Survey of neonatal microbiota associated with spontaneous preterm labor in Kenya

Background – Prematurity is the leading cause of perinatal morbidity and mortality worldwide. Necrotizing enterocolitis (NEC) and neonatal sepsis are the most devastating complication of prematurity which might be caused by intestinal dysbiosis. This study was designed to explore the vaginal microbiota with NEC and gram negative sepsis, determine whether fecal microbiota in premature infants differs from the term infant how early administration of antibiotic affect the outcome of preterm infant. Methods – A case-control design was used to enroll 33 women with spontaneous preterm labor between 26 to 36 weeks and 33 controls with term delivery matched for age and parity. At birth, the infants were also enrolled. We obtained a vaginal swab from the mother prior to delivery, infant rectal swabs or stool samples weekly thereafter. These samples were assessed using 16S ribosomal RNA (rRNA) gene sequencing. Beta-diversity was calculated using Permutational Multivariate Analysis of variance and Bray-Curtis dissimilarity indices were measured. Results – Three preterm infants developed the endpoints of necrotizing enterocolitis, one of whom also developed gram-negative sepsis. There were no differences in community richness of maternal vaginal microbiota between the term and preterm groups. All of the preterm infants admitted to the neonatal intensive care unit received penicillin and gentamicin from the day of birth. Although day 0 fecal microbiota sequences were rarely positive, the majority of infants had a predominance of Enterobacterales by day 3 or 7. Conclusions – Penicillin and gentamicin are routinely prescribed for preterm infants who require NICU admission from the time of birth as part of a prophylaxis protocol. Klebsiella and/or Escherichia (primarily Klebsiella) dominated the microbiota of the preterm infants. Further study is required to determine whether early treatment with penicillin and gentamicin is a risk factor for K. pneumoniae sepsis in these preterm infants.