Intestinal Barrier Maturation in Very Low Birthweight Infants: Relationship to Feeding and Antibiotic Exposure.

ABSTRACT: OBJECTIVE:To test the hypothesis that feeding and antibiotic exposures affect intestinal barrier maturation in preterm infants, we serially measured intestinal permeability (IP) biomarkers in infants <33?weeks gestation (gestational age [GA]) during the first 2 weeks of life. STUDY DESIGN:Eligible infants <33?weeks GA were enrolled within 4 days of birth in a prospective study of IP biomarkers (NCT01756040). Study participants received the nonmetabolized sugars lactulose/rhamnose enterally on study days 1, 8, and 15 and lactulose/rhamnose were measured in urine by high-performance liquid chromatography. Serum zonulin and fecal alpha-1-anti-trypsin, 2 other IP markers, were measured by semiquantitative Western blot and ELISA, respectively. RESULTS:In a cohort of 43 subjects, the lactulose/rhamnose ratio was increased on day 1 and decreased over 2 weeks, but remained higher in infants born at ?28?weeks of gestation compared with IP in infants born at >28?weeks of gestation. Exclusive breastmilk feeding was associated with more rapid maturation in intestinal barrier function. A cluster analysis of 35 subjects who had urine samples from all time points revealed 3 IP patterns (cluster 1, normal maturation: n?=?20 [57%]); cluster 2, decreased IP during the first week and subsequent substantial increase: n?=?5 [14%]); and cluster 3, delayed maturation: n?=?10 [29%]). There were trends toward more prolonged antibiotic exposure (P?=?.092) and delayed initiation of feeding ?4 days (P?=?.064) in infants with abnormal IP patterns. CONCLUSIONS:Intestinal barrier maturation in preterm infants is GA and postnatal age dependent, and is influenced by feeding with a maturational effect of breastmilk feeding and possibly by antibiotic exposures. TRIAL REGISTRATION:ClinicalTrials.gov: NCT01756040.

SUBMITTER: Saleem B 

PROVIDER: S-EPMC5367935 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature