There is significant communication and interdependence among the gut, the microbiome, and the brain during development. Diseases, such as necrotizing enterocolitis (NEC), highlight how injury to the immature gastrointestinal tract leads to long-term neurological consequences, due to vulnerabilities of the brain in the early stages of life. A better understanding of the developing gut–microbiota–brain axis is needed to both prevent and treat the devastating consequences of these disease processes. The gut–microbiota–brain axis is a bidirectional communication pathway that includes metabolic, nervous, endocrine, and immune components. In this review, we discuss gut development, microbiome colonization and maturation, and the interactions that influence neurodevelopment in the context of NEC. We describe the components of the gut–brain axis and how the microbiome is an integral member of this relationship. Finally, we explore how derangements within the microbiome and gut–microbiota–brain axis affect the normal development and function of the other systems and long-term neurodevelopmental consequences for patients.

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality for preterm infants in the neonatal intensive care unit. From the first surgical approaches for NEC in the 1970s and the development of Bell’s staging criteria, there has been a continuous medical and scientific journey towards understanding the pathophysiology, clinical progression, and treatment possibilities for this devastating disease. Basic science research has played a crucial role in understanding the pathogenesis of NEC. In vivo NEC models, which include rodents (mice, rats) and pigs, and in vitro NEC models, which utilize intestinal cell lines and organoids, have identified critical disease biomarkers, pathways in NEC pathogenesis, and novel therapeutic targets. These potential therapies have been brought into clinical trials to improve treatment options for infants with NEC. This review will provide a comprehensive assessment of research conducted over the last decade, leading to a deeper understanding of the disease’s development and progression through the use of innovative models, the identification of novel biomarkers, the development of new therapeutic approaches, and, finally, an overview of the latest clinical trials. We will conclude with a discussion of ongoing challenges and future research directions, highlighting the optimism and hope that these advancements bring to the field of neonatology and pediatric surgery. This review will serve as a reference and guide for future NEC research, with the ultimate goal of enhancing clinical outcomes and improving the quality of life for patients with NEC and their families.

Predominantly androgen secreting juvenile granulosa cell tumors (JGCT) are uncommon and few reports have been published. We present a case of a JGCT that presented with signs of prepubertal hyperandrogenism and insulin resistance to highlight the possible interaction between hyperandrogenemia and hyperinsulinism. A 4 -year -old girl presented with acanthosis nigricans and hyperinsulinism, mimicking the hyperandrogenism, insulin resistance and acanthosis nigricans syndrome at an age much younger than is typical for this diagnosis. Laboratory studies revealed elevated insulin, inhibin A and B, and total testosterone. All laboratory results normalized after unilateral salpingo-oophorectomy. The final diagnosis was Stage 1A JGCT. This case highlights the importance of including ovarian tumors in the differential diagnosis when considering causes of virilization and insulin resistance. This case also suggests a potential relationship between excess testosterone secretion and hyperinsulinemia and strengthens evidence that hyperandrogenemia may promote hyperinsulinism in ovarian disease.