Abstract
Preterm microbial colonization is affected by gestational age, antibiotic treatment, type of birth, but also by type of feeding. Breast milk has been acknowledged as the gold standard for human nutrition. In preterm infants breast milk has been associated with improved growth and cognitive development and a reduced risk of necrotizing enterocolitis and late onset sepsis. In the absence of their mother’s own milk (MOM), pasteurized donor human milk (DHM) could be the best available alternative due to its similarity to the former. However, little is known about the effect of DHM upon preterm microbiota and potential biological implications. Our objective was to determine the impact of DHM upon preterm gut microbiota admitted in a referral neonatal intensive care unit (NICU). A prospective observational cohort study in NICU of 69 neonates <32 weeks of gestation and with a birth weight ≤1,500 g was conducted. Neonates were classified in three groups according to feeding practices consisting in their MOM, DHM, or formula. Fecal samples were collected when full enteral feeding (defined as ≥150 cc/kg/day) was achieved. Gut microbiota composition was analyzed by 16S rRNA gene sequencing. Despite the higher variability, no differences in microbial diversity and richness were found, although feeding type significantly influenced the preterm microbiota composition and predictive functional profiles. Preterm infants fed MOM showed a significant greater presence of Bifidobacteriaceae and lower of Staphylococcaceae, Clostridiaceae, and Pasteurellaceae compared to preterm fed DHM. Formula fed microbial profile was different to those observed in preterm fed MOM. Remarkably, preterm infants fed DHM showed closer microbial profiles to preterm fed their MOM. Inferred metagenomic analyses showed higher presence of Bifidobacterium genus in mother’s milk group was related to enrichment in the Glycan biosynthesis and metabolism pathway that was not identified in the DHM or in the formula fed groups. In conclusion, DHM favors an intestinal microbiome more similar to MOM than formula despite the differences between MOM and DHM. This may have potential beneficial long-term effects on intestinal functionality, immune system, and metabolic activities.
Highlights
MATERIALS AND METHODSIn preterm infants, neonatal microbial dynamics and alterations in early gut microbiota may precede and/or predispose to diseases such as necrotizing enterocolitis (NEC) or late onset sepsis (LOS) (The European Perinatal Health Report, 2010)
A total of 69 preterm infants ≤32 weeks of gestation pertaining to the mother’s own milk (MOM) (n = 34), donor human milk (DHM) (n = 28), and formula (n = 7) groups were recruited
The low number is explained because the protocol of our neonatal intensive care unit (NICU) recommends for all preterm ≤32 weeks of gestation and ≤1,500 g MOM and DHM as an alternative and preterm fed with formula render exceptional
Summary
Neonatal microbial dynamics and alterations in early gut microbiota may precede and/or predispose to diseases such as NEC or LOS (The European Perinatal Health Report, 2010). HM contains important bioactive compounds such oligosaccharides, cytokines, immunoglobulins, microbes, and proteins among others that directly influence the developing infant and shape the intestinal microbiota colonization. Those bioactive compounds are considered protective and stimulate the development and maturation of the immature immune system (Agostoni, 2010; Ballard and Morrow, 2013). Pasteurization is still a matter of debate (Bertino et al, 2009; ESPGHAN Committee on Nutrition et al, 2013; Corpeleijn et al, 2016; Madore et al, 2017)
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