What the gut microbiome can say about preterm newborn outcomes

The gut microbiome has been a source of a vast amount of information about how the human body works. It’s also been the target of many complementary and alternative medicine therapies. A report in JAMA Network Open examined how the dysbiosis of the gut microbiome in very preterm newborns could have a potential impact on later health.¹

The researchers ran a prospective observational cohort study. Preterm newborns who were born in 2011; were less than 32 weeks of gestational age; and were from 24 neonatal intensive care units across France were included. They collected a stool sample during the fourth week following delivery. Two-year outcomes were defined by the researchers as death or neurodevelopmental delay using a Global Ages and Stages questionnaire score. The gut microbiota was analyzed by 16S ribosomal RNA gene sequencing. The researchers assessed 8 neonatal intensive care unit strategies that concerned sedation, ventilation, skin-to-skin practice, antibiotherapy, ductus arteriosus, and breastfeeding.

A total of 577 newborns were included in the study who had an average gestational age of 28.3 weeks. The gut microbiota was placed into 5 discrete groups. A sixth group included nonamplifiable samples. Cluster 3 (driven by Escherichia/Shigella [n = 61]) was the reference was significantly linked with a higher average gestational age (29.4 [1.6] weeks; P = .001). (driven by Enterococcus [n = 63]), cluster 5 (driven by Staphylococcus [n = 52]), and cluster 6 (n = 93) had a significant toe to a lower average gestational age (26.7 [1.8] weeks and 26.8 [1.9] weeks, respectively).

Following adjustment for confounders, no assisted ventilation at day 1 in the neonatal intensive care unit was linked with a decreased risk of being in cluster 5 or cluster 6 (adjusted odds ratio [AOR], 0.21 [95% CI, 0.06-0.78] and 0.19 [95% CI, 0.06-0.62], respectively. However, sedation (AOR, 10.55 [95% CI, 2.28-48.87] and 4.62 [1.32-16.18], respectively) as well as a low volume of enteral nutrition (AOR, 10.48 [95% CI, 2.48-44.29] and 7.28 [95% CI, 2.03-26.18], respectively) were found to have an increased risk. Skin-to skin contact was linked with a decreased risk of being a part of cluster 5 (AOR, 0.14 [95% CI, 0.04-0.48]). Additionally, clusters 4, 5, and 6 had significant ties to 2-year nonoptimal outcomes (AOR, 6.17 [95% CI, 1.46-26.0]; AOR, 4.53 [95% CI, 1.02-20.1]; and AOR, 5.42 [95% CI, 1.36-21.6], respectively).

The investigators concluded that a very preterm newborn’s gut microbiota at week 4 of life was linked to neonatal intensive care unit practices as well as 2-year outcomes. They also believe that gut microbiota could serve as a noninvasive biomarker for immaturity.

Reference

1 Rozé J, Ancel P, Marchand-Martin L, et al. Assessment of neonatal intensive care unit practices and preterm newborn gut microbiota and 2-year neurodevelopmental outcomes. JAMA Netw Open. 2020;3(9):e2018119. doi:10.1001/jamanetworkopen.2020.18119