Fecal Volatile Organic Compounds in Preterm Infants Are Influenced by Enteral Feeding Composition.

Daniel Berkhout,Anton Van Kaam,Tim De Meij,Hager Said,Richard Van Lingen,Sofia El Manouni El Hassani,Hendrik Niemarkt,Marc Benninga,Nanne De Boer

doi:10.3390/s18093037

Abstract

Fecal volatile organic compound (VOC) analysis has shown great potential as a noninvasive diagnostic biomarker for a variety of diseases. Before clinical implementation, the factors influencing the outcome of VOC analysis need to be assessed. Recent studies found that the sampling conditions can influence the outcome of VOC analysis. However, the dietary influences remains unknown, especially in (preterm) infants. Therefore, we assessed the effects of feeding composition on fecal VOC patterns of preterm infants (born at <30 weeks gestation). Two subgroups were defined: (1) daily intake >75% breastmilk (BM) feeding and (2) daily intake >75% formula milk (FM) feeding. Fecal samples, which were collected at 7, 14 and 21 days postnatally, were analyzed by an electronic nose device (Cyranose 320®). In total, 30 preterm infants were included (15 FM, 15 BM). No differences in the fecal VOC patterns were observed at the three predefined time-points. Combining the fecal VOC profiles of these time-points resulted in a statistically significant difference between the two subgroups although this discriminative accuracy was only modest (AUC [95% CI]; p-value; sensitivity; and specificity of 0.64 [0.51–0.77]; 0.04; 68%; and 51%, respectively). Our results suggest that the influence of enteral feeding on the outcome of fecal VOC analysis cannot be ignored in this population. Furthermore, in both subgroups, the fecal VOC patterns showed a stable longitudinal course within the first month of life.

Highlights

Recognition and timely initiation of targeted treatment is a key prognostic factor in a wide variety of pediatric diseases, such as necrotizing enterocolitis (NEC), sepsis or inflammatory bowel disease (IBD)
The difference in volatile organic compound (VOC) profiles between BM and formula milk (FM) fed infants may be explained by the the influence of dietary intake on the outcome of fecal VOC analysis cannot be ignored in this specific population
No differences in the fecal VOC profiles between BM and FM fed preterm infants were observed at the separate postnatal time-points of days 7, 14 and 21

Summary

Introduction

Recognition and timely initiation of targeted treatment is a key prognostic factor in a wide variety of pediatric diseases, such as necrotizing enterocolitis (NEC), sepsis or (pediatric) inflammatory bowel disease (IBD). This is often hampered by a lack of accurate preclinical diagnostic biomarkers. An increasing number of studies have demonstrated the potential of fecal volatile organic compound (VOC) analysis as a diagnostic biomarker. VOC are the gaseous carbon-based organic chemicals and products of metabolic (patho-)physiological processes in the human body, which can be detected in various bodily excrements (e.g., exhaled breath, urine and feces). Fecal VOCs are considered to reflect the gut microbiota composition, function and interactions with the host [1,2]

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