Breastfed Term Infants Research Articles

Hypernatremic Dehydration in Breastfed Term Infants: Retrospective Evaluation of 159 Cases.

The aim of this study was to reveal the frequency, presenting complaints, risk factors, complications, and ways for prevention of hypernatremic dehydration (HD) among term breastfed infants. The files of 159 breastfed term infants hospitalized because of HD between the years 2009 and 2014 were examined retrospectively in the Neonatal Intensive Care Unit of Sivas State Hospital, Turkey. The patients were classified according to serum sodium (Na) levels, group 1 (Na: 146-149 mEq/L, n = 68) and group 2 (Na ≥150 mEq/L, n = 91). The most common complaint was fever (67.9%), and the most common physical finding was oral mucosal dryness (76%). There were positive correlations between serum Na levels and weight loss, hospital stay, admission age, admission to neonatal unit after discharge, serum urea levels, and body temperature (p < 0.05). The normalization period of Na levels was significantly longer (21.7 ± 8.8 versus 29.3 ± 17.8 hours, p = 0.03), and Na reduction rate was faster in group 2 (0.41 ± 0.3 versus 0.50 ± 0.3 mEq/L/hour, p = 0.02). Bradycardia was seen more commonly in group 2 (1.5% versus 16.5%, p = 0.002). HD is a significant condition that should be treated appropriately to avoid serious complications.

Determinants of body composition in breastfed infants using bioimpedance spectroscopy and ultrasound skinfolds-methods comparison.

Accurate, noninvasive, and inexpensive methods are required to measure infant body composition. Ultrasound (US) and bioimpedance spectroscopy (BIS) have been validated in adults and introduced in pediatric populations. The aim of this study was to evaluate the performance of both methods in determining percentage fat mass (%FM) in breastfed infants. %FM of 2, 5, 9, and 12 mo-old healthy, breastfed term infants (n = 58) was calculated using BIS-derived total body water equations and skinfold equations then compared with reference models. Skinfolds were measured with US at two and four sites (biceps, suprailiac and/or triceps, and subscapular). %FM differed widely within and between methods, with the degree of variation affected by infant age/sex. Not a single method/equation was consistent with the distributions of appropriate reference values for all age/sex groups. Moderate number of matches with references values (13-24 out of 36) was seen for both types of equations. High number of matches (25-36) was seen for US skinfold-based equations. %FM values calculated from US and BIS were not significantly different (P = 0.35). Both BIS and US are practical for predicting %FM in infants. BIS calculations are highly dependent upon an appropriate set of validated age-matched equations.

Vitamin D status, calcium metabolism and linear growth parameters in exclusively breast fed term infants with and without supplementation of Vitamin D

Objective: To compare the levels of vitamin D, calcium, phosphorus and alkaline phosphatase and linear growth parameters in exclusively breast fed term infants with and without supplementation of vitamin D. Design: Interventional study (Non Randomized). Setting: Department of Paediatrics and OBG in a Tertiary care Teaching Hospital, Mysuru. Participants: 60 term Healthy Neonates who were delivered in the hospital. In order to estimate the expected level with an allowable error of 20% and 95% confidence, the required sample size was considered to be a minimum of 28 for each group of only breast fed and breast fed with vitamin D supplementation. Thus we recruited 30 healthy term newborns for each group in our study. Main outcome measures: Study infants were divided into two groups, Group A-Only breast fed; Group B-breast fed with Vitamin D supplementation (800 IU/day for 4 months). The cord blood sample reports and linear growth parameters at birth with results at the end of 4th month+15days between the two groups were compared and statistical analysis was made. Results: This study showed significant improvement in vitamin D, calcium and phosphorus levels at the end of 4 months after supplementing daily 800 IU of vitamin D (cholecalciferol). However, there were no significant change in linear growth parameters between the two groups at the end of 4 months. Conclusion: This study shows the advantage of supplementing vitamin D to all infants at a relatively higher (800IU) but safe dose since birth in preventing rickets and complications of hypocalcemia.

