Young, Greg, Berrington, Janet E., Cummings, Stephen, Dorling, Jon, Ewer, Andrew K., Frau, Alessandra, Lett, Lauren, Probert, Chris, Juszczak, Ed, Kirby, John, Beck, Lauren C., Renwick, Victoria L., Lamb, Christopher, Lanyon, Clare, McGuire, William, Stewart, Christopher and Embleton, Nicholas (2023) Mechanisms affecting the gut of preterm infants in enteral feeding trials: a nested cohort within a randomised controlled trial of lactoferrin. Archives of Disease in Childhood - Fetal and Neonatal Edition, 108 (3). pp. 272-279. ISSN 1359-2998
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Abstract
Objective To determine the impact of supplemental bovine lactoferrin on the gut microbiome and metabolome of preterm infants.
Design Cohort study nested within a randomised controlled trial (RCT). Infants across different trial arms were matched on several clinical variables. Bacteria and metabolite compositions of longitudinal stool and urine samples were analysed to investigate the impact of lactoferrin supplementation.
Setting Thirteen UK hospitals participating in a RCT of lactoferrin.
Patients 479 infants born <32 weeks’ gestation between June 2016 and September 2017.
Results 10 990 stool and 22 341 urine samples were collected. Analyses of gut microbiome (1304 stools, 201 infants), metabolites (171 stools, 83 infants; 225 urines, 90 infants) and volatile organic compounds (314 stools, 117 infants) were performed. Gut microbiome Shannon diversity at 34 weeks corrected age was not significantly different between infants in the lactoferrin (mean=1.24) or placebo (mean=1.06) groups (p=0.11). Lactoferrin receipt explained less than 1% variance in microbiome compositions between groups. Metabolomic analysis identified six discriminative features between trial groups. Hospital site (16%) and postnatal age (6%) explained the greatest variation in microbiome composition.
Conclusions This multiomic study identified minimal impacts of lactoferrin but much larger impacts of hospital site and postnatal age. This may be due to the specific lactoferrin product used, but more likely supports the findings of the RCT in which this study was nested, which showed no impact of lactoferrin on reducing rates of sepsis. Multisite mechanistic studies nested within RCTs are feasible and help inform trial interpretation and future trial design.
| Item Type: | Article |
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| Additional Information: | Funding information: The MAGPIE study was funded by the Efficacy and Mechanistic Evaluation programme (EME) (Project Reference Number 13/122/02). The EME Programme is funded by the Medical Research Council (MRC) and the National Institute for Health and Care Research (NIHR). The Speed of Increases in Feeds Trial (SIFT) and the Enteral Lactoferrin in Neonates trial (ELFIN) were funded by the Health Technology Assessment programme of the UK NIHR. VLR also received PhD support from NECUK (registered charity 1181026). CL was an Academic Clinical Lecturer supported by the NIHR. The other authors received no additional funding. All funders did not participate in the work or have any influence on study design or conduct, data collection, management, interpretation of results, manuscript review or preparation. |
| Subjects: | A300 Clinical Medicine B100 Anatomy, Physiology and Pathology |
| Department: | Faculties > Health and Life Sciences > Applied Sciences |
| Depositing User: | Rachel Branson |
| Date Deposited: | 22 Nov 2022 14:24 |
| Last Modified: | 22 May 2023 15:00 |
| URI: | https://nrl.northumbria.ac.uk/id/eprint/50707 |
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