GOLD Learning Speakers

There is increasing evidence that the pattern of gut microbes affects a range of health and disease outcomes for both term and preterm infants. At birth, the gastro-intestinal tract is largely sterile, but rapidly becomes colonized by organisms in the environment, contact with the mother and from breast milk. The numerous advantages of breast milk throughout the life-course may be due, in part, to the patterns of early gut bacteria, and the interactions between milk, microbes and the immune system. These interactions are likely to be pivotal to the development of infections and necrotising enterocolitis (NEC, a serious inflammatory gut complication) in preterm infants. Data show that early colonisation in preterm infants on NICUs is profoundly abnormal. However, knowing how these patterns are affected by milk type, immuno-nutrients (such as lactoferrin), antibiotics and probiotics is important as it may allow the design of strategies to improve health outcomes.

There is increasing evidence that the pattern of gut microbes affects a range of health and disease outcomes for both term and preterm infants. At birth, the gastro-intestinal tract is largely sterile, but rapidly becomes colonized by organisms in the environment, contact with the mother and from breast milk. The numerous advantages of breast milk throughout the life-course may be due, in part, to the patterns of early gut bacteria, and the interactions between milk, microbes and the immune system. These interactions are likely to be pivotal to the development of infections and necrotising enterocolitis (NEC, a serious inflammatory gut complication) in preterm infants. Data show that early colonisation in preterm infants on NICUs is profoundly abnormal. However, knowing how these patterns are affected by milk type, immuno-nutrients (such as lactoferrin), antibiotics and probiotics is important as it may allow the design of strategies to improve health outcomes.

Survival in preterm infants has increased over the last few years, and this has been accompanied by an increasing focus on the importance of nutrition and the effects of preterm birth on later outcomes. Providing nutrition to sick preterm infants in the NICU is complex, and almost all preterm infants are discharged with growth outcomes (weight and length) considerably below their birth centiles. This is important because data show an association between poorer growth and nutritional status in the NICU, and worse longterm neurodevelopmental outcomes. Whilst greater efforts are required to improve nutritional status prior to discharge, the post-discharge setting represents a time period when brain growth is also rapid, and where the potential exists to improve outcome through nutritional interventions. However, the potential benefits of improved brain outcomes need to be considered alongside the possibility of metablic harm induced by excessively rapid growth which may increase risks of obesity and later chronic disease. This talk will consider the continued importance of breast milk after discharge, the potential role of fortifiers and supplements in meeting nutrient requirements, and issues around the timing of introduction of complementary foods.

Preterm infants are at increased risks of death and serious morbidity, although outcomes have improved significantly over the last 20 years. However, complications associated with gastrointestinal disorders, especially necrotising enterocolitis (NEC), and sepsis are increasingly important problems as respiratory care has improved. There is over-whelming data to support the use of mother’s own breastmilk, but only a few other interventions have shown important impacts on NEC and sepsis. However, meta-analyses, systematic reviews, large scale randomised controlled trials (RCTs) and observational studies all suggest that the administration of probiotics decrease the prevalence of NEC and sepsis, and improve other measures of gastrointestinal function such as enteral feed tolerance. Probiotics are live bacteria associated with a health benefit. Multiple different species and strains are considered to be ‘probiotics’ but only a few of these have been tested in high quality RCTs in preterm infants. This talk will review aspects of gut microbiota development, the interaction between breast milk nutrients and the microbiome and the role of probiotics. Methodological challenges associated with the interpretation of existing data will be discussed, and practical steps and considerations for the use of probiotics and potential risks will be considered.