420 - Analysis of Antibiotics on Feeding Tolerance in Preterm Infants from the REASON study.

Poster Number: 420
Publication Number: 420.223

Neel K. Singh, University of Florida College of Medicine, Gainesville, FL, United States; Will T. Lester, University of Florida College of Medicine, GAINESVILLE, FL, United States; Sharef Al-Mulaabed, Presbyterian Hospital, Albuquerque, NM, United States; Diomel de la Cruz, University of Florida College of Medicine, Gainesville, FL, United States; Josef Neu, University of Florida, Gainesville, FL, United States; J Lauren Ruoss, University of Florida College of Medicine, Gainesville, FL, United States; Catalina Bazacliu, University of Florida, Gainesville, FL, United States; Nan LI, University of Florida, Gainesville, FL, United States

Background: Korpella et al. (1) identified a relationship between the first-pass meconium microbiota and the eventual development of infantile colic. The use of antibiotics has been associated with alterations in the gut microbiome-brain axis. The REASON study, a trial that randomly assigned symptomatic preterm neonates to receive or not receive antibiotics in the first 48 hours following birth, demonstrated differences in fecal metabolites such as GABA related to this axis (2). Reference: 1. Katja Korpela, et al. Microbiome of the first stool after birth and infantile colic Pediatr Res. 2020 Nov;88(5):776-783. 2. Laura Patton, et al. Antibiotics Effects on the Fecal Metabolome in Preterm Infants Metabolites. 2020 Aug; 10(8): 331

Objective: To study the effect of antibiotics on the establishment of feeding intolerance in preterm infants enrolled in the REASON trial (3). Reference: 3. J Lauren Ruoss et al. Routine Early Antibiotic Use in SymptOmatic Preterm Neonates: A Pilot Randomized Controlled Trial J Pediatr. 2021 Feb;229:294-298

Design/Methods: As indicated in Figure 1, the infants tested were divided into three groups: those who were not randomized due to a pre-existing ailment (Group A) that prevented randomization, group B where no antibiotics were indicated, and those who were randomized to receive antibiotics or not, C1 and C2, respectively. Time to sustained feeding tolerance is measured as the number of days from birth to the first day (Day F) when: 1. Enteral feeding at ≥120 ml/kg/day for 10 consecutive days. 2. No use of parenteral nutrition for 10 consecutive days. 3. Average body weight gain is ≥10g/kg/day during these days.

Results: - Patients in group A took longer to achieve feeding tolerance than patients in group C1 who were randomly assigned to receive antibiotics. (Table 1) - There was no difference in the achievement of feeding tolerance in patients who were randomly assigned to get antibiotics (C1) or not receive antibiotics (C2). (Table 2)Conclusion(s): Intention to treat randomly assigned patients to group C, where patients were randomized to receive initial antibiotics, showed no difference in the establishment of feeding tolerance compared to those who did not receive antibiotics. This could be due to poor sample power in our study and thus warrants more research with larger sample size. Although there is a link between feeding intolerance and antibiotic use, confounding factors such as the severity of the illness cannot be ruled out in our study.
Neel Kamal Singh MBBS MD FAAP CVNeel Singh MBBS MD FAAP 2021 CV.pdf
Table 1Comparison between Group A and Group C1.