[Hot Science] Progressive changes in gut microbiome of infants receiving total parenteral nutrition

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Clinical Nutrition Gastroenterology Neonatology Gut health
[Hot Science] Progressive changes in gut microbiome of infants receiving total parenteral nutrition
  • Life-threatening outcomes such as necrotizing enterocolitis (NEC) have been correlated with altered gut microbiome in Neonatal Intensive Care Unit (NICU) infants
  • Meanwhile, the progressive changes in the intestinal bacteria of infants receiving total parenteral nutrition (TPN) requires further research to be well understood


  • 47 NICU infants were split into two groups:
    • TPN group (n = 25) – received TPN with soy lipid
    • Control group (n = 22) – did not receive TPN or soy lipid


  • Intervention
    • All subjects received routine care advised by the providing physician
    • All subjects received none or no more than 10 days of antibiotics
    • All subjects received no probiotics
    • TPN group received TPN with soy lipid following pre-established NICU guidelines+
    • Both groups received breast milk as primary source of enteral nutrition as available, if not, formula was given as alternative
  • Data collection and analysis
    • Demographic and clinical data were collected from medical records
    • Fecal samples were collected for the first 4 weeks of life and microbial genomic DNA was then isolated and analyzed

+TPN was administered as follow: (1) intravenous amino acid initiated at 3 g/kg/day, then advanced to a maximum of 3.5-4 g/kg/day for preterm infants and a maximum of 3 g/kg/day for term infants; (2) soy lipid initiated at 2 g/kg/day, then advanced to a maximum of 3 g/kg/day; (3) carbohydrates initiated at a glucose infusion rate of 4-6 mg/kg/min, then advanced to a maximum of 10-12 mg/kg/min

Key Findings

  • As compared to control group, TPN infants were found to have:
    • A higher likelihood of having a gastrointestinal (GI) diagnosis on admission, requiring GI surgery, and requiring antibiotic therapy
    • A persistently lower fecal bacterial alpha diversity (p = 0.03)
    • Lower
    • Lower Bacteroidetes abundance (p < 0.05)
    • Higher Verrucomicrobia abundance (p < 0.05)


TPN-associated dysbiosis, including loss of biodiversity and alteration of colonization pattern, may assert progressive detrimental impacts on the gut microbiome of infants, predisposing them to adverse NICU outcomes.

Link to the article: https://www.nature.com/articles/s41390-019-0391-y.pdf



Dahlgren A, Pan A, Lam V, Gouthro K, Simpson P, Salzman N, Nghiem-Rao T. Longitudinal changes in the gut microbiome of infants on total parenteral nutrition. Pediatric Research. Doi:10.1038/s41390-019-0391-y

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