Breast Milk Feeding and the Middle Ear Microbiome of Children With Cleft Palate

ObjectiveTo delineate the impact of breast milk feeding (BMF) on the middle ear (ME) and nasopharyngeal (NP) microbiota of children with and without cleft palate with or without cleft lip (CP ± L); to define differences in ME and NP bacterial composition.DesignProspective cohort.SettingTertiary children's hospital.ParticipantsChildren aged <24 months undergoing first bilateral myringotomy and tubes (BMTs). Groups included CP ± L with BMF ≥3 months (n = 6), CP ± L with no BMF (n = 5), controls with BMF ≥3 months (n = 14), and controls with no BMF (n = 14). Exclusions were immunodeficiency, genetic disorders, and antibiotic treatment ≤14 days prior.Main Outcome MeasuresME effusions (MEEs) and NP swabs were collected. Bacterial 16S rRNA gene sequencing was performed. Main outcome measures were abundance (additive-log ratio transformed), β-diversity (permutational multivariate analysis of variance), and α-diversity.ResultsBMF was associated with increased Acinetobacter (β = 1.46) in MEE. In the NP, BMF was associated with increased Haemophilus (β = 2.40), Neisseria (β = 2.39), Granulicatella (β = 1.53), Gemella (β = 1.86), and Prevotella (β = 1.83), and decreased Staphylococcus (β = -1.88). CP ± L was associated with greater α-diversity (Tail β = 1.58; Shannon β = 1.30) and increased Gemella (β = 2.13), Acinetobacter (β = 1.81), and Pseudomonas (β = 2.90) in MEE. In the NP, CP ± L was associated with an increased abundance of Veillonella (β = 3.48), Streptococcus (β = 2.15), and Staphylococcus (β = 1.74) and a decreased abundance of Afipia (β = -1.58). Paired differences revealed more Staphylococcus in MEE relative to the NP (β = -5.98) and a significant difference in β-diversity between the NP and MEE (β = 1.27). All p < .05.ConclusionsBMF and CP ± L may alter ME and NP microbiota. This represents a first step in the identification of factors that could improve ME health in this population.