Abstract

Lactobacillus reuteri DSM 17938 supplementation reduces morbidities in very low birth weight infants (<1500 g), while the effect on extremely low birth weight infants (ELBW, <1000 g) is still questioned. In a randomised placebo-controlled trial (ClinicalTrials.gov ID NCT01603368), head growth, but not feeding tolerance or morbidities, improved in L. reuteri-supplemented preterm ELBW infants. Here, we investigate colonisation with the probiotic strain in preterm ELBW infants who received L. reuteri DSM 17938 or a placebo from birth to postmenstrual week (PMW) 36. Quantitative PCR was used on 582 faecal DNA samples collected from 132 ELBW infants at one, two, three, and four weeks, at PMW 36, and at two years of age. Human milk oligosaccharides were measured in 31 milk samples at two weeks postpartum. At least 86% of the ELBW infants in the L. reuteri group were colonised with the probiotic strain during the neonatal period, despite low gestational age, high antibiotic pressure, and independent of infant feeding mode. Higher concentrations of lacto-N-tetraose, sialyl-lacto-N-neotetraose c, and 6′-sialyllactose in mother’s milk weakly correlated with lower L. reuteri abundance. Within the L. reuteri group, higher L. reuteri abundance weakly correlated with a shorter time to reach full enteral feeding. Female sex and L. reuteri colonisation improved head growth from birth to four weeks of age. In conclusion, L. reuteri DSM 17938 supplementation leads to successful colonisation in ELBW infants.

Highlights

  • 582 faecal samples collected at six time points from 132 of the 134 infants were analysed for the probiotic L. reuteri using quantitative PCR (qPCR)

  • Female sex was more common at one week, three weeks, and postmenstrual week (PMW) 36, more infants were born by caesarean section at two weeks, three weeks, and PMW 36, more infants were from a multiple pregnancy at PMW 36, and more infants were born to mothers with chorioamnionitis at PMW 36 and two years of age in the L. reuteri-supplemented group compared to the placebo group

  • Even though breast milk feeding lowered L. reuteri abundance in faeces in a previous trial in full-term infants [13] who received L. reuteri ATCC 55730, the mother strain of the probiotic used in this study, we found no negative effect of any feeding mode on L. reuteri colonisation in extremely preterm ELBW infants

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Summary

Introduction

Mortality and morbidity of extremely preterm (birth before gestational week (GW). 28) extremely low birth weight (ELBW,

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