Oxf)"},{"key":"ref59","doi-asserted-by":"crossref","first-page":"741233","DOI":"10.3389\/fimmu.2021.741233","article-title":"Gut-lung axis: microbial crosstalk in pediatric respiratory tract infections","volume":"12","author":"W Zhu","year":"2021","journal-title":"Front Immunol"},{"key":"ref60","doi-asserted-by":"crossref","first-page":"1030588","DOI":"10.3389\/fcimb.2022.1030588","article-title":"Alterations of the gut microbiota and short chain fatty acids in necrotizing enterocolitis and food protein-induced allergic protocolitis infants: a prospective cohort study","volume":"12","author":"J Xiong","year":"2022","journal-title":"Front Cell Infect Microbiol"},{"issue":"02","key":"ref61","first-page":"561","article-title":"Therapeutic potential of gut microbiota and its metabolite short-chain fatty acids in neonatal necrotizing enterocolitis","volume":"13","author":"N A Alsharairi","year":"2023","journal-title":"Life (Basel)"},{"issue":"12","key":"ref62","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.3390\/nu14122412","article-title":"Decreased acetic acid in the stool of preterm infants is associated with an increased risk of bronchopulmonary dysplasia","volume":"14","author":"L C Frazer","year":"2022","journal-title":"Nutrients"},{"issue":"02","key":"ref63","doi-asserted-by":"crossref","first-page":"e0229283","DOI":"10.1371\/journal.pone.0229283","article-title":"Short chain fatty acids produced by colonizing intestinal commensal bacterial interaction with expressed breast milk are anti-inflammatory in human immature enterocytes","volume":"15","author":"N Zheng","year":"2020","journal-title":"PLoS One"},{"key":"ref64","doi-asserted-by":"crossref","first-page":"595157","DOI":"10.3389\/fped.2020.595157","article-title":"Acetate downregulates the activation of NLRP3 inflammasomes and attenuates lung injury in neonatal mice with bronchopulmonary dysplasia","volume":"8","author":"Q Zhang","year":"2021","journal-title":"Front Pediatr"},{"issue":"01","key":"ref65","doi-asserted-by":"crossref","first-page":"3273","DOI":"10.1038\/s41467-019-11152-6","article-title":"Microbiota-derived acetate protects against respiratory syncytial virus infection through a GPR43-type 1 interferon response","volume":"10","author":"K H Antunes","year":"2019","journal-title":"Nat Commun"},{"key":"ref66","doi-asserted-by":"crossref","first-page":"109872","DOI":"10.1016\/j.clim.2023.109872","article-title":"Lactobacillus rhamnosus (LR) ameliorates pulmonary and extrapulmonary acute respiratory distress syndrome (ARDS) via targeting neutrophils","volume":"258","author":"L Sapra","year":"2024","journal-title":"Clin Immunol"},{"issue":"01","key":"ref67","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3390\/ijms22010065","article-title":"Butyrate and propionate restore the cytokine and house dust mite compromised barrier function of human bronchial airway epithelial cells","volume":"22","author":"L B Richards","year":"2020","journal-title":"Int J Mol Sci"},{"issue":"04","key":"ref68","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1038\/s41390-022-02333-z","article-title":"Butyrate induces development-dependent necrotizing enterocolitis-like intestinal epithelial injury via necroptosis","volume":"93","author":"K Wang","year":"2023","journal-title":"Pediatr Res"},{"key":"ref69","doi-asserted-by":"crossref","first-page":"108443","DOI":"10.1016\/j.pharmthera.2023.108443","article-title":"Bacterial extracellular vesicles and their interplay with the immune system","volume":"247","author":"E Dor\u00e9","year":"2023","journal-title":"Pharmacol Ther"},{"issue":"11","key":"ref70","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1016\/j.jpedsurg.2021.02.016","article-title":"Urine-derived extracellular vesicle miRNAs as possible biomarkers for and mediators of necrotizing enterocolitis: a proof of concept study","volume":"56","author":"J D Galley","year":"2021","journal-title":"J Pediatr Surg"},{"key":"ref71","doi-asserted-by":"crossref","first-page":"924","DOI":"10.3389\/fimmu.2018.00924","article-title":"Extracellular vesicle: an emerging mediator of intercellular crosstalk in lung inflammation and injury","volume":"9","author":"H Lee","year":"2018","journal-title":"Front Immunol"},{"issue":"01","key":"ref72","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1096\/fj.201700488r","article-title":"Exosomes in postshock mesenteric lymph are key mediators of acute lung injury triggering the macrophage activation via Toll-like receptor 4","volume":"32","author":"M Kojima","year":"2018","journal-title":"FASEB J"},{"issue":"05","key":"ref73","doi-asserted-by":"crossref","first-page":"e93994","DOI":"10.1172\/jci.insight.93994","article-title":"Exosomal microRNA predicts and protects against severe bronchopulmonary dysplasia in extremely premature infants","volume":"3","author":"C V Lal","year":"2018","journal-title":"JCI