Indications and Recommendations by Societies and Institutions for the Use of Probiotics and Prebiotics in Paediatric Functional Intestinal Disorders

ABSTRACTPurpose of review:To report the indications and/or recommendations by Societies and Institutions for the use of probiotics and prebiotics in functional intestinal disorders in childhood.Recent findings:A position by Societies and Institutions is available only for infant colic, irritable bowel syndrome and constipation. Supplementation with the probiotic L reuteri DSM 17938 in breastfed term infants with colic appears to be effective in reducing crying, while still debated is its role in the prevention of colic. Irritable bowel syndrome is a common disorder in children and at present no specific treatments are available; existing data show that although high‐quality studies are still needed, some evidence support the efficacy of LGG and VSL#3 in paediatric IBS. At present there is no evidence for the use of pre‐ or probiotics in childhood constipation.Summary:Probiotics in a near future may have a definite role is some FGIDs of infants and children. The main limitations for the recommendation by Societies and Institutions are the methodological issues that limit the quality of the evidence and the heterogeneity of treatments (probiotic strain and dose, mode, dose and duration of supplementation, primary outcomes, etc). Some specific strains are promising for infant colic (L. reuteri DSM 17938) and irritable bowel syndrome (LGG) while at present there is no indication for their use in the treatment of childhood constipation.

Predicting body composition in breastfed term infants

Predicting body composition in breastfed term infants

Arachidonic acid needed in infant formula when docosahexaenoic acid is present.

Recently, the European Food Safety Authority asserted that arachidonic acid (ARA) is an optional nutrient for the term infant even when docosahexaenoic acid (DHA) is present. The brief rationale is based on an explicit, widespread misapplication of the concept of "essential fatty acids" to linoleic acid that implies it is uniquely required as a nutrient per se. Linoleic acid prevents acute clinical symptoms caused by polyunsaturated fatty acid-deficient diets and is the major precursor for ARA in most human diets. Experimental diets with ARA as the sole n-6 similarly prevent symptoms but at a lower energy percentage than linoleic acid and show ARA is a precursor for linoleic acid. The absence of consistent evidence of ARA benefit from randomized controlled trials is apparently an issue as well. This review highlights basic and clinical research relevant to ARA requirements as an adjunct to DHA in infancy. ARA is a major structural central nervous system component, where it rapidly accumulates perinatally and is required for signaling. Tracer studies show that ARA-fed infants derive about half of their total body ARA from dietary preformed ARA. Clinically, of the 3 cohorts of term infants studied with designs isolating the effects of ARA (DHA-only vs DHA+ARA), none considered ARA-specific outcomes such as vascular or immune function; the study with the highest ARA level showed significant neurocognitive benefit. All breastfed term infants of adequately nourished mothers consume both DHA and ARA. The burden of proof to substantially deviate from the composition of breastmilk is greater than that available from inherently empirical human randomized controlled trial evidence. Infant formulas with DHA but without ARA risk harm from suppression of ARA-mediated metabolism manifest among the many unstudied functions of ARA.

Vacuum characteristics of the sucking cycle and relationships with milk removal from the breast in term infants

BackgroundThe importance of an infant's intra-oral vacuum in milk removal from the breast has been established. However, the relationship between the vacuum curve and milk transfer is not well understood. AimsTo investigate the parameters of the infant suck cycle in relation to the volume of milk removed from the breast. Study designCross-sectional study to elucidate the role of infant intra-oral vacuum in efficient milk removal from the breast. SubjectsNineteen fully breastfed term infants. MethodsIntra-oral vacuum was recorded during monitored breastfeeds using a pressure transducer. Ultrasound imaging (milk flow) and respiratory inductive plethysmography (swallowing) were used to determine the nutritive sucking (NS) portion of the feed. Milk intake was determined by weighing infants before and after feeds. Vacuum traces of the first and next 2min of NS from the first breast were analysed. ResultsThe volumes of milk removed during both NS periods were negatively associated with peak vacuum (p<0.001) and rate of vacuum application (p<0.001), and positively related to area under first half of the suck cycle (p<0.001). Most parameters changed significantly from the first 2min of NS to the next 2min including significant reduction in peak vacuum and area under first half of the suck cycle. ConclusionThese results further support the role of intra-oral vacuum, specifically optimal peak vacuum, in effective and efficient milk removal during breastfeeding. It also appears that infants modify their sucking dynamics to adapt to changes in milk flow during milk ejection as the breast empties.

Age of introduction of first complementary feeding for infants: a systematic review.

