Nutritional strategies and gut microbiota composition as risk factors for necrotizing enterocolitis in very-preterm infants
| Autor: | Jean-Christophe Rozé, Pierre-Yves Ancel, Patricia Lepage, Laetitia Martin-Marchand, Ziad Al Nabhani, Johanne Delannoy, Jean-Charles Picaud, Alexandre Lapillonne, Julio Aires, Mélanie Durox, Dominique Darmaun, Josef Neu, Marie-José Butel, Farid Boudred, Delphine Mitanchez, Charlotte Casper, Valerie Biran, Laurent Storme, Olivier Claris, Gilles Cambonie, Jacques Sizun, Anne Sauret, Odile Dicky, Emmanuel Lopez, Jean-Michel Hascoet, Geraldine Gascoin, Rachel Vieux, Blandine de Lauzon, Luc Desfrere, Clement Chollat, Marie-Jose Butel, Clotilde Rousseau, Joel Doré, Karine Le Roux, Céline Monot |
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| Přispěvatelé: | Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes (UN)-Institut National de la Recherche Agronomique (INRA), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5), AP-HP Hôpitaux Universitaires Paris Centre, MICrobiologie de l'ALImentation au Service de la Santé (MICALIS), Institut National de la Recherche Agronomique (INRA)-AgroParisTech, Ecosystème intestinal, probiotiques, antibiotiques (EA 4065), Department of Neonatal Medicine, University Hospital, Paris Descartes Univ, Risks Pregnancy Dept, Paris, France, Partenaires INRAE, Paris Descartes Univ, EA Intestinal Ecosyst Probiot Antibiot 4065, Fac Pharm, Paris, France, University of Florida [Gainesville] (UF), French Institute of Public Health Research/Institute of Public Health, French Health Ministry, NIH and Medical Research, National Institute of Cancer, National Solidarity Fund for Autonomy, National Research Agency [ANR-11-EQPX-0038, ANR-12-SV, ANR-12-BSV3-0025001/EPIFLORE], PremUp Foundation, Nestec Research Center (Vers-chez-les-Blanc, Switzerland) |
| Rok vydání: | 2017 |
| Předmět: |
Time Factors
Neonatal intensive care unit breastfeeding [SDV]Life Sciences [q-bio] Medicine (miscellaneous) Enteral administration Gastroenterology 0302 clinical medicine Risk Factors RNA Ribosomal 16S Odds Ratio Prospective Studies 030212 general & internal medicine speed of increasing enteral nutrition 2. Zero hunger Enterocolitis education.field_of_study Nutrition and Dietetics Infant Formula 3. Good health Breast Feeding Necrotizing enterocolitis France medicine.symptom clostridia Infant Premature Staphylococcus aureus medicine.medical_specialty Population preterm infant 03 medical and health sciences Enteral Nutrition Enterocolitis Necrotizing Intensive Care Units Neonatal 030225 pediatrics Intensive care Internal medicine medicine Humans education Clostridium necrotizing enterocolitis Bacteria Milk Human business.industry Infant Newborn Editorials medicine.disease digestive system diseases Gastrointestinal Microbiome Parenteral nutrition Case-Control Studies Intensive Care Neonatal business Breast feeding |
| Zdroj: | American Journal of Clinical Nutrition American Journal of Clinical Nutrition, American Society for Nutrition, 2017, 106 (3), pp.821-830. ⟨10.3945/ajcn.117.152967⟩ |
| ISSN: | 0002-9165 |
| Popis: | International audience; Background: The pathophysiology of necrotizing enterocolitis (NEC) remains poorly understood. Objective: We assessed the relation between feeding strategies, intestinal microbiota composition, and the development of NEC. Design: We performed a prospective nationwide population-based study, EPIPAGE 2 (Etude Epidemiologique sur les Petits Ages Ges-tationnels), including preterm infants born at,32 wk of gestation in France in 2011. From individual characteristics observed during the first week of life, we calculated a propensity score for the risk of NEC (Bell's stage 2 or 3) after day 7 of life. We analyzed the relation between neonatal intensive care unit (NICU) strategies concerning the rate of progression of enteral feeding, the direct-breastfeeding policy, and the onset of NEC using general linear mixed models to account for clustering by the NICU. An ancillary propensitymatched case-control study, EPIFLORE (Etude Epidemiologique de la flore), in 20 of the 64 NICUs, analyzed the intestinal microbiota by culture and 16S ribosomal RNA gene sequencing. Results: Among the 3161 enrolled preterm infants, 106 (3.4%; 95% CI: 2.8%, 4.0%) developed NEC. Individual characteristics were significantly associated with NEC. Slower and intermediate rates of progression of enteral feeding strategies were associated with a higher risk of NEC, with an adjusted OR of 2.3 (95% CI: 1.2, 4.5; P = 0.01) and 2.0 (95% CI: 1.1, 3.5; P = 0.02), respectively. Less favorable and intermediate direct-breastfeeding policies were associated with higher NEC risk as well, with an adjusted OR of 2.5 (95% CI: 1.1, 5.8; P = 0.03) and 2.3 (95% CI: 1.1, 4.8; P = 0.02), respectively. Microbiota analysis performed in 16 cases and 78 controls showed an association between Clostridium neonatale and Staphylococcus aureus with NEC (P = 0.001 and P = 0.002). Conclusions: A slow rate of progression of enteral feeding and a less favorable direct-breastfeeding policy are associated with an increased risk of developing NEC. For a given level of risk assessed by propensity score, colonization by C. neonatale and/or S. aureus is significantly associated with NEC. This trial (EPIFLORE study) was registered at clinicaltrials.gov as NCT01127698. |
| Databáze: | OpenAIRE |
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