Background The intestinal microbiome in preterm infants differs markedly from term infants. It is unclear whether the microbiome develops over time according to infant specific factors. Methods We analysed (clinical) metadata - to identify the main factors influencing the microbiome composition development - and the first meconium and faecal samples til the 4th week via 16 S rRNA amplican sequencing. Results We included 41 infants (gestational age 25–30 weeks; birth weight 430-990 g. Birth via Caesarean section (CS) was associated with placental insufficiency during pregnancy and lower BW. In meconium samples and in samples from weeks 2 and 3 the abundance of Escherichia and Bacteroides (maternal faecal representatives) were associated with vaginal delivery while Staphylococcus (skin microbiome representative) was associated with CS. Secondly, irrespective of the week of sampling or the mode of birth, a transition was observed as children children gradually increased in weight from a microbiome dominated by Staphylococcus (Bacilli) towards a microbiome dominated by Enterobacteriaceae (Gammaproteobacteria). Conclusions Our data show that the mode of delivery affects the meconium microbiome composition. They also suggest that the weight of the infant at the time of sampling is a better predictor for the stage of progression of the intestinal microbiome development/maturation than postconceptional age as it less confounded by various infant-specific factors.

Objectives Robot-assisted coronary bypass surgery has been developed as a less invasive alternative for conventional CABG enhancing postoperative recovery, patient satisfaction and early discharge to home destination. Furthermore, it may provide a basis for hybrid coronary revascularisation. To determine the feasibility of this procedure, we compared robot-assisted with conventional off-pump CABG. Methods All consecutive patients undergoing a robot-assisted LIMA to LAD procedure were compared to consecutive patients undergoing conventional off-pump CABG for single-vessel disease from October 2016 to July 2019. Primary outcome was discharge to home destination within five days after surgery. Secondary outcomes were total hospital stay, reoperations within 48 hours, transfusion, atrial fibrillation, 30-day mortality, and quality of life one month after surgery. A propensity-matched cohort was composed to correct for possible confounders. Results One hundred seven robot-assisted CABG patients were compared to 194 conventional off-pump CABG. Primary outcome was reached in 51% of the robot-assisted group versus 19% of the conventional off-pump group (p < 0.01). Median postoperative hospital stay was five days in the robot-assisted group versus seven days in the conventional off-pump group (p < 0.01). Other secondary outcomes did not differ significantly between groups, and quality of life one month after surgery was equal. The results after propensity matching were similar. Conclusion Early discharge to home destination is more frequent in robot-assisted CABG than in conventional off-pump CABG patients, with no difference in health-related quality of life. Therefore, this approach may reduce healthcare resources and provide a solid basis for hybrid coronary revascularisation.

Background: The intestinal microbiome in preterm infants differs markedly from term infants. It is unclear whether the microbiome develops over time according to infant specific factors. Methods: We analysed (clinical) metadata - to identify the main factors influencing the microbiome composition development - and the first meconium and feacal samples til the 4th week via 16S rRNA amplican sequencing. Results: We included 41 infants (gestational age 25-30 weeks; birth weight 430-990g. Birth via Caesarean section (CS) was associated with placental insufficiency during pregnancy and lower BW. In meconium and in weeks 2 and 3 an increased combined abundance of Escherichia and Bacteroides (maternal fecal representatives) was associated with vaginal delivery (p=0.021, p=0.0002, p=0.028, respectively) while Staphylococcus (skin microbiome representative) was associated with CS (p=0.0008, p=0.0003 p=0.046, respectively). Secondly, irrespective of the week of sampling or the mode of birth, a transition was observed as children children gradually increased in weight from a microbiome dominated by Staphylococcus (Bacilli) towards a microbiome dominated by Enterobacteriaceae (Gammaproteobacteria). Conclusions: Mode of delivery affects the meconium microbiome composition. It also suggests that the weight of the infant at the time of sampling is a better predictor for the stage of progression of the intestinal microbiome development/maturation than postconceptional age.

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