Impact of Traditional Pre-Lacteal Feeding Practices on Early Neonatal Gut Microbiota Colonization and Risk of Neonatal Sepsis in Rural Sindh, Nawabshah Pakistan: A Prospective Cohort Study

Abstract

Background: Pre-lacteal feeding remains a common traditional practice in rural communities of Sindh, Pakistan, where neonates may receive honey, ghee, sugar-water, or ghutti before initiation of breastfeeding. Such practices may delay colostrum exposure and potentially influence early gut microbiota colonization, which is important for neonatal immune development and resistance to pathogenic organisms. This study evaluated the association between traditional pre-lacteal feeding, early neonatal gut microbiota colonization, and the risk of neonatal sepsis.

Methods: A prospective cohort study was conducted among mother-infant dyads in selected rural health centers and community clusters of Nawabshah, Sindh, Pakistan. Neonates were followed from birth to 28 days of life. Maternal and neonatal characteristics, timing of breastfeeding, and type of pre-lacteal feeding were recorded. Meconium and stool samples were collected at predefined time points and analyzed using 16S rRNA gene sequencing to characterize gut microbiota. Neonates were clinically assessed for sepsis throughout follow-up, with blood culture performed when clinically indicated. Associations between pre-lacteal feeding, microbiota patterns, and neonatal sepsis were assessed using appropriate statistical methods and multivariable regression.

Results: Pre-lacteal feeding was associated with delayed initiation of breastfeeding and differences in early gut microbiota composition, including relatively lower representation of beneficial Bifidobacterium and greater representation of potentially pathogenic Enterobacteriaceae. Neonates exposed to pre-lacteal feeds showed a higher frequency of clinically suspected and culture-confirmed sepsis. After adjustment for relevant maternal and neonatal factors, pre-lacteal feeding remained associated with increased odds of neonatal sepsis.

Conclusion: Traditional pre-lacteal feeding may be associated with altered early gut microbial colonization and increased neonatal sepsis risk. Prospective community-based interventions promoting early breastfeeding and reducing potentially unsafe pre-lacteal feeding practices warrant further evaluation.