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Published on: January 27, 2019
The gut microbiome of extremely preterm infants randomized to the early progression of enteral feeding
Ariel A Salas1, Kent A Willis1, Waldemar A Carlo1
1Division of Neonatology, Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Insights
Early feeding in preterm infants did not increase gut microbiome diversity but did show differences in specific bacterial genera. This suggests potential benefits of early enteral feeding progression, warranting further investigation in infant gut microbiome development.
Area of Science:
- Neonatalogy
- Microbiome research
- Pediatric nutrition
Background:
- Early feeding interventions in extremely preterm infants may impact gut microbiome development.
- The gut microbiome plays a crucial role in infant health and development.
Purpose of the Study:
- To investigate the effect of early versus delayed enteral feeding progression on the gut microbiome in extremely preterm infants.
- To determine longitudinal differences in gut microbial taxa between feeding groups.
Main Methods:
- Fecal samples were collected from 51 extremely preterm infants randomized to early (day 2) or delayed (day 5) feeding.
- Samples were analyzed at weeks 1, 2, and 3 using negative binomial and zero-inflated mixed models.
- Analyses were adjusted for mode of delivery, breastmilk intake, and antibiotic exposure.
Main Results:
- No significant differences in alpha or beta diversity were observed between early and delayed feeding groups.
- Longitudinal analysis revealed consistent differences in the genera Lactococcus, Veillonella, and Bilophila between groups.
- These differences were independent of confounding factors like mode of delivery and antibiotic exposure.
Conclusions:
- Early progression of enteral feeding volumes may offer benefits, as indicated by single-taxon differences in the gut microbiome.
- This dietary intervention did not increase gut microbiome diversity within the first 28 days of life.
- Randomized trials evaluating human milk diets are valuable for understanding their impact on the infant gut microbiome.
Background:
Early progression of feeding could influence the development of the gut microbiome.
Methods:
We collected fecal samples from extremely preterm infants randomized to receive either early (feeding day 2) or delayed (feeding day 5) feeding progression. After study completion, we compared samples obtained at three different time points (week 1, week 2, and week 3) to determine longitudinal differences in specific taxa between the study groups using unadjusted and adjusted negative binomial and zero-inflated mixed models. Analyses were adjusted for a mode of delivery, breastmilk intake, and exposure to antibiotics.
Results:
We analyzed 137 fecal samples from 51 infants. In unadjusted and adjusted analyses, we did not observe an early transition to higher microbial diversity within samples (i.e., alpha diversity) or significant differences in microbial diversity between samples (i.e., beta diversity) in the early feeding group. Our longitudinal, single-taxon analysis found consistent differences in the genera Lactococcus, Veillonella, and Bilophila between groups.
Conclusions:
Differences in single-taxon analyses independent of the mode of delivery, exposure to antibiotics, and breastmilk feeding suggest potential benefits of early progression of enteral feeding volumes. However, this dietary intervention does not appear to increase the diversity of the gut microbiome in the first 28 days after birth.
Trial Registration:
ClinicalTrials.gov identifier: NCT02915549.
Impact:
Early progression of enteral feeding volumes with human milk reduces the duration of parenteral nutrition and the need for central venous access among extremely preterm infants. Early progression of enteral feeding leads to single-taxon differences in longitudinal analyses of the gut microbiome, but it does not appear to increase the diversity of the gut microbiome in the first 28 days after birth. Randomization in enteral feeding trials creates appealing opportunities to evaluate the effects of human milk diets on the gut microbiome.
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