We plan to establish a core network of 6 neonatal units (NNUs; 4 Nigeria/2 Kenya) to improve gut health and early nutrition in low birthweight (LBW) infants. LBW results from premature birth, intra-uterine growth retardation or both. Immature gut structure and function in preterm infants compromises nutrition, facilitates sepsis through bacterial translocation and risks necrotising enterocolitis (NEC). Abnormal microbial colonization of the gut occurs during prolonged NNU admission including with anti-microbial resistant bacteria. Improved gut health and early nutrition would likely prevent sepsis and improve brain and other organ development.
A weak evidence base contributes to the variation in practice regarding establishing feeds especially in vLBW infants (<1500g). Nutritional interventions to improve gut health and reduce mortality that have become routine practice in many NNUs in richer countries may be practical, safe and affordable in low-resource settings. An example is probiotics that reduce all-cause mortality in vLBW infants (RR 0.72; 95% CI 0.57-0.92) and prevent NEC stage 2 or greater (0.57; 0.43-0.74).
Our network will evaluate current evidence and document variation in feeding practices, adapt core outcome sets for common diseases, share anonymised clinical data and identify priorities for research. The dataset will collect information about maternal and early life variables as a basis for the assessment of long-term growth, respiratory and neurodevelopmental outcomes. We will pilot test volumetric absorptive microsampling technology combined with QPlex Array for measuring inflammatory markers and micronutrients in small blood samples and high resolution melt based qPCR to describe acquisition of anti-microbial resistance genes in faecal flora. We will also bank samples for future analysis. We will engage other low-resource NNUs and develop processes that can be rolled-out to expand the network as a resource for multicentre clinical trials.