Effects of Lactobacillus reuteri supplementation on the gut microbiota in extremely preterm infants in a randomized placebo-controlled trial

Magalí Martí,Johanne E Spreckels,Purnika Damindi Ranasinghe,Erik Wejryd,Giovanna Marchini,Eva Sverremark-Ekström,Maria C Jenmalm,Thomas Abrahamsson

doi:10.1016/j.xcrm.2021.100206

Abstract

SummaryExtremely low birth weight (ELBW) infants often develop an altered gut microbiota composition, which is related to clinical complications, such as necrotizing enterocolitis and sepsis. Probiotic supplementation may reduce these complications, and modulation of the gut microbiome is a potential mechanism underlying the probiotic effectiveness. In a randomized, double-blind, placebo-controlled trial, we assessed the effect of Lactobacillus reuteri supplementation, from birth to post-menstrual week (PMW)36, on infant gut microbiota. We performed 16S amplicon sequencing in 558 stool samples from 132 ELBW preterm infants at 1 week, 2 weeks, 3 weeks, 4 weeks, PMW36, and 2 years. Probiotic supplementation results in increased bacterial diversity and increased L. reuteri abundance during the 1st month. At 1 week, probiotic supplementation also results in a lower abundance of Enterobacteriaceae and Staphylococcaceae. No effects were found at 2 years. In conclusion, probiotics may exert benefits by modulating the gut microbiota composition during the 1st month in ELBW infants.

Highlights

The care of preterm infants has developed dramatically during the last decades, about 23% of extremely low birth weight (ELBW) preterm infants, born in Sweden, die due to clinical complications,[1] such as necrotizing enterocolitis (NEC)[2] and sepsis,[3] and the survivors have a high risk of longterm neurological disabilities.[4]
Current research interest has focused on the composition and function of the developing gut microbiota, because an altered bacterial composition and lower diversity may be a major risk factor linked to these severe clinical complications.[2,3,4,7]
The following clinical characteristics significantly differed between the L. reuteri and placebo groups: gender at 1 week and 3 weeks; delivery mode at 3 weeks; and treatment with antibiotics at 4 weeks, as well as chorioamnionitis, infants from multiple pregnancies, and total days on antibiotics at PMW36 (Table S1)