An open-label pilot single-subject study to monitor the impact of a Food-Based enteral formula on faecal short-chain fatty acid concentrations in children admitted to intensive care with sepsis

Abstract

Summary: Background: Non-digestible dietary fiber undergoes fermentation by the intestinal microbiota to produce short-chain fatty acids (SCFAs). Intestinal SCFAs control the production of T-helper cells, antibodies and are involved in maintaining homeostasis of the mucosal system. Sepsis is the leading cause of mortality in hospitalised children and is treated with antibiotics which disrupts the normal maturation of the microbiome causing dysbiosis. This study assessed the impact of a high-fibre Food-Based formula on feed tolerance and faecal SCFA concentrations in children admitted to intensive care with sepsis. Methods: An open-label single-subject study was based on repeated observations over 14 days in children admitted to intensive care with sepsis who commenced a high-fiber Food-Based enteral formula Compleat®Paediatric, (Nestle Health Science). Stool samples were collected to measure SCFA concentrations (acetate, butyrate and propionate). A Wilcoxon Signed-Rank test was used to measure change in SCFA concentrations. Other data collection included feed tolerance, anthropometrics, antibiotic administration and inflammatory markers. Results: Twenty children with sepsis were recruited over six months. The mean age was 10.8 years (±5.6 years SD). The most common sepsis-related organ failure was the respiratory tract (50 %). The mean duration of mechanical ventilation was 9 days (±4 SD), 25 % of children were treated with more than two antibiotics during their time in intensive care. Faecal propionate and butyrate concentrations were maintained during the children's time in intensive care. Stool frequency reduced from 2.6 per day (±1.08 SD) at baseline to 1.2 per day (±0.45 SD) after one week in intensive care (p < 0.004). Conclusion: In this pilot study children admitted to intensive care with sepsis tolerated a Food-Based formula. Faecal butyrate and propionate concentrations were maintained whilst feeding on a high fiber Food-Based formula. Further research is warranted to assess whether a Food-Based formula is superior to a standard enteral formula in preserving the intestinal microbiota, thereby mitigating gastrointestinal complications associated with antibiotic-related dysbiosis.

Keywords

• Paediatric intensive care unit
• Sepsis
• Food-Based formula
• Enteral feed intolerance
• Short-chain fatty acids