Davis, Jessica A.
(2023)
Neonatal Diet Type and Associations with Adverse Feeding Outcomes and Gut Microbiome Composition in Neonates with Critical Congenital Heart Defects.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Background: About 10,000 neonates are born with critical congenital heart defects (CCHD neonates) in the United States each year. Critical congenital heart defects often require surgical intervention in the first 28 days of life for survival and their abnormal cardiac physiology predisposes them to significant comorbidities. Feeding intolerance, necrotizing enterocolitis (NEC), and malnutrition are common adverse feeding outcomes in this population. Research in other neonatal populations suggests that human milk diets significantly decrease the risk of adverse feeding outcomes, possibly due to effects on gut microbiome composition, but research is limited in this unique population of critically ill neonates The purpose of this research project is to examine the relationship between neonatal diet type, adverse feeding outcomes, and neonatal gut microbiome composition in CCHD neonates.
Methods: A retrospective electronic health record review was undertaken to evaluate the relationship between neonatal diet and incidence of feeding intolerance, NEC, and malnutrition in the first 28 days of life in CCHD neonates (Aim 1). Various regression models were applied to analyze associations between measures for adverse feeding outcomes, percentage of enteral feeds that were human milk, and additional variables related to neonatal diet and feeding. A complementary prospective cohort of four CCHD neonates was used to (a) describe the feasibility of a longitudinal microbiome study using fecal samples from CCHD neonates and (b) explore the associations between neonatal diet, adverse feeding outcomes, and neonatal gut microbiome composition (Aim 2).
Results: Seventy-four CCHD neonates were included in the final cohort for Aim 1; two were diagnosed with NEC. Higher percentages of enteral feeds that were human milk were not associated with any measures for adverse feeding outcomes. Increased number of days any direct chest/breastfeeding occurred was associated with fewer incidents of any gastrointestinal (GI) disturbances (P = .047) and bloody stools (P = .021) with no corresponding risk of weight-for- age z-score (WAZ) less than -2 (malnutrition). Increased days of all human milk feeds was associated with improved WAZ over time over the mean growth rate (P<.001), but the trend in growth remained negative. In the prospective cohort of CCHD neonates (Aim 2; n = 4), there was increased relative abundance of potentially pathogenic bacteria and low relative abundance of Bifidobacteria in CCHD neonates over the first four weeks of life. One CCHD neonate had bloody stools and their gut microbiome was dominated by Clostridium difficile. Compared to exclusively human milk fed CCHD neonates (n = 3), the CCHD neonate that received commercial milk formula supplementation (n = 1) had lower bacterial alpha diversity at week of life four.
Conclusions: Although increased percentage of human milk was not associated with decreased risk of adverse feeding outcomes in the retrospective cohort, direct chest/breastfeeding may be associated with decreased risk of symptoms for feeding intolerance and NEC in CCHD neonates. This project provides the first available evidence regarding the role of neonatal diet and adverse feeding outcomes on neonatal gut microbiome composition in this population. Data generated from this project may introduce the potential for preventing, managing, and diagnosing feeding intolerance, NEC, and malnutrition through neonatal gut microbiome analysis.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
8 June 2023 |
| Date Type: |
Publication |
| Defense Date: |
24 May 2023 |
| Approval Date: |
8 June 2023 |
| Submission Date: |
31 May 2023 |
| Access Restriction: |
1 year -- Restrict access to University of Pittsburgh for a period of 1 year. |
| Number of Pages: |
161 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
critical congenital heart defects, lactation, human milk, neonate, gut microbiome |
| Date Deposited: |
08 Jun 2023 13:43 |
| Last Modified: |
08 Jun 2024 05:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/44919 |
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