Early High Breast Milk Feeding Improves Respiratory Microbiota in Extremely Preterm Infants: A Cohort Study

ObjectivesThis study aimed to assess the impact of early breastfeeding on the respiratory tract microbiota of extremely preterm infants (≤ 32 weeks gestational age).MethodsOut of 339 infants enrolled, 65 infants with prolonged endotracheal intubation (≥ 20 days) were selected based on predetermined criteria. They were divided into two groups: high breast milk group (≥ 50% breast milk within 7 days, n = 127) and low breast milk group (< 50%, n = 179). The pure formula group (n = 33) was excluded due to insufficient eligible cases. Tracheal aspirates were collected on days 3, 7, and 20, resulting in 208 samples, of which 140 passed quality control. Microbiota analysis was conducted using 16S rDNA high-throughput sequencing.ResultsThe high breast milk group demonstrated greater microbial diversity (Shannon index: 3.76 ± .38 vs. 3.24 ± .52 on day 7, P < .01), which was sustained through day 20. By day 20, the high breast milk group showed significantly higher abundance of Lactobacillus (29.06% vs. 6.34%) and lower abundance of Staphylococcus (33.66% vs. 57.07%) compared to the low breast milk group. Multivariate analysis confirmed a positive correlation between breastfeeding and diversity (β = 0.412, P < .001).ConclusionsEarly breastfeeding enhances respiratory microbiota diversity, fosters beneficial bacterial colonization, and potentially mitigates respiratory complications in extremely preterm infants.