Stephanie Patterson, MD, MS
Assistant Professor
Monroe Carell Jr. Children's Hospital at Vanderbilt
Nashville, Tennessee
Disclosure information not submitted.
Rachel Klausner, MD
Internal Medicine-Pediatrics Resident, Department of Medicine
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Jennifer Laws, MD
Chief Resident
Vanderbilt University Medical Center
Nashville, Tennessee
Disclosure information not submitted.
Helen Boone, BAS
Graduate Student, Department of Cell and Molecular Biology
Tulane University, United States
Disclosure information not submitted.
Meghan Shilts, MS, MHS
Senior Research Specialist, Department of Medicine, Division of Infectious Disease
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Suman Das, PhD
Associate Professor, Department of Medicine, Division of Infectious Disease
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
C. Buddy Creech, MD, MPH
Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases
Vanderbilt University Medical Center, United States
Disclosure information not submitted.
Title: Delayed Gastrointestinal Microbial Diversification in Infants with Congenital Heart Disease
Introduction: Infants with congenital heart disease (CHD) are at risk for gastrointestinal (GI) dysbiosis during critical illness. The GI microbiome is instrumental for normal immune function; therefore, microbial community disruption in these infants may contribute to increased infection risk. We report a single-center investigation of the impact of critical illness, surgery, and infections on GI microbiota development in infants with CHD.
Methods: Infants with CHD were enrolled soon after birth. Infants >2 weeks of age at enrollment or those unable to provide stool samples were excluded. Demographic and clinical variables were collected prospectively, and stool samples were collected weekly. Following DNA extraction from stool specimens, bacterial V4 16S rRNA amplicon sequencing was performed. Statistical analyses for bacterial richness and alpha-/beta-diversity were performed using R to test taxonomic associations with metadata.
Results: 99 subjects provided 456 stool samples with a median of 4 samples per subject. Cohort characteristics include 50 (51%) males, 74 (75%) white, 53 (54%) vaginal deliveries, 11 (11%) mortalities, and 54 (55%) infants requiring cardiac surgery, including 35 (36%) congenital heart surgery mortality (STAT) category 4-5. Infants undergoing cardiac surgery experienced decreased richness and alpha-diversity (p=0.006) and different microbial colonization post-surgery compared to patients not having surgery and those pre-surgery (p=0.002). Twenty-six (26%) patients developed a culture-confirmed bacterial infection; patients with bacterial infections were found to have decreased microbial richness post-infection (p=0.039). Progressively decreasing richness and alpha-diversity was identified in patients with infection compared to patients that did not experience infection (p=0.035); with decrease in richness and alpha-diversity at 35-40 days of life in infants developing infection (p < 0.05).
Conclusions: These results highlight the impact of cardiac surgery and infections in infants with CHD resulting in delayed GI microbial diversification in the first 2 months of life. Moreover, decreasing GI microbial richness and diversity may be indicators of infection risk among hospitalized children with CHD.