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Enhanced nutrient supply and intestinal microbiota development in very low birth weight infants



Promoting a healthy intestinal microbiota may have positive effects on short- and long-term outcomes in very low birth weight (VLBW; BW < 1500 g) infants. Nutrient supply influences the intestinal microbiota.


Fifty VLBW infants were randomized to an intervention group receiving enhanced nutrient supply or a control group. Fecal samples from 45 infants collected between birth and discharge were analyzed using 16S ribosomal RNA (rRNA) amplicon sequencing.


There was considerable individual variation in microbiota development. Microbial richness decreased towards discharge in the controls compared to the intervention group. In the intervention group, there was a greater increase in diversity among moderately/very preterm (MVP, gestational age ≥ 28 weeks) infants and a steeper decrease in relative Staphylococcus abundance in extremely preterm (EP, gestational age < 28 weeks) infants as compared to controls. Relative Bifidobacterium abundance tended to increase more in MVP controls compared to the intervention group. Abundance of pathogens was not increased in the intervention group. Higher relative Bifidobacterium abundance was associated with improved weight gain.


Nutrition may affect richness, diversity, and microbiota composition. There was no increase in relative abundance of pathogens among infants receiving enhanced nutrient supply. Favorable microbiota development was associated with improved weight gain.

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This work was supported by the University of Oslo, the South-Eastern Norway Regional Health Authority, the Research Council of Norway, the Norwegian Foundation for Health and Rehabilitation, the Johan Throne Holst Foundation for Nutrition Research, and the Freia Medical Fund. This work was also supported by the SIAM Gravity Grant 024.002.002 of the Netherlands Organization for Scientific Research and Grants 137389, 141140, and 1272870 of the Academy of Finland.

Author information

E.W.B.: Conceptualized and designed the study, included participants, acquired, analyzed growth/clinical characteristics data, interpreted growth and microbiota data, and drafted and reviewed the manuscript. K.K.: Conceptualized and designed study method for bioinformatical analyses of the microbiota and interpreted the microbiota data. Drafted, reviewed, and approved the manuscript. S.L.: Biostatistical analyses and interpretations of the microbiota data. Drafted, reviewed, and approved the manuscript. B.N.: Obtained grant money. Conceptualized and designed the study, included participants, interpreted data, and reviewed and approved the manuscript. S.J.M.: Conceptualized and designed the study, included participants, and reviewed and approved the manuscript. K.S.: Conceptualized and designed the study, included participants, and reviewed and approved the manuscript. A.E.R.: Conceptualized and designed the study, included participants, and reviewed and approved the manuscript. K.B.: Conceptualized and designed the study, included participants, and reviewed and approved the manuscript. P.O.I.: Obtained grant money, conceptualized and designed the study, interpreted data, and reviewed and approved the manuscript. W.M.d.V.: Conceptualized and designed the study method for analyzing the microbiota. Analyzed and interpreted the microbiota data, and reviewed and approved the manuscript. C.A.D.: Obtained grant money, conceptualized and designed the study, analyzed and interpreted data, and reviewed and approved several versions of the manuscript.

Competing interests

S.J.M. has during the past 2 years received payment/honorarium for lectures/consultations from Baxter. The remaining authors declare no competing interests.

Correspondence to Elin W. Blakstad.

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