Intestinal microbiome changes in an infant with right atrial isomerism and recurrent necrotizing enterocolitis: A case report and review of literature

Figure 1 Chest radiograph of the patient taken on the first day of life. The radiograph depicts right-sided heart and symmetrical liver.

Figure 2 Computed tomography images of the patient with right atrial isomerism before cardiac surgery. A: Single ventricle, common atrium; B: Right descending aorta; C: Symmetrical liver, asplenia; stomach, bowel; D: Right pulmonary artery stenosis, left pulmonary artery. SV: Single ventricle; SA: Common atrium; RPA: Right pulmonary artery; LPA: Left pulmonary artery; Ао: Right descending aorta; ST: Stomach; Bo: Bowel.

Figure 3 Enteral feeding volume of the infant with right atrial isomerism before and after modified Blalock-Taussig shunt placement. POD: Postoperative day; DOL: Day of life; BM: Breast milk; PF: Preterm formula; NPO: Nil per os; NEC: Necrotizing enterocolitis; CICU: Cardiac intensive care unit.

Figure 4 Taxa plot demonstrating relative abundance at the species level in feces of the infant before and after modified Blalock-Taussig shunt placement. The patient had episodes of necrotizing enterocolitis on postoperative days 1 (day 15 of life) and 28 (day 42 of life). The relative abundances of intestinal microbiome species in serial fecal samples of the neonate are shown.

Figure 5 Microbiota diversity (Shannon diversity index) in serial fecal samples of the neonate with right atrial isomerism before and after modified Blalock-Taussig shunt placement. The patient had episodes of necrotizing enterocolitis on postoperative days 1 (day 15 of life) and 28 (day 42 of life). The Shannon diversity indexes of intestinal microbiota in serial fecal samples of the neonate are shown.

Figure 6 Abdominal radiograph series performed at the onset of the second episode of necrotizing enterocolitis. The radiographs demonstrate dilated bowel loops and thickness of the intestinal wall. Free air is absent. A: Anteroposterior view; B: Lateral view.