BackgroundDespite a World Health Organization recommendation for exclusive breastfeeding of all full-term infants to 6 months of age, it is not clear what the health implications may be. Breast milk alone may not meet the nutrition needs for all growing infants, leaving them at risk for deficiencies. The objective of this study was to investigate the relationship between moderate (4 months) versus late (6 months) introduction of complementary foods to the full-term breastfed infant on iron status and growth.MethodsAn electronic search of peer-reviewed and gray-literature was conducted for randomized control trials (RCTs) and observational studies related to the timing of introduction of complementary foods. Iron status and growth data from the relevant RCTs were analyzed using RevMan 5.2.11.ResultsThree RCTs and one observational study met the inclusion criteria. Meta-analysis showed significantly higher hemoglobin levels in infants fed solids at 4 months versus those fed solids at 6 months in developing countries [mean difference [MD]: 5.0 g/L; 95 % CI: 1.5, 8.5 g/L; P = 0.005]. Meta-anaysis also showed higher serum ferritin levels in the 4-month group in both developed and developing countries [MD: 26.0 μg/L; 95 % CI: -0.1, 52.1 μg/L, P = 0.050], [MD: 18.9 μg/L; 95 % CI: 0.7, 37.1 μg/L, P = 0.040]. Short follow-up periods and small sample sizes of the included studies were the major limitations.ConclusionsRCT evidence suggests the rate of iron deficiency anemia in breastfed infants could be positively altered by introduction of solids at 4 months.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0409-5) contains supplementary material, which is available to authorized users.

First-Pass Meconium Samples from Healthy Term Vaginally-Delivered Neonates: An Analysis of the Microbiota.

BackgroundConsiderable effort has been made to categorise the bacterial composition of the human gut and correlate findings with gastrointestinal disease. The infant gut has long been considered sterile at birth followed by rapid colonisation; however, this view has recently been challenged. We examined first-pass meconium from healthy term infants to confirm or refute sterility.MethodsHealthy mothers were approached following vaginal delivery. First-pass meconium stools within 24 hours of delivery were obtained from healthy, breastfed infants with tight inclusion/exclusion criteria including rejecting any known antibiotic exposure - mother within 7 days preceding delivery or infant after birth. Stools were processed in triplicate for fluorescent in-situ hybridisation (FISH) with 16S rRNA-targeted probes including Bifidobacterium; Bacteroides-Prevotella; Lactobacillaceae/Enterococcaceae; Enterobacteriaceae; Streptococcaceae; Staphylococcaceae and Enterococcaceae. Absolute counts of all bacteria and proportional identification of each bacterial group were calculated. Confirmation of bacterial presence by PCR was undertaken on FISH-positive samples.ResultsThe mothers of 31 newborn infants were recruited, 15 met inclusion/exclusion criteria and provided a sample within 24 hours of birth, processed in the lab within 4 hours. All babies were 37–40 weeks gestation. 8/15 were male, mean birth weight was 3.4kg and mean maternal age was 32 years. Meconium samples from 10/15 (66%) infants had evidence of bacteria based on FISH analysis. Of these, PCR was positive in only 1. Positive FISH counts ranged from 2.2 - 41.8 x 104 cells/g with a mean of 15.4 x 104 cells/g. (The limit of detection for automated counting is 106 cells/g). Cell counts were too low to allow formal diversity analysis. Amplification by PCR was not possible despite positive spiked samples demonstrating the feasibility of reaction. One baby was dominated by Enterobacteriaceae. The others contained 2-5 genera, with Bifidobacterium, Enterobacteriaceae, Enterococcaceae and Bacteroides-Prevotella the most prevalent. There was no association between bacterial counts and rupture of membrane duration, time to passage of meconium or time to lab.ConclusionThis study provides evidence that low numbers of bacteria are present in first-pass meconium samples from healthy, vaginally-delivered, breastfed term infants. Only two-thirds of meconium samples had detectable bacteria, though at levels too low for automated counting or for reliable confirmation by PCR. This study suggests that gut bacterial colonisation is extremely limited at birth and occurs rapidly thereafter.

