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Neonatal Fetal Nutrition & Metabolism

Neonatal GI Physiology & NEC 4: Gut Health, Enteral Nutrition and Oral Feeding

80 - Growth faltering and the gut microbiome in VLBW infants: A prospective cohort study

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 80
Publication Number: 80.236

Sagori Mukhopadhyay, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Scott G. Daniel, Children's hospital of Philadelphia, Philadelphia, PA, United States; Matthew B. Green, Childrens Hospital of Philadelphia, Voorhees, NJ, United States; Dustin D. Flannery, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Emily Woodford, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Babette S.. Zemel, CHILDREN'S HOSPITAL OF PHILADELPHIA, Philadelphia, PA, United States; Kyoung Joung, Massachusetts General Hospital, Boston, MA, United States; Mark A. Underwood, UC Davis, MEDICAL LAKE, WA, United States; Caterina Tiozzo, Icahn School of Medicine, New York, NY, United States; Miren B. Dhudasia, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kyle Bittinger, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Presenting Author(s)

Sagori Mukhopadhyay, MD, MMSc (she/her/hers)

Assistant Professor
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Background: Among very low birth weight (VLBW; < 1500g) infants, failure to gain appropriate weight during hospitalization is associated with adverse outcomes. The gut microbiome plays a critical role in nutrient accretion. VLBW infants with weight-for-age < 10^th percentile (growth failure) at discharge have lower gut microbial diversity and increased proportions of facultative vs obligate anaerobes. However, the microbiome of VLBW infants with growth faltering, a potentially more relevant marker of malnutrition defined as decreases in weight or length z-scores over time, has not been explored

Objective: To determine if the gut microbiome in VLBW infants differs with growth faltering status at 36 weeks post menstrual age (PMA) and with weight and length trajectories from birth to hospital discharge

Design/Methods: Prospective cohort study of 107 VLBW infants with 855 serial fecal specimens collected from birth to hospital discharge and sequenced using shotgun metagenomics. Gut microbiome measures were compared in three groups based on level of growth faltering categorized as reduction in weight-for-age z scores (Fenton 2013) from birth to 36 weeks PMA: ≤0.8 (none), >0.8 to 1.2 (mild); >1.2 (moderate to severe). Weight and length trajectories from birth to discharge were converted to size and velocity parameters using the Super Imposition by Translation And Rotation model and analyzed for association with microbiome diversity at 36 weeks PMA using the MicRobiome Kernel Association Test model

Results:

Infant characteristics differed across groups (Table). By 36 weeks PMA, 43.5% of infants had growth failure and 53.5% growth faltering, but the groups did not fully overlap: 51% of infants with no growth faltering had growth failure. Microbiome richness and diversity increased with age (P < 0.001). The relative abundance of Staphylococcus epidermidis decreased with age; the abundance of Proteobacteria increased (Fig. 1). When accounting for postnatal age, groups with and without growth faltering did not differ in microbiome richness, diversity, or species relative abundances (Fig. 2). Microbiome diversity was also not associated with the size and velocity parameters of weight and length trajectories

Conclusion(s): Gut microbiome measures did not differ between VLBW infants with and without growth faltering or by growth trajectory. Our findings contrast with microbiome changes reported in infant’s with growth failure. The contribution of the microbiome in infants with growth faltering may differ from that in growth failure