Case Report
Copyright ©The Author(s) 2022.
World J Clin Cases. Oct 16, 2022; 10(29): 10583-10599
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10583
Table 1 Baseline characteristics of the patient
CHD (according to echocardiography and CT results)Right-sided heart. Double-inlet single ventricle. Common atrium. Malposition of the great arteries. Complete, unbalanced common atrioventricular valve. Right pulmonary artery stenosis. Double superior vena cava. Total, anomalous pulmonary venous return to the left superior vena cava (supracardiac type)
Noncardiac congenital anomalies (according to CT and abdominal ultrasound imaging)Tracheal and esophageal displacement to the vertebral column. Tracheal narrowing to 4 mm × 2 mm at the level of the brachiocephalic trunk. Symmetrical liver. Asplenia. Common origin of the celiac trunk and superior mesenteric artery from the abdominal aorta. Right-sided aortic arch, right descending aorta
Table 2 Characteristics of cardiac surgery and the postoperative period
Cardiopulmonary bypass duration (min)105
Aortic cross-clamp during operationNot performed
Mechanical ventilation duration after cardiac surgery (h)95
Inotrope therapy duration (number of postoperative days)4
Length of stay in the cardiac intensive care unit (d)6
Length of stay after cardiac surgery (number of postoperative days)55
Table 3 Resistive index of the visceral arteries according to Doppler ultrasonography
ParametersPostoperative day (day of life)
- (1)
1 (15)
5 (19)
Course of the first episode of NEC stage IIA
RI AbdAo> 1.0> 1.01.17
RI celiac trunk0.91.05Not evaluated because patient exhibited anxiety
RI SMA0.861.05
ConclusionHolodiastolic flow reversal in AbdAoHolodiastolic flow reversal in AbdAo, celiac trunk, SMAHolodiastolic flow reversal in AbdAo
Table 4 Complete blood count and C-reactive protein values before cardiac surgery and during the first episode of necrotizing enterocolitis
Parameters- (9)Postoperative day (day of life)
1 (15)
2 (16)
3 (17)
4 (18)
5 (19)
6 (20)
7 (21)
Course of the first episode of NEC IIA
Hemoglobin, g/L147171148135134148157154
Red blood cells, 1012/L3.955.544.854.394.384.835.195.11
Platelets, 109/L559154144152158208263289
White blood cells, 109/L13.419.524.718.711.112.717.618.4
Normoblasts per 100 white blood cells262
Metamyelocytes, %1
Myelocytes, %1
Stab neutrophils, %119122
Segmented neutrophils, %2566807950403541
Eosinophils, %31922
Basophils, %1
Monocytes, %16133710131126
Lymphocytes, %531081437374930
С-reactive protein, mg/L4781816138211616
Table 5 Time points of the microbiological examinations and fecal sampling for 16S rRNA gene-based microbiota profiling
ExaminationsPostoperative day (day of life)
- (2)
- (7)
- (10)
- (14)
5 (19)
8 (22)
18 (32)
21 (35)
29 (43)
35 (49)
40 (54)
16S rRNA gene-based microbiota profiling-+-+-+-++--
Fecal culture--+-+++--++
Gastric content culture----+-+----
Pharynx smear culture--+++-+--++
Blood culture+--++---+--
Table 6 Results of 16S rRNA gene-based fecal microbiota profiling in serial fecal samples of the neonate
Class level
Family level
Genus level
Before surgical treatment of CHD (DOL 7) – feeding with fortified BM with preterm formula added (because of low BM supply)
- (7)Negativicutes 44.9%Veillonellaceae 44.9%Veillonella 44.9%
Gammaproteobacteria 41.1%Enterobacteriaceae 38.8% Pasteurellaceae 2.3%Escherichia/Shigella 38.8%
Bacilli 12.3%Streptococcaceae 8.0% Enterococcaceae 4.3%Streptococcus 8.0% Enterococcus 4.3%
Before surgical treatment of CHD (DOL 14) – before the first episode of NEC stage IIA on POD 1 (DOL 15) Feeding with fortified BM with preterm formula added (because of low BM supply)
