ppharmПедиатрическая фармакологияPediatric pharmacology1727-57762500-3089Издательство «ПедиатрЪ»10.15690/pf.v12i3.1354ppharm-484Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWКишечная микробиота у недоношенных детей — современное состояние проблемы (обзор литературы)Intestinal Microbiota in Premature Children — the Modern State of the Problem (Literature Analysis)БеляеваИрина АнатольевнаBelyaevaI. A.

доктор медицинских наук, заведующая отделением для недоношенных детей,

119991, Москва, Ломоносовский проспект, д. 2, стр. 1

Moscow

belyaeva@nczd.ruБомбардироваЕ. П.BombardirovaE. P.

Москва

Moscow

ТуртиТ. В.TurtiT. V.

Москва

Moscow

МитишМ. Д.MitishM. D.

Москва

Moscow

ПотехинаТ. В.PotekhinaT. V.

Москва

Moscow

ФГБНУ «Научный центр здоровья детей»РоссияScientific Center of Children’s HealthRussian FederationФГБНУ «Научный центр здоровья детей»; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияScientific Center of Children’s Health; Pirogov National Research Medical UniversityRussian Federation201530052015123296303Copyright © Беляева И.А., Бомбардирова Е.П., Турти Т.В., Митиш М.Д., Потехина Т.В., 20152015Беляева И.А., Бомбардирова Е.П., Турти Т.В., Митиш М.Д., Потехина Т.В.Belyaeva I.A., Bombardirova E.P., Turti T.V., Mitish M.D., Potekhina T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pedpharma.ru/jour/article/view/484

Проблема влияния микробиоты кишечника на состояние здоровья детей раннего возраста приобрела особую актуальность в последние годы. Это связано, с одной стороны, со значительным ухудшением экологии среды обитания человека, с другой — с высокой частотой расстройств пищеварения у детей, особенно родившихся преждевременно. Внедрение современных высокоинформативных молекулярно-генетических методов исследования (ПЦР-амплификация с секвенированием генов) позволило выявить начальный этап микробной колонизации человека еще в периоде внутриутробного онтогенеза и подробно расшифровать структуру микробиоты у новорожденных и младенцев 1-го года жизни. Установлено, что на количественную выраженность и качественный состав кишечной микробиоты влияет состав микробиоты матери, который зависит от наличия/отсутствия у нее не только воспалительных, но и метаболических болезней (ожирения). Обнаружено, что имеется достоверная связь состава микробиоты у младенцев со способом родоразрешения их матерей (более благоприятный состав после естественных родов), причем указанные различия сохраняются на протяжении нескольких месяцев после рождения. Один из основных факторов, влияющих на микробиоту с первых дней, — питание; большинство исследований убедительно подтверждают роль грудного вскармливания в становлении оптимального микробиоценоза у младенца. Антибактериальная терапия, получаемая матерью и/или ребенком, оказывает негативное воздействие на колонизацию кишечника микробами-симбионтами. Негативные внешние влияния на микробиоту особенно значимы у недоношенных детей, прежде всего у родившихся с очень низкой и экстремально низкой массой тела. Онтогенез этих младенцев наиболее отягощен вредными факторами (инфекцией и необходимостью массивной антибактериальной терапии, гипоксией, оперативным родоразрешением, вынужденным искусственным вскармливанием) на фоне общей незрелости, в том числе несформированности защитных механизмов организма. Направленная коррекция микробиоты у недоношенных детей является важным условием профилактики и лечения таких грозных заболеваний, как сепсис и некротизирующий энтероколит. Именно поэтому использование препаратов-пробиотиков представляется одним из перспективных направлений практической неонатологии. В статье приводится пример исследования эффективности пробиотикотерапии у недоношенных детей с сочетанной перинатальной патологией.

The problem of intestinal microbiota influencing the health of early aged children has become especially relevant over the past few years. On one hand, this is due to the significant worsening of the human environment ecology, on the other — due to the high prevalence of digestive disorders in children, especially premature ones. The introduction of modern high-informative molecular-genetic research methods (PCR-amplification with gene sequenation) made it possible to reveal the primary stage of human colonization by bacteria even at the stage of fetal ontogenesis and to thoroughly decode the microbiota structure in newborns and first-year babies. It is established, that the mothers microbiota has a direct effect on the quantity and quality of the child’s microbiota. The mother’s microbiota depends not only on her possessing inflammatory, but also metabolic diseases (obesity). There is also a direct correlation between the children’s microbiota and the wway they were born (microbiota is better in cases of natural birth), and these differences are prevalent after a number of months after birth. One of the main factors affecting microbiota after birth from the very first day is nutrition. Most studies earnestly confirm the role of breastfeeding in contributing to an optimal microbiocenosis in the child. Antibacterial therapy, being received by either the mother or the child has a negative effect on the colonization of the intestines by symbiont microbes. The negative impacts on the micro flora are especially significant for premature children especially those born with a very low and extremely low body mass. The ontogenesis of these children is most severed by malicious factors (infections followed by the necessity of a massive antibacterial therapy, hypoxia, surgical birth, forced artificial feeding) in connection with a general immaturity, including not yet fully-fledged body defense systems. Directive microbiota correction in premature children is an important condition for prevention and treatment of such severe diseases as sepsis necrotizing enterocolitis. For this reason, the usage of probiotics is considered as one of the promising practices of practical neonatology. The article contains an example of studying the effectiveness of probiotic therapy in premature babies with a combined perinatal pathology.

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The authors declare that there are no conflicts of interest present.