Richard A. Polin
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Researcher at Columbia University
Antibiotic use in neonates can have detrimental effects on the developing gut microbiome, increasing the risk of morbidity. A majority of preterm neonates receive antibiotics after birth without clear evidence to guide this practice. Here microbiome, metabolomic, and immune marker results from the Routine Early Antibiotic use in SymptOmatic preterm Neonates (REASON) study are presented. The REASON study is the first trial to randomize symptomatic preterm neonates to receive or not receive antibiotics in the first 48 hours after birth. Using 16S rRNA sequencing of stool samples collected longitudinally for 91 neonates, the effect of such antibiotic use on microbiome diversity is assessed. The results illustrate that type of nutrition shapes the early infant gut microbiome. By integrating data for the gut microbiome, stool metabolites, stool immune markers, and inferred metabolic pathways, an association was discovered between Veillonella and the neurotransmitter gamma-aminobutyric acid (GABA). These results suggest early antibiotic use may impact the gut-brain axis with the potential for consequences in early life development, a finding that needs to be validated in a larger cohort. ### Competing Interest Statement Dr. Josef Neu is the principal investigator of a study with Infant Bacterial Therapeutics and on the Scientific Advisory Boards of Medela and Astarte. No other authors have conflicts of interest to disclose.
Within a randomized prospective pilot study of preterm infants born less than 33 weeks gestation, fecal samples were collected weekly and metabolomic analysis was performed. The objective is to evaluate for differences in fecal metabolites in infants exposed to antibiotics vs not exposed to antibiotics in the first 48hours after birth. Significant differences were seen in the antibiotics vs no antibiotics group, including pathways related to vitamin biosynthesis, bile acids, amino acid metabolism and neurotransmitters. Early antibiotic exposure in preterm infants may alter metabolites in the intestinal tract of preterm infants. Broader multi-omic studies that address mechanisms will guide more prudent antibiotic use in this population. ### Competing Interest Statement Dr. Josef Neu is the principal investigator of a study with Infant Bacterial Therapeutics and on the Scientific Advisory Boards of Medela and Astarte. No other authors have conflicts of interest to disclose.