Insight"},{"key":"ref74","doi-asserted-by":"crossref","first-page":"1550115","DOI":"10.3389\/fped.2025.1550115","article-title":"Extracellular vesicles and preterm infant diseases","volume":"13","author":"W Chen","year":"2025","journal-title":"Front Pediatr"},{"issue":"01","key":"ref75","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s00383-023-05490-2","article-title":"Bovine milk-derived exosomes attenuate NLRP3 inflammasome and NF-\u03baB signaling in the lung during neonatal necrotizing enterocolitis","volume":"39","author":"R Filler","year":"2023","journal-title":"Pediatr Surg Int"},{"issue":"04","key":"ref76","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1016\/j.bbrc.2018.08.019","article-title":"Intraperitoneal injection of MSC-derived exosomes prevent experimental bronchopulmonary dysplasia","volume":"503","author":"R K Braun","year":"2018","journal-title":"Biochem Biophys Res Commun"},{"key":"ref77","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.3389\/fimmu.2019.01168","article-title":"Lymphatic migration of immune cells","volume":"10","author":"H R Hampton","year":"2019","journal-title":"Front Immunol"},{"key":"ref78","doi-asserted-by":"crossref","first-page":"3049302","DOI":"10.1155\/2020\/3049302","article-title":"Mesenteric lymph duct drainage attenuates lung inflammatory injury and inhibits endothelial cell apoptosis in septic rats","volume":"2020","author":"Y Liu","year":"2020","journal-title":"BioMed Res Int"},{"issue":"05","key":"ref79","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.chom.2017.10.007","article-title":"Segmented filamentous bacteria provoke lung autoimmunity by inducing gut-lung axis Th17 cells expressing dual TCRs","volume":"22","author":"C P Bradley","year":"2017","journal-title":"Cell Host Microbe"},{"issue":"02","key":"ref80","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s10753-021-01543-7","article-title":"Dynamic changes of NCR\u2212 type 3 innate lymphoid cells and their role in mice with bronchopulmonary dysplasia","volume":"45","author":"J Cai","year":"2022","journal-title":"Inflammation"},{"issue":"05","key":"ref81","doi-asserted-by":"crossref","first-page":"e0324230","DOI":"10.1371\/journal.pone.0324230","article-title":"The role of gut leakage and immune cell miss-homing on gut dysbiosis-induced lung inflammation in a DSS mice model","volume":"20","author":"M W Eladham","year":"2025","journal-title":"PLoS One"},{"issue":"03","key":"ref82","doi-asserted-by":"crossref","first-page":"859","DOI":"10.4049\/jimmunol.1600618","article-title":"Pulmonary epithelial TLR4 activation leads to lung injury in neonatal necrotizing enterocolitis","volume":"197","author":"H Jia","year":"2016","journal-title":"J Immunol"},{"issue":"02","key":"ref83","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/SHK.0000000000001255","article-title":"Toll like receptor 4 mediated lymphocyte imbalance induces NEC-induced lung injury","volume":"52","author":"H Jia","year":"2019","journal-title":"Shock"},{"issue":"10","key":"ref84","doi-asserted-by":"crossref","first-page":"e111228","DOI":"10.1371\/journal.pone.0111228","article-title":"Changes in the bacterial microbiota in gut, blood, and lungs following acute LPS instillation into mice lungs","volume":"9","author":"M A Sze","year":"2014","journal-title":"PLoS One"},{"issue":"02","key":"ref85","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1038\/s41385-020-00361-8","article-title":"The lung-gut axis during viral respiratory infections: the impact of gut dysbiosis on secondary disease outcomes","volume":"14","author":"V Sencio","year":"2021","journal-title":"Mucosal Immunol"},{"issue":"05","key":"ref86","doi-asserted-by":"crossref","first-page":"e1005572","DOI":"10.1371\/journal.ppat.1005572","article-title":"Influenza virus affects intestinal microbiota and secondary Salmonella infection in the gut through type I interferons","volume":"12","author":"E Deriu","year":"2016","journal-title":"PLoS Pathog"},{"issue":"09","key":"ref87","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1084\/jem.20122762","article-title":"Lung dendritic cells induce migration of protective T cells to the gastrointestinal tract","volume":"210","author":"D Ruane","year":"2013","journal-title":"J Exp Med"},{"issue":"30","key":"ref88","doi-asserted-by":"crossref","first-page":"10493","DOI":"10.1074\/jbc.REV120.011188","article-title":"Oxygen battle in the gut: hypoxia and hypoxia-inducible factors in metabolic and inflammatory responses in the intestine","volume":"295","author":"R Singhal","year":"2020","journal-title":"J Biol Chem"},{"key":"ref89","doi-asserted-by":"crossref","first-page":"354","DOI":"10.3389\/fped.2020.00354","article-title":"Maturation of intestinal oxygenation: a review of mechanisms and clinical implications for preterm neonates","volume":"8","author":"B M Dotinga","year":"2020","journal-title":"Front Pediatr"},{"issue":"07","key":"ref90","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1038\/s41390-024-03669-4","article-title":"Severe