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Changes in the intestinal microbiome of the preterm baby associated with stopping non-invasive pressure support: a
Richard Hutchinson1,2, William Wade3,4, Michael Millar5
1Queen Mary University of London, London, UK richard.hutchinson@lwh.nhs.uk.
Insights
Non-invasive positive pressure ventilation in preterm infants suppresses gut microbiome diversity and anaerobic bacteria growth. Strategies like probiotics may support a healthy gut microbiome during this critical period.
Area of Science:
- Neonatal Medicine
- Microbiome Research
- Gastroenterology
Background:
- Intestinal dysbiosis is linked to necrotising enterocolitis and sepsis in preterm infants.
- Non-invasive positive pressure ventilation (NIPPV) is common in preterm neonates.
- NIPPV's impact on the preterm gut microbiome is not well understood.
Purpose of the Study:
- To investigate the effect of transitioning off NIPPV on the preterm infant gut microbiome.
- To characterize changes in bacterial diversity and composition during respiratory support withdrawal.
Main Methods:
- Prospective cohort study involving 14 preterm infants.
- High-throughput 16S rRNA gene sequencing.
- Contemporaneous clinical data collection.
Main Results:
- Bacterial diversity increased significantly after discontinuing NIPPV.
- A notable increase in anaerobic genera (Bifidobacteria, Veillonella) was observed.
- A trend towards decreased Enterobacteriaceae was noted.
Conclusions:
- NIPPV is associated with reduced gut microbiome diversity and anaerobic bacterial growth in preterm infants.
- These findings have implications for neonatal care and highlight the need for microbiome-supportive strategies.
- Potential interventions include probiotic supplementation and minimizing aerophagia.
Background:
Intestinal dysbiosis is implicated in the pathogenesis of necrotising enterocolitis and late-onset sepsis in preterm babies. The provision of non-invasive positive pressure ventilation is a common clinical intervention in preterm babies, and may be hypothesised to adversely affect intestinal bacterial growth, through increased aerophagia and induction of a hyperoxic intestinal environment; however this relationship has not been previously well characterised.
Methodology:
In this prospectively recruited cohort study, high-throughput 16S rRNA gene sequencing was combined with contemporaneous clinical data collection, to assess within-subject changes in microbiome development around the time of transitioning from non-invasive positive pressure respiratory support to unsupported spontaneous breathing.
Results:
In a group of 14 preterm infants, bacterial diversity was seen to increase by 0.34 units/week (inverse Simpson index) at the point of transitioning off non-invasive positive pressure respiratory support. Correspondingly, a significant increase in anaerobic genera (Bifidobacteria spp, Veillonella spp), and a non-significant fall in Enterobacteriaceae was also seen at this time.
Conclusions:
Provision of non-invasive positive pressure ventilation is associated with suppression of both diversity accrual and obligate anaerobic growth in the preterm intestine. This has clinical implications in view of the widespread use of non-invasive positive pressure ventilation in preterm neonatal care (and wider adult use), and demonstrates the need for potential strategies (eg, probiotic support; reduced aerophagia) to support the development of a healthy gut microbiome during this time.
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