Prevalence of Hyperbilirubinemia in Purely Breastfed Term Infants Appropriate for Gestational Age born in a Tertiary Hospital in Quezon City

The most common problem in a full-term breastfed infant is neonatal jaundice. Our institution has no written guidelines about management of neonatal jaundice and more evidence is still needed to support the cost and efficacy of the recommended predischarge total bilirubin level determination. To determine the prevalence of clinically significant hyperbilirubinemia in purely breastfed newborns at 37 or more weeks appropriate for gestational age and compare newborns as to risks, management and outcome. A hospital-based cross-sectional retrospective study on 1,394 purely breastfed term, healthy, roomed-in newborns from September 1, 2012 to August 31, 2013. The demographic, clinical and laboratory data were extracted from the medical records and descriptive analysis was done. About 66% developed visible jaundice and 9.8% had clinically significant hyperbilirubinemia. A total of 1.6% were readmitted due to clinically significant hyperbilirubinemia and five of them had significant hyperbilirubinemia, during birth hospitalization. There were 23% of infants with progression of jaundice had a pre-discharge bilirubin taken and stratified based on Bhutani nomogram. Phototherapy was done on all infants in high risk zone and some infants in high-intermediate risk zone but no phototherapy done on infants in low risk zone. Breastfeeding term infants do not have a high risk in developing clinically significant hyperbilirubinemia and risk factors listed in AAP were also not found to be associated. Establishing protocols and implementing policy regarding neonatal jaundice are recommended.

G116(P) The human gut is probably sterile at birth

Aims Considerable effort has been made to categorise the bacterial composition of the human gut and correlate findings with gastrointestinal disease. The infant gut has long been considered sterile at birth followed by rapid colonisation by pioneer microbiota. We examined first-pass meconium from healthy term infants to confirm/refute sterility. Methods Healthy mothers were approached following vaginal delivery. First-pass meconium within 24 h of delivery were obtained from healthy, breastfed infants. Antibiotic use was an exclusion criterion- mother within 7 days or infant after birth. Stools were processed in triplicate for fluorescent in-situ hybridisation (FISH) with16S rRNA-targeted probes against all bacteria; Bifidobacterium; Bacteroides-Prevotella; Lactobacillaceae/Enterococcaceae; Enterobacteriaceae; Streptococcaceae; Staphylococcaceae and Enterococcaceae. Absolute counts of all bacteria and proportional identification for each bacterial group were calculated. DNA extraction followed by universal bacterial RT-PCR was performed on FISH-positive samples. Results 15 babies met inclusion/exclusion criteria. All babies were 37–40 weeks gestation. 8/15 were male, mean birth weight was 3.36kg and mean maternal age was 31.9 years. 10/15 (66%) infants had evidence of bacteria on FISH. Of these, RT-PCR was positive in only 1. Positive FISH counts ranged from 2.2 to 41.8*104 cells/g with the mean of positive samples being 15.4*104 cells/g. (Limit of detection for automated counting is 106 cells/g). Cell counts were too low to allow formal diversity analysis. Amplification by RT-PCR was not possible despite positive spiked samples demonstrating the feasibility of reaction. Three babies were dominated by a single family, either Enterobacteriaceae or Enterococcaceae. The others contained 2–5 genera. Bifidobacterium, Enterobacteriaceae and Bacteroides-Prevotella were the most dominant bacteria identified. There was no association between rupture of membrane duration, time to passage of meconium or time to lab with bacterial counts. Conclusion Evidence of bacteria in first-pass meconium samples from healthy, vaginally-delivered, breastfed term infants is scant with only two-thirds having demonstrable bacteria at levels too low for automated counting. Bacterial RT-PCR failed to amplify 9/10 FISH-positive samples. This study suggests that gut bacterial diversity is extremely limited at birth and supports the hypothesis that the neonatal gut is sterile and colonised rapidly thereafter.

The higher temperature in the areola supports the natural progression of the birth to breastfeeding continuum.

Numerous functional features that promote the natural progression of the birth to breastfeeding continuum are concentrated in the human female’s areolar region. The aim of this study was to look more closely into the thermal characteristics of areola, which are said to regulate the local evaporation rate of odors and chemical signals that are uniquely important for the neonate’s ‘breast crawl’. A dermatological study of the areolae and corresponding intern breast quadrants was undertaken on the mothers of 70 consecutive, healthy, full-term breastfed infants. The study took place just after the births at the Policlinico Abano Terme, in Italy from January to February 2014. Temperature, pH and elasticity were assessed one day postpartum using the Soft Plus 5.5 (Callegari S.P.A., Parma, Italy). The mean areolar temperature was found to be significantly higher than the corresponding breast quadrant (34.60 ±1.40°C vs. 34.04 ±2.00°C, p<0.001) and the pH was also significantly higher (4.60±0.59 vs. 4.17±0.59, p<0.001). In contrast, the elasticity of the areolar was significantly lower (23.52±7.83 vs. 29.02±8.44%, p<0.003). Our findings show, for the first time, that the areolar region has a higher temperature than the surrounding breast skin, together with higher pH values and lower elasticity. We believe that the higher temperature of the areolar region may act as a thermal signal to guide the infant directly to the nipple and to the natural progression of the birth to breastfeeding continuum.