anemia in preterm infants associated with increased bacterial virulence potential and metabolic disequilibrium","volume":"97","author":"J A Gibbons","year":"2025","journal-title":"Pediatr Res"},{"issue":"05","key":"ref91","doi-asserted-by":"crossref","first-page":"4366","DOI":"10.3390\/ijms24054366","article-title":"Molecular mechanisms of hyperoxia-induced neonatal intestinal injury","volume":"24","author":"H C Wang","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"01","key":"ref92","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s40168-023-01673-0","article-title":"Antimicrobial peptides modulate lung injury by altering the intestinal microbiota","volume":"11","author":"A Abdelgawad","year":"2023","journal-title":"Microbiome"},{"issue":"09","key":"ref93","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.freeradbiomed.2010.01.006","article-title":"Linking oxidative stress to inflammation: Toll-like receptors","volume":"48","author":"R Gill","year":"2010","journal-title":"Free Radic Biol Med"},{"key":"ref94","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4103\/ijpvm.IJPVM_542_18","article-title":"Can high average oxygen saturation be a risk factor for necrotizing enterocolitis in VLBW infants?","volume":"10","author":"I K Gokce","year":"2019","journal-title":"Int J Prev Med"},{"issue":"21","key":"ref95","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1001\/jama.2018.5725","article-title":"Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration","volume":"319","author":"L M Askie","year":"2018","journal-title":"JAMA"},{"issue":"07","key":"ref96","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1038\/s41372-020-0599-z","article-title":"The development of intestinal dysbiosis in anemic preterm infants","volume":"40","author":"T TB Ho","year":"2020","journal-title":"J Perinatol"},{"issue":"05","key":"ref97","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/01.ANC.0000338019.56405.29","article-title":"Risk factors for necrotizing enterocolitis in preterm infants: how race, gender, and health status contribute","volume":"8","author":"B M Carter","year":"2008","journal-title":"Adv Neonatal Care"},{"key":"ref98","first-page":"625","article-title":"Invasive mechanical ventilation induces necrotizing enterocolitis (NEC) and dysregulates peroxisome proliferator-activator receptor gamma (PPAR gamma) in the ileum of chronically ventilated preterm lambs","volume":"80","author":"L Ruybal","year":"2016","journal-title":"Pediatr Res"},{"issue":"03","key":"ref99","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1038\/pr.2012.77","article-title":"Cellular strain amplifies LPS-induced stress signaling in immature enterocytes: potential implications for preterm infant NCPAP","volume":"72","author":"A M Alcamo","year":"2012","journal-title":"Pediatr Res"},{"issue":"09","key":"ref100","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1038\/s41372-024-01918-2","article-title":"Characterizing continuous positive airway pressure (CPAP) Belly Syndrome in preterm infants in the neonatal intensive care unit (NICU)","volume":"44","author":"H Gu","year":"2024","journal-title":"J Perinatol"},{"issue":"09","key":"ref101","first-page":"CD003212","article-title":"Nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation","author":"B Lemyre","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"10","key":"ref102","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1038\/s41590-019-0451-9","article-title":"The influence of the microbiome on respiratory health","volume":"20","author":"T P Wypych","year":"2019","journal-title":"Nat Immunol"},{"issue":"03","key":"ref103","doi-asserted-by":"crossref","first-page":"e2024069102","DOI":"10.1542\/peds.2024-069102","article-title":"Effectiveness and risks of probiotics in preterm infants","volume":"155","author":"B N Alshaikh","year":"2025","journal-title":"Pediatrics"},{"key":"ref104","doi-asserted-by":"crossref","first-page":"570247","DOI":"10.3389\/fped.2020.570247","article-title":"Perspectives on probiotics and bronchopulmonary dysplasia","volume":"8","author":"K Yang","year":"2020","journal-title":"Front Pediatr"},{"issue":"01","key":"ref105","doi-asserted-by":"crossref","first-page":"17060","DOI":"10.1038\/s41598-021-96489-z","article-title":"Association between probiotics and bronchopulmonary dysplasia in preterm infants","volume":"11","author":"Y Qu","year":"2021","journal-title":"Sci Rep"},{"issue":"11","key":"ref106","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.3390\/nu9111197","article-title":"Probiotic supplementation in preterm infants does not affect the risk of bronchopulmonary dysplasia: a meta-analysis of randomized controlled Trials","volume":"9","author":"E Villamor-Mart\u00ednez","year":"2017","journal-title":"Nutrients"},{"key":"ref107","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3389\/fimmu.2020.00357","article-title":"Intestinal