- (14)Clostridia 57.8%Clostridiaceae 57.8%Clostridium sensu stricto I 57.8% 1Clostridium paraputrificum 56.1%
Gammaproteobacteria 29.6%Enterobacteriaceae 24.8% Pasteurellaceae 4.8%Escherichia/Shigella 24.8% Actinobacillus 4.8%
Bacilli 5.7%Streptococcaceae 5.7%Streptococcus 5.7%
Actinobacteria 3.8%Bifidobacteriaceae 3.8%Bifidobacterium 3.8%
Negativicutes 3.1%Veillonellaceae 3.1%Veillonella 3.1%
POD 8 (DOL 22) – after ampicillin/sulbactam therapy (POD 1-7) and metronidazole therapy (POD 2-6) had been completed and piperacillin/tazobactam therapy was started (POD 7-14) (nil per os)
8 (22)Gammaproteobacteria 99.8%Enterobacteriaceae 99.8%Escherichia/Shigella 99.8%
Clostridia 0.2%Ruminococcaceae 0.2%1Ruminococcus bucirculans 0.2%
POD 21 (DOL 35) – 7 d after the antibacterial therapy was completed on POD 14 Feeding with hydrolyzed formula
21 (35)Clostridia 58.0%Clostridiaceae 56.9% Lachnospiraceae 1.1%Clostridium sensu stricto I 56.9% Anaerostripes 1.1%
Gammaproteobacteria 38.7%Enterobacteriaceae 38.7%Escherichia/Shigella 38.7%
Bacilli 3.2%Enterococcaceae 3.2%Enterococcus 3.2%
POD 29 (DOL 43) – on the day after onset of the second episode of NEC IIA Feeding before NEC IIA onset: Expressed BM (from DOL 37) with hydrolyzed formula dotation
29 (43)Clostridia 72.0%Clostridiaceae 72.0%Clostridium sensu stricto I 72.0%
Gammaproteobacteria 22.7%Enterobacteriaceae 19.8% Pasteurellaceae 2.9%Escherichia/Shigella 18.1%
Negativicutes 5.3%Veillonellaceae 5.3%Veillonella 5.3%
Table 7 Results of bacterial cultures and 16S rRNA gene-based fecal microbiota profiling
Fecal microbiome at the genus level, 16S rRNA
Fecal culture
Gastric culture
Pharynx smear culture
Blood culture
Antibacterial therapy
- (2)----No growthNo
- (7)Escherichia/Shigella, Veillonella, Streptococcus, Enterococcus----No
- (10)-No growth-Staphylococcus hominis-No
- (14)Clostridium sensu stricto I, Escherichia/Shigella, Streptococcus, Actinobacillus, Bifidobacterium, Veillonella--No growthNo growthCUR: POD 0-1 (perioperative prophylaxis)
5 (19)-No growthEnterococcus faecalis R: TETEscherichia coli S: CUR, PIT, GEN R: AMSNo growthNEC IIA AMS: POD 1-7; MET: POD 2-6 GEN+PIT: POD 7-14
8 (22)Escherichia/Shigella, RuminococcusNo growth---
18 (32)-No growthNo growthStreptococcus oralis-No
21 (35)Clostridium sensu stricto I, Escherichia/Shigella, Enterococcus----No
29 (43)Clostridium sensu stricto I, Escherichia/Shigella, Veillonella---No growthNEC IIA No
35 (49)-No growth-Streptococcus mitis, Rothia mucilaginosa-No
40 (54)-No growth-No growth-No
Table 8 Complete blood count and C-reactive protein values before and during the second episode of necrotizing enterocolitis
ParametersPostoperative day (day of life)/day after the pericardial drainage procedure
26 (40)29 (43)
32 (46)
36 (50)
40 (54)/1
41 (55)/2
43 (57)/4
Course of the second episode of NEC IIA
Hemoglobin, g/L136132139155124115122
Red blood cells, 1012/L4.
Platelets, 109/L461554139331216141236
White blood cells, 109/L7.69.713.68.817.521.914.3
Stab neutrophils, %111
Segmented neutrophils, %27602019555028
Eosinophils, %343121
Basophils, %1
Monocytes, %138101197
Lymphocytes, %57286767393963
С-reactive protein, mg/L41NA15320354

  • Citation: Kaplina A, Zaikova E, Ivanov A, Volkova Y, Alkhova T, Nikiforov V, Latypov A, Khavkina M, Fedoseeva T, Pervunina T, Skorobogatova Y, Volkova S, Ulyantsev V, Kalinina O, Sitkin S, Petrova N. Intestinal microbiome changes in an infant with right atrial isomerism and recurrent necrotizing enterocolitis: A case report and review of literature. World J Clin Cases 2022; 10(29): 10583-10599
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