Clinical and laboratory-based approaches to investigating the development of biofilms in neonatal enteral feeding tubes: influence of infant care regime and environment

Abstract

Premature infants display a diminished immune system in comparison to full term infants. This, coupled with long hospital stays and increased exposure to invasive procedures, predisposes these infants to increased rates of morbidity and mortality. One such procedure is the placement of an enteral feeding tube. These devices deliver essential, highly nutritional, feeds to infants who are unable to do so naturally. The internal environment of these tubes provides the perfect replicative niche for biofilms to form.

Biofilms are a well-documented clinical concern, owing to their difficulty to treat, potential to cause serious infection and ability to harbour pathogenic organisms. Many studies have been conducted into contamination of adult feeding devices and the impact on patient morbidity and mortality – however, there is very little research into the impact this may have in neonates.

Initial laboratory-based experiments sought to understand the ability to adhere to and growth characteristics of a number of potentially pathogenic microorganism upon the tubes. The utilisation of liquid, static and flow-based feeding models allowed us to display the ability of different microorganisms to grow upon different NGT material types, within different clinically used infant formulas.

The latter section encompassed a two-part clinical concept trial in which, via a combination of molecular and culture-based analysis, we demonstrated that not only is there a correlation between insertion time and increased colonisation but were also able to truly highlight the microbial diversity of this niche. Analysis of infant care regimes also demonstrated the impact specific patient factors have on these populations.

The results generated throughout the initial laboratory-based models provided the groundwork for establishing, and understanding, the representative feeding model created. This model will provide clinicians and researchers with the ability to analyse multiple aspects of infant care, within a safe and controlled environment, on enteral tube contamination and blockage. The results from the clinical concept trial reinforced the accuracy of the flow model, as comparable levels of of contamination were observed over similar time periods, as well as demonstrating a link between increased insertion time and colonisation. The sequencing analysis is the first of its kind to truly represent the extent of microbial diversity within this niche, whilst also displaying how specific care regime factors, impact this diversity, such as increased abundance of Streptococcus with exclusive infant formula feeding.

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Identifiers

ORCID for Charles Keevil: orcid.org/0000-0003-1917-7706

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