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Hospital Regimens Including Probiotics Guide the Individual Development of the Gut Microbiome of Very Low Birth
Stefan Kurath-Koller1,2, Charlotte Neumann3, Christine Moissl-Eichinger3,4
1Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria Auenbruggerplatz 34/2, 8036 Graz, Austria.
Insights
Probiotics are safe for preterm infants and promote earlier bacterial growth, potentially preventing necrotizing enterocolitis (NEC). Hospital practices influence infant microbiome development, showing distinct patterns across centers.
Area of Science:
- Neonatal microbiome research
- Probiotic efficacy studies
- Infant gut health
Background:
- The impact of hospital practices and probiotics on preterm infant gut microbiome and necrotizing enterocolitis (NEC) prevention remains unclear.
- Understanding these influences is critical for improving neonatal intensive care unit (NICU) outcomes.
Purpose of the Study:
- To investigate the influence of hospital regimens and probiotic use on the microbiome of very low birth weight preterm infants.
- To assess the safety and impact of probiotics on bacterial load and diversity in this vulnerable population.
Main Methods:
- A prospective, controlled, multicenter cohort study involving very low birth weight infants in three NICUs.
- Stool samples were collected bi-daily for the first two weeks and analyzed using amplicon-based microbiome techniques.
- The study included 54 infants (3 groups of 18) and 17 negative controls, registered under the German Registry of Clinical Trials (DRKS00009290).
Main Results:
- No significant differences in gestational age, birth weight, APGAR scores, or oxygen demand were observed between groups.
- A total of 2029 taxa were identified, with *Enterococcus*, *Staphylococcus*, *Lactobacillus*, and *Bifidobacterium* predominating.
- Probiotic use led to an earlier increase in bacterial load, with *Lactobacillus* and *Bifidobacterium* contributing significantly, though some infants showed no response.
- Microbiome diversity became similar across centers after two weeks, but distinct center-specific clustering was evident.
Conclusions:
- Probiotics are safe for preterm infants and accelerate bacterial load increase, potentially aiding in preventing neonatal morbidities.
- Hospital regimens contribute to distinct, center-specific microbiome profiles.
- Meconium contains bacterial DNA, and oral antibiotics did not negatively impact fecal microbiome development.
Background:
It is unknown to what extent the microbiome of preterm infants is influenced by hospital regimens including the use of different probiotics when it comes to the prevention of necrotizing enterocolitis (NEC).
Methods:
Prospective controlled multicenter cohort study including very low birth weight infants from three neonatal intensive care units (NICUs) between October 2015 and March 2017. During this time span, stool was sampled every other day during the first two weeks and samples were subjected to amplicon-based microbiome analyses. Out of these, seventeen negative controls were processed (German Registry of Clinical Trials (No.: DRKS00009290)).
Results:
The groups (3 × 18 infants) showed no statistically significant difference regarding gestational age, birth weight, APGAR scores and oxygen demand. 2029 different taxa were detected, including Enterococcus and Staphylococcus, as well as the probiotic genera Lactobacillus and Bifidobacterium predominating. The bacterial load was found to increase earlier on when probiotics were used. Without probiotics administration, Lactobacillus and Bifidobacterium contributed only marginally to the fecal microbiome. Some infants did not respond to probiotic administration. The samples from all centers participating reached a very similar diversity after two weeks while the microbiome samples from all three centers clustered significantly yet varied from each other.
Conclusion:
Probiotics proved to be safe and initiated an earlier increase of bacterial load (with marked individual divergences), which might play a crucial role in the prevention of neonatal morbidities. Meconium was found not to be free of bacterial DNA, and oral antibiotics did not influence the fecal microbiome development negatively, and hospital regimes led to a center-specific, distinct cluster formation.
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