Gut Microbiota Maturation and Neurological Injury in Extremely Preterm Infants

Objective: To examine the association between gut microbiota maturation and neurological injury in extremely preterm infants. Study Design: We prospectively studied 75 extremely preterm infants (28–<32 weeks, 1.0–<1.5 kg) and 20 term-born controls. Neurological outcomes were assessed by neuroimaging, amplitude-integrated EEG, and developmental evaluations up to 3 months corrected age. Stool samples collected on days 3, 10, and 20 were analyzed by 16S rDNA sequencing. Results: At day 3, preterm infants had reduced diversity versus term controls (P<0.01) and were enriched in facultative anaerobes. By day 20, neurologically normal infants showed increased colonization by Bifidobacterium and Akkermansia , whereas injury group infants retained facultative-dominated profiles. Beneficial taxa correlated positively with neurodevelopmental scores, while Enterococcus correlated negatively. Conclusions: Delayed microbial maturation is associated with neurological injury in extremely preterm infants and may serve as an early biomarker and target for intervention.