dysbiosis and the developing lung: the role of Toll-like receptor 4 in the gut-lung axis","volume":"11","author":"S Wedgwood","year":"2020","journal-title":"Front Immunol"},{"issue":"03","key":"ref108","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1038\/s41390-019-0578-2","article-title":"The developing gut-lung axis: postnatal growth restriction, intestinal dysbiosis, and pulmonary hypertension in a rodent model","volume":"87","author":"S Wedgwood","year":"2020","journal-title":"Pediatr Res"},{"issue":"05","key":"ref109","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1038\/jp.2016.255","article-title":"Pulmonary hypertension in preterm infants: results of a prospective screening program","volume":"37","author":"C G Weismann","year":"2017","journal-title":"J Perinatol"},{"issue":"01","key":"ref110","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1136\/archdischild-2019-318531","article-title":"Fate of pulmonary hypertension associated with bronchopulmonary dysplasia beyond 36 weeks postmenstrual age","volume":"106","author":"S Arjaans","year":"2021","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"02","key":"ref111","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1111\/jam.15602","article-title":"Microbial and metabolic profiles of bronchopulmonary dysplasia and therapeutic effects of potential probiotics Limosilactobacillus reuteri and Bifidobacterium bifidum","volume":"133","author":"Y Li","year":"2022","journal-title":"J Appl Microbiol"},{"key":"ref112","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1038\/pr.2014.155","article-title":"Linking fat intake, the intestinal microbiome, and necrotizing enterocolitis in premature infants","volume":"77","author":"D T Robinson","year":"2015","journal-title":"Pediatr Res"},{"issue":"06","key":"ref113","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1017\/S0007114521004104","article-title":"The administration of a pre-digested fat-enriched formula prevents necrotising enterocolitis-induced lung injury in mice","volume":"128","author":"C P Sodhi","year":"2022","journal-title":"Br J Nutr"},{"issue":"01","key":"ref114","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1186\/s12915-023-01531-3","article-title":"Targeting the gut-lung axis by synbiotic feeding to infants in a randomized controlled trial","volume":"21","author":"K S Sj\u00f6din","year":"2023","journal-title":"BMC Biol"},{"issue":"04","key":"ref115","doi-asserted-by":"crossref","first-page":"e0320938","DOI":"10.1371\/journal.pone.0320938","article-title":"Extra virgin olive oil mitigates lung injury in necrotizing enterocolitis: effects on TGF\u03b21, caspase-3, and MDA in a neonatal rat model","volume":"20","author":"M Tu\u015fat","year":"2025","journal-title":"PLoS One"},{"issue":"02","key":"ref116","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1089\/bfm.2015.0134","article-title":"Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet","volume":"11","author":"A B Hair","year":"2016","journal-title":"Breastfeed Med"},{"key":"ref117","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.jpeds.2015.10.080","article-title":"Does breastmilk influence the development of bronchopulmonary dysplasia?","volume":"169","author":"J Spiegler","year":"2016","journal-title":"J Pediatr"},{"issue":"01","key":"ref118","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3390\/nu12010014","article-title":"A review of the immunomodulating components of maternal breast milk and protection against necrotizing enterocolitis","volume":"12","author":"L S Nolan","year":"2019","journal-title":"Nutrients"},{"issue":"03","key":"ref119","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jcmgh.2019.11.002","article-title":"A novel role for necroptosis in the pathogenesis of necrotizing enterocolitis","volume":"9","author":"A D Werts","year":"2020","journal-title":"Cell Mol Gastroenterol Hepatol"},{"issue":"06","key":"ref120","doi-asserted-by":"crossref","first-page":"e01874-17","DOI":"10.1128\/mBio.01874-17","article-title":"Bacteriophage transcytosis provides a mechanism to cross epithelial cell layers","volume":"8","author":"S Nguyen","year":"2017","journal-title":"MBio"},{"issue":"01","key":"ref123","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s40168-025-02032-x","article-title":"The fungal microbiota modulate neonatal oxygen-induced lung injury","volume":"13","author":"I Martin","year":"2025","journal-title":"Microbiome"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2821-3458.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:41:32Z","timestamp":1789598492000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2821-3458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":119,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,9,16]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2821-3458","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2,26]]},"published":{"date-parts":[[2026,2,26]]}}}