Children with medical complexity (CMC) often require enteral tube feedings to meet their nutritional needs. Many, however, experience symptoms of feeding intolerance, such as vomiting and pain. The goal of this analysis was to examine the relationship between diet and the gut microbiome, controlling for medications, among CMC receiving enteral tube feedings, CMC consuming oral nutrition, and healthy controls. Given the variety of available commercial formula preparations, we were also interested in examining the impact of different formula types on the CMC microbiome.
Fecal samples from 91 children (57 CMC and 34 healthy controls) were collected and analyzed. Parents completed clinical and dietary questionnaires. 16S rRNA amplicon sequencing was completed using the QIIME2 pipeline.
A significant decrease in alpha diversity among CMC receiving exclusive enteral nutrition (CMC EEN) compared to healthy controls (Shannon p=0.006 and Faith’s PD p=0.006) was found that was not observed between CMC on oral nutrition and healthy controls. Significant differences in beta diversity were also observed between CMC EEN and healthy controls, with CMC EEN having greater relative abundance of Enterobacteriaceae and obligate anaerobes. Differences were also noted between CMC EEN and CMC on oral nutrition (Aitchison distance p=0.001); however, no differences were observed between CMC on oral nutrition and healthy controls.
Despite similarities in medication profiles, CMC EEN have decreased alpha diversity and differences in beta diversity compared to healthy controls not observed in CMC on oral nutrition, highlighting the impact of diet over medications.
Chronic gastrointestinal (GI) distress experienced by CMC translates into frequent healthcare resource utilization and compounds the already significant disease burden of the affected child and caregivers. Literature on enteral tube feedings in CMC exploring the impact of gut microbiota is limited. Understanding the interplay of host and gut microbiota may lead to novel strategies to mitigate symptoms of GI distress in CMC dependent on EEN. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.