Prospective Study On Changes Of Intestinal Microflora In Infants With Congenital Anorectal Malformation After Surgery

Objective To comprehend the condition of the main microflorascolonized in the gut of infants with congenital anorectalmalformation(ARM) and the differences compared with the normal infants,we observe the level of Escherichia coli, Bifidobacteria and Lactobacilli ofpostoperative infants with congenital anorectal malformation at differenttime points.Methods21ARM infants from the department of neonatalgastrointestinal surgery, who were in accordance with the inclusion criteria,were enrolled as the ARM group. Another21healthy infants from acommunity of Yuzhong district were selected as the normal group. Themode of delivery, feeding type and time points of selecting samples ofinfants in two groups were all matched. Real-time quantitative PCR methodwas used to analyse the numbers of three main intestinal microflora instools of the ARM group on the sixth day after surgery (average10daysafter birth),at1month and3to4months’age. After log transformation,compared the levels of microflora within the group and with those of the normal group.Results (1) The calculation of Bifidobacteria/Escherichia coli ratiovalue (B/E) was less than1.The number of Escherichia coli was higher thanthat of Bifidobacteria and Lactobacilli in the ARM group on average10days（P=0.021and P=0.004）,the number of Lactobacilli was higher thanthat in the normal group（P=0.001）.(2) B/E was more than1at1month’sage which was higher than that on average10days in the ARM group（P=0.030）.The number of Bifidobacteria increased significantly（P=0.001）,which was higher than the number of Escherichia coli andLactobacilli（P=0.001and P<0.001）in the ARM group. The numbers ofBifidobacteria and Lactobacilli were higher than those in the normal group（P=0.004and P<0.001）.(3) The number of Lactobacilli decreasedsignificantly at3to4months’ age than that at1month’age （P=0.005）andhad no significant difference with that in the normal group (P=0.571）.Thenumber of Bifidobacteria in the ARM group was still higher than that in thenormal group（P=0.004）.(4) There were13ARM infants who usedprobiotics continuously during the follow up and there were8infants whoused probiotics continuously till1month’s age, stopped using probioticsbetween1month and3to4months’ age. The number of Bifidobacteriaof infants in ARM group taking probiotics continuously was higher thanthat in normal group(P=0.013) whereas there was no significant differencebetween the number of Bifidobacteria in infants taking probiotics discontinuously and normal group(P=0.032).Conclusion (1) Gut surgery in early life and antibiotics may influencecolonization of the three main microfloras. Escherichia coli was thepredominant bacteria on average10days after birth in the ARM group. Thenumber of Lactobacilli was higher than that in the normal group. Thestructure of three main microflora was different from that in the normalgroup. Same with the normal group, Bifidobacteria became thepredominant bacteria in the ARM group at1month’ age. The number ofLactobacilli was still high. The number of Lactobacilli decreased to thelevel of normal group at3to4months’ age. The structure of three mainmicroflora was similar to that in the normal group.(2) Early use ofprobiotics help rebuild the intestinal microbiota after gut surgery in ARMinfants. Taking probiotics continuously till3to4months’age can keep thehigh level of Bifidobacteria in the intestine.