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Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk.
Am J Clin Nutr. 2019 04 01; 109(4):1088-1097.AJ

Abstract

BACKGROUND

Mother's own milk (MOM) is protective against gut microbiota alterations associated with necrotizing enterocolitis (NEC) and feeding intolerance among preterm infants. It is unclear whether this benefit is preserved with donor milk (DM) feeding.

OBJECTIVE

We aimed to compare microbiota development, growth, and feeding tolerance in very-low-birth-weight (VLBW) infants fed an exclusively human milk diet of primarily MOM or DM.

METHODS

One hundred and twenty-five VLBW infants born at Texas Children's Hospital were enrolled and grouped into cohorts based on percentage of MOM and DM in enteral feeds. Feeds were fortified with DM-derived fortifier per unit protocol. Weekly stool samples were collected for 6 wk for microbiota analysis [16S ribosomal RNA (rRNA) sequencing]. A research nurse obtained weekly anthropometrics. Clinical outcomes were compared via Wilcoxon's rank-sum test and Fisher's exact test, as well as multivariate analysis.

RESULTS

The DM cohort (n = 43) received on average 14% mothers' milk compared with 91% for the MOM cohort (n = 74). Diversity of gut microbiota across all time points (n = 546) combined was increased in MOM infants (P < 0.001). By 4 and 6 wk of life, microbiota in MOM infants contained increased abundance of Bifidobacterium (P = 0.02) and Bacteroides (P = 0.04), whereas DM-fed infants had increased abundance of Staphylococcus (P = 0.02). MOM-fed infants experienced a 60% reduction in feeding intolerance (P = 0.03 by multivariate analysis) compared with DM-fed infants. MOM-fed infants had greater weight gain than DM-fed infants.

CONCLUSIONS

Compared with DM-fed infants, MOM-fed infants have increased gut microbial community diversity at the phylum and genus levels by 4 and 6 wk of life, as well as better feeding tolerance. MOM-fed infants had superior growth. The incidence of NEC and other gastrointestinal morbidity is low among VLBW infants fed an exclusively human milk diet including DM-derived fortifier. This trial was registered at clinicaltrials.gov as NCT02573779.

Authors+Show Affiliations

Section of Neonatology, Department of Pediatrics.Section of Neonatology, Department of Pediatrics.Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.Clinical Research Center.Section of Neonatology, Department of Pediatrics.Section of Neonatology, Department of Pediatrics.Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX.Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX. Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX.Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX. Texas Children's Microbiome Center, Department of Pathology, Texas Children's Hospital, Houston, TX.Section of Neonatology, Department of Pediatrics.

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30982856

Citation

Ford, Steven L., et al. "Improved Feeding Tolerance and Growth Are Linked to Increased Gut Microbial Community Diversity in Very-low-birth-weight Infants Fed Mother's Own Milk Compared With Donor Breast Milk." The American Journal of Clinical Nutrition, vol. 109, no. 4, 2019, pp. 1088-1097.
Ford SL, Lohmann P, Preidis GA, et al. Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk. Am J Clin Nutr. 2019;109(4):1088-1097.
Ford, S. L., Lohmann, P., Preidis, G. A., Gordon, P. S., O'Donnell, A., Hagan, J., Venkatachalam, A., Balderas, M., Luna, R. A., & Hair, A. B. (2019). Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk. The American Journal of Clinical Nutrition, 109(4), 1088-1097. https://doi.org/10.1093/ajcn/nqz006
Ford SL, et al. Improved Feeding Tolerance and Growth Are Linked to Increased Gut Microbial Community Diversity in Very-low-birth-weight Infants Fed Mother's Own Milk Compared With Donor Breast Milk. Am J Clin Nutr. 2019 04 1;109(4):1088-1097. PubMed PMID: 30982856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved feeding tolerance and growth are linked to increased gut microbial community diversity in very-low-birth-weight infants fed mother's own milk compared with donor breast milk. AU - Ford,Steven L, AU - Lohmann,Pablo, AU - Preidis,Geoffrey A, AU - Gordon,Pamela S, AU - O'Donnell,Andrea, AU - Hagan,Joseph, AU - Venkatachalam,Alamelu, AU - Balderas,Miriam, AU - Luna,Ruth Ann, AU - Hair,Amy B, PY - 2018/07/03/received PY - 2019/01/08/accepted PY - 2019/4/16/entrez PY - 2019/4/16/pubmed PY - 2020/1/31/medline KW - breast milk KW - donor milk KW - feeding intolerance KW - growth KW - microbiota KW - neonate KW - premature infant KW - very low birth weight SP - 1088 EP - 1097 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 109 IS - 4 N2 - BACKGROUND: Mother's own milk (MOM) is protective against gut microbiota alterations associated with necrotizing enterocolitis (NEC) and feeding intolerance among preterm infants. It is unclear whether this benefit is preserved with donor milk (DM) feeding. OBJECTIVE: We aimed to compare microbiota development, growth, and feeding tolerance in very-low-birth-weight (VLBW) infants fed an exclusively human milk diet of primarily MOM or DM. METHODS: One hundred and twenty-five VLBW infants born at Texas Children's Hospital were enrolled and grouped into cohorts based on percentage of MOM and DM in enteral feeds. Feeds were fortified with DM-derived fortifier per unit protocol. Weekly stool samples were collected for 6 wk for microbiota analysis [16S ribosomal RNA (rRNA) sequencing]. A research nurse obtained weekly anthropometrics. Clinical outcomes were compared via Wilcoxon's rank-sum test and Fisher's exact test, as well as multivariate analysis. RESULTS: The DM cohort (n = 43) received on average 14% mothers' milk compared with 91% for the MOM cohort (n = 74). Diversity of gut microbiota across all time points (n = 546) combined was increased in MOM infants (P < 0.001). By 4 and 6 wk of life, microbiota in MOM infants contained increased abundance of Bifidobacterium (P = 0.02) and Bacteroides (P = 0.04), whereas DM-fed infants had increased abundance of Staphylococcus (P = 0.02). MOM-fed infants experienced a 60% reduction in feeding intolerance (P = 0.03 by multivariate analysis) compared with DM-fed infants. MOM-fed infants had greater weight gain than DM-fed infants. CONCLUSIONS: Compared with DM-fed infants, MOM-fed infants have increased gut microbial community diversity at the phylum and genus levels by 4 and 6 wk of life, as well as better feeding tolerance. MOM-fed infants had superior growth. The incidence of NEC and other gastrointestinal morbidity is low among VLBW infants fed an exclusively human milk diet including DM-derived fortifier. This trial was registered at clinicaltrials.gov as NCT02573779. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/30982856/Improved_feeding_tolerance_and_growth_are_linked_to_increased_gut_microbial_community_diversity_in_very_low_birth_weight_infants_fed_mother's_own_milk_compared_with_donor_breast_milk_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/nqz006 DB - PRIME DP - Unbound Medicine ER -