Development of the gut microbiota during early life in premature and term infants

ABSTRACT Background The gastrointestinal (GI) microbiota has been linked to health consequences throughout life, from early life illnesses (e.g. sepsis and necrotising enterocolitis) to lifelong chronic conditions such as obesity and inflammatory bowel disease. It has also been observed that events in early life can lead to shifts in the microbiota, with some of these changes having been documented to persist into adulthood. A particularly extreme example of a divergent early GI microbiota occurs in premature neonates, who display a very different GI community to term infants. Certain characteristic patterns have been associated with negative health outcomes during the neonatal period, and these patterns may prove to have continual damaging effects if not resolved. Results In this study we contrast a set of premature infants with a paired set of term infants (n=37 pairs) at six weeks of life and at two years. In the samples taken at six weeks we find microbial communities differing in both diversity and specific bacterial groups between the two infant cohorts. We identify clinical factors associated with over-abundance of potentially pathogenic organisms (e.g. Enterobacteriaceae) and reduced abundances of some beneficial organisms (e.g. Bifidobacterium ). We contrast these findings with samples taken at two years of age, which show that despite a very different initial microbiota, the two infant groups converge to a similar, more adult-like state. We identify clinical factors, including both prematurity and delivery method, that remain associated with components of the microbiota. Both clinical factors and microbial characteristics are compared to the occurrence of childhood wheeze and eczema, revealing associations between components of the GI microbiota and the development of these allergic conditions. Conclusions The faecal microbiota differs greatly between infants born at term and those born prematurely during early life, yet it converges over time. Despite this, early clinical factors remain significantly associated with the abundance of some bacterial groups at two years of age. Given the associations made between health conditions and the microbiota, factors that alter the makeup of the gut microbiota, and potentially its trajectory through life, could have important lifelong consequences.