The University of Southampton
University of Southampton Institutional Repository

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

Clinical and laboratory-based approaches to investigating the development of biofilms in neonatal enteral feeding tubes: influence of infant care regime and environment
Clinical and laboratory-based approaches to investigating the development of biofilms in neonatal enteral feeding tubes: influence of infant care regime and environment
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.
University of Southampton
Winnard, Christopher
23a6fa57-b2b3-465c-9fda-9b358d54bddd
Winnard, Christopher
23a6fa57-b2b3-465c-9fda-9b358d54bddd
Keevil, Charles
cb7de0a7-ce33-4cfa-af52-07f99e5650eb

Winnard, Christopher (2019) Clinical and laboratory-based approaches to investigating the development of biofilms in neonatal enteral feeding tubes: influence of infant care regime and environment. University of Southampton, Doctoral Thesis, 318pp.

Record type: Thesis (Doctoral)

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.

Text
Christopher Winnard FINAL Thesis 2019 - Version of Record
Available under License University of Southampton Thesis Licence.
Download (97MB)

More information

Published date: 30 June 2019

Identifiers

Local EPrints ID: 438623
URI: http://eprints.soton.ac.uk/id/eprint/438623
PURE UUID: 059cbdda-b327-459d-811b-5d49aba0e935
ORCID for Charles Keevil: ORCID iD orcid.org/0000-0003-1917-7706

Catalogue record

Date deposited: 18 Mar 2020 17:40
Last modified: 05 Jan 2021 05:01

Export record

Contributors

Author: Christopher Winnard
Thesis advisor: Charles Keevil ORCID iD

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×