Pediatric Hospital Medicine Fellow UCSD San Diego, California, United States
Background: Children with medical complexity (CMC), who have one or more chronic conditions and severe functional limitations, are often on exclusive enteral nutrition (EEN) and experience recurrent episodes of retching, vomiting, and gastrointestinal (GI) pain. Prior research found differences in the diversity of the gut microbiome in CMC patients on EEN compared to healthy controls. At this time, it is unclear whether there are further changes in the microbiome during periods of feeding intolerance which may explain changes in gut functioning and ultimately symptomatology. Objective: To describe changes in microbiome composition and their metabolites during an acute flare of feeding intolerance in CMC patients on EEN. As a secondary aim, we will correlate these changes with changing clinical symptoms, gut inflammatory markers (fecal calprotectin), and systemic inflammatory markers (serum IL-6/ TNF-alpha). Design/Methods: To meet these aims, we are conducting an observational study (UCSD IRB #805609) of CMC patients ages 2-18 years who are on EEN and have a history of at least 3 episodes of feeding intolerance in the past year. Feeding intolerance is defined as an increase in vomiting, retching, or abdominal distension requiring a clinical intervention (e.g., changing formula, medications, or rate of feeds). Stool samples are collected at 3 timepoints in a 12-month period: baseline, 1-3 days after acute onset of a feeding intolerance flare, and 2-3 days after return to baseline GI function. As of Oct 2023, we have consented 12 patients and collected 10 baseline samples. Recruitment is ongoing (goal of 15-20 patients) and feeding intolerance samples are collected as they occur. Clinical data and demographic information is obtained through Electronic Health Records chart review and a REDCap survey to parents. Metagenomic sequencing will be conducted by the UCSD Microbiome Core and analyzed using QIIME pipeline. Metabolomic data will be analyzed by the Institute of Metabolomics Medicine at UCSD. Examination of changes in the microbiome and metabolites will occur in early 2024.
