The first days and weeks of life are characterized by a truly impressive cascade of biological processes that drive neonatal growth and development—all of which are crucial to preparing the newborn for life outside the womb.

First, vaginal delivery exposes neonates to an important natural microbial inoculum from the vaginal microbiota in labor and from the maternal intestinal microbiota at birth. Together, these early colonization events lay the foundation for gut microbiota assembly, inform the arrival of subsequent species through microbial interactions, and dictate infant microbiota maturation. Whether the gut microbial assembly, maturation, and functional potential differs between pre- versus full-term infants, or is coupled to growth and development, remains unresolved. Secondly, the first days and weeks of life represent a time of heightened vulnerability to infectious disease. Neonatal infections account for a tragic 40% of mortality in children under five years of age. This critical time period is increasingly seen as a key determinant in health over the entire lifespan.  The impacts of preterm birth on immune development and function remain enigmatic  and the mediating effect of the gut microbiome unknown. Thirdly, neonatal nutrition plays a vital role in the two aforementioned processes—because breastfeeding both initiates tropic priming of the newborn gut and transfers numerous immunological factors to the baby. But because few studies have evaluated the association between early milk composition and infant growth and development, it is unclear which components are most imperative for a healthy gut microbiota and a robust immune system, particularly in the preterm infant.

The aim of the DenBalo study is to apply integrated multi-omics methods to examine the biological mechanisms underlying this vulnerability in preterm neonates in LMICs, with the ultimate goal of identifying targeted interventions to reduce morbidity and mortality in this high-risk population. The evidence generated from this project will ultimately help promote healthy pregnancies and the birth of healthy babies.

To achieve this goal, three research objectives are proposed:

1. To describe and compare gut microbiota, immune system and breastmilk components in pre- versus full-term neonates in urban Burkina Faso.
2. To describe and compare the development of the gut microbiota, the immune system and breastmilk components during the first six months of life in pre- versus full-term infants in urban Burkina Faso.
3. To investigate the relationship between the composition of the gut microbiota, the immune system and breastmilk components during the first six months of life in pre- versus full-term infants in urban Burkina Faso.