Polymer Coating Reduces Bacterial Biofilm on Neonatal Enteral Feeding Tubes after Infant Formula-Conditioning

Abstract We report a flexible polymer coating, poly(cyclododecyl methacrylate-co-di(ethylene glycol) methyl ether methacrylate) [p(CyDMA-co-DEGMA)], that significantly reduces bacterial biofilm formation on polyurethane neonatal feeding tubes, including on milk-conditioned surfaces that mimic the neonatal feeding environment. Neonatal enteral feeding tubes are essential for clinical care but are highly susceptible to microbial colonization and biofilm formation, which are associated with severe infections in premature and vulnerable infants. Milk not only promotes bacterial growth but also rapidly conditions device surfaces through the adsorption of its components, forming a complex interfacial layer that challenges non-eluting surface-chemistry-based antibiofilm strategies. Surface conditioning was characterized by time-of-flight secondary ion mass spectrometry (ToF-SIMS), which revealed ions consistent with the adsorption of amino acids, carbohydrates, and lipids. Lipids were patterned on the surface in structures resembling deposited milk fat globules. Despite this complex conditioning layer, p(CyDMA-co-DEGMA)-coated tubes reduced in vitro biofilm formation by Pseudomonas aeruginosa, Escherichia coli, and Enterobacter cloacae by 85%, 59%, and 34%, respectively, compared to uncoated polyurethane. No significant reduction was observed for Staphylococcus aureus.These findings provide molecular-level insight into feeding tube surface conditioning and represent a significant advance in demonstrating antibiofilm performance on surfaces under complex conditioning environments. This work supports the development of a surface-based strategy to reduce device-associated infections in neonatal care.