Perinatal Factors Associated with Neonatal Microbiome Development and Their Implications for Nursing Practice: An Integrative Review.

Background: The neonatal microbiome plays a fundamental role in immune, metabolic, and physiological development from the earliest stages of life. Its establishment is influenced by several perinatal factors, many of which are closely related to nursing care practices. Objective: This study aimed to identify the principal perinatal factors associated with neonatal microbiome development and, secondarily, to explore their implications for nursing practice based on the available evidence. Methods: An integrative review was conducted using PubMed, Scopus, Web of Science, and CINAHL. Studies published between 2016 and 2026 involving newborns or neonates and addressing factors influencing neonatal microbiome development were considered. Following screening, eligibility assessment, and methodological quality appraisal, 14 studies were included in the final synthesis. Results: The evidence consistently identified mode of delivery, breastfeeding, and perinatal antibiotic exposure as the perinatal factors most consistently associated with neonatal microbial colonization. Vaginal delivery and breastfeeding were associated with greater abundances of beneficial bacterial genera, including Bifidobacterium, Lactobacillus, and Bacteroides, whereas cesarean delivery and antibiotic exposure were associated with reduced microbial diversity and altered colonization patterns. Emerging interventions such as vaginal microbial transfer showed promising results, although current evidence remains limited. Nursing-related practices, particularly breastfeeding support, promotion of early skin-to-skin contact, and participation in antimicrobial stewardship, were identified as key strategies for supporting healthy microbiome development. Conclusions: Current evidence suggests that nursing care may play an important role in promoting healthy neonatal microbial colonization through interventions that support physiological birth processes, breastfeeding, and appropriate antibiotic use. Further research is needed to evaluate the direct impact of specific nursing interventions on neonatal microbiome development and subsequent health outcomes.