[Hot science] Two types of HMOs, infant fecal community types and antibiotic uses

4 min read /
Neonatology Paediatrics Gut health Nutrition & Disease Management

Following a previous report demonstrating the safety and tolerance of an infant formula containing two major types of HMOs (2’-fucosyllactose and lacto-N-neotetraose), the authors further assessed the impact of HMO-supplementation on infant fecal community type as well as its relationship with reported illness and infection related medication use.

Link to publication: https://pubmed.ncbi.nlm.nih.gov/32184252/?from_term=gut+microbiome+infant&from_filter=years.2020-2020&from_sort=date&from_pos=1



  • Healthy newborn infants aged < 14 days, enrolled to receive intervention until 6 months of age,
    • Test group (n = 51): infant formulas with 2 HMOs, 2’-fucosyllactose at 1.0 g/L and Lacto-N-neotetraose at 0.5 g/L
    • Control group (n = 59): same formulas without HMOs
    • BF group (n = 38): exclusively breastfed infants as reference
  • Test group and control group then received the same follow-up formula without HMOs until 12 months of age
  • All groups were allowed to receive complementary feeding starting from 4 months as recommended by the pediatric societies
  • Stool samples were collected at 3- and 12-months, clustered into fecal community types and stratified by delivery mode for microbiota composition analysis

Key Findings

Seven fecal community types (FCTs) of stool samples were defined by their respective dominant taxa:

  • At 3 months, samples were clustered into FCT Bi for Bifidobacteriaceae (n = 72), FCT BiH for Bifidobacteriaceae at higher abundance (n = 50) and FCT En for Enterobacteriaceae (n = 31)
  • At 12 months, samples were clustered into FCT Fi for Firmicutes (n = 54), FCT In for intermediate state between 3- and 12-month FCTs (n = 41), FCT Ba for Bacteroidaceae (n = 27), FCT Pr for Prevotellaceae (n = 8)
  • As compared to infants with FCT En or FCT Bi at 3 months, those with FCT BiH at 3 months were less likely to require antibiotics up to 12 months (OR = 0.4, P = 0.033)

At 3 months, test group with HMO supplementation showed:

  • A significantly lower microbiota diversity as compared to control group (P < 0.05), while BF group had the lowest
  • A higher number of infants with FCT BiH (predominant in BF) as opposed to FCT Bi (predominant in control)
  • Abundances of Escherichia, Bifidobacterium, unclassified Peptostreptococcaceae, and Streptococcus closer to the BF group, as compared to control group  
    • Caesarean-delivered test infants had similar abundance levels as that of vaginally-delivered control infants

At 12 months (6 months after cessation of HMO supplementation), test group showed:

  • No significant differences in microbiota composition or genus abundances with control group
  • No significant association with FCT transition


The addition of two HMOs, 2’-fucosyllactose and Lacto-N-neotetraose to an infant formula shifts the gut microbiota towards that of breastfed infants. Furthermore, HMO-influenced fecal community type with higher Bifidobacteriaceae (FCT Bi) was associated with less antibiotic usages.




Berger B et al. Linking human milk oligosaccharides, infant fecal community types, and later risk to require antibiotics. mBio. 2020;11(2):e03196-19.

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