The influence of impact delivery mode, lactation time, infant gender, maternal age and rural or urban life on total number of Lactobacillus in breast milk Isfahan - Iran.

Background:Breast milk is known as the most crucial postpartum issue in metabolic and immunologic programming of neonatal health. Human milk microbial changes over Lactation. The factors influencing the milk microbiome as well as potential impact of microbes on infant health have not yet been discovered. The objective was to identify pre- and post-natal factors that can potentially influence the bacterial communities inhabiting human milk.Materials and Methods:Breast milk samples (n = 40) with all full-term breastfed infants were collected from lactating randomized. Information on personal characteristics, dietary habits, information about infants were collected after birth. The samples were plated with serial dilutions on three selective culture media man rogosa sharp and then colonies were counted. Colonies tested for catalase reaction, Gram-staining and microscopic examination.Results:The result of this study showed that the overall incidence of positive Lactobacillus in mother's milk was 87.5%. The results based on (infant gender, mode of delivery, rural or urban and lactation time) rural or urban and lactation time were significant (P < 0.05). The results showed that all of the variables were significant in this regression model (P < 0.001). The median of log10 Lactobacillus counts in rural mothers, vaginal delivery, infant male gender and Lactation time for first 3-month were meaningfully high.Conclusions:The findings of this study about the breast milk Lactobacillus potential probiotic bacteria of healthy Iranian mothers, suggested that the breast milk microbiome is significantly influenced by several factors, mode of delivery, rural or urban and lactation time.

An Overview of Iron in Term Breast-Fed Infants.

BACKGROUNDIron is an essential nutrient for normal growth and neurodevelopment of infants. Iron deficiency (ID) remains the most common micronutrient deficiency worldwide. There are convincing data that ID is associated with negative effects on neurological and psychomotor development.OBJECTIVESIn this review, we provide an overview of current knowledge of the importance of iron in normal term breast-fed infants with a focus on recommendations, metabolism, and iron requirements.CONCLUSIONSHealth organizations around the world recommend the introduction of iron-rich foods or iron supplements for growing infants to prevent ID. However, there is no routine screening for ID in infancy. Multicenter trials with long-term follow-up are needed to investigate the association between iron fortification/supplementation and various health outcomes.

PS-271 Cytokine Content Of Human Milk And Atopic Dermatitis In Breastfed Infants

Background The protective effect of breastfeeding has been linked to immunomodulating agents in human milk, including cytokines. Objective To evaluate the possible relationship between human milk cytokine content and atopic dermatitis in breastfed term infants. Material and methods In 114 samples of milk fed to term infants, IL-1β, IL-2, IL-4, IL-5, IL-10, IFNγ, TGF-β1 and TNF content were determined by flow cytometry. Breastfeeding duration and diagnosis of atopic dermatitis were telephonically recorded at 18 months. Results Atopic dermatitis appeared in 24 infants (21%). No allergies were recorded in 89 (78%). We found no significant differences in maternal age (34.8 ± 2.7 vs 34.7 ± 3.6 years), maternal allergies (54% vs 46%), birth-weight (3288 ± 512 vs 3270 ± 586 g) or breastfeeding duration (5.7 ± 1.2 vs 5.6 ± 1.4 months). Cytokines studied were detected in the following samples of mature milk: IL-1β 25%, IL-2 42%, IL-4 23%, IL-5 17%, IL-10 28%, IFNγ 25%, TGF-β1 16% and TNF 18%. In milk fed to infants with atopic dermatitis, mean concentration of TGF-β1 was higher (428 ± 221 vs 282 ± 222 pg/ml), while that of IL-1β (2.2 ± 1.1 vs 3.6 ± 7.5 pg/ml), IL-2 (6.7 ± 3.3 vs 9.6 ± 6.8 pg/ml), IL-4 (2.0 ± 0.7 vs 4.0 ± 5.2 pg/ml), IL-5 (0.6 ± 0.3 vs 1.2 ± 0.9 pg/ml), IL-10 (1.8 ± 0.7 vs 3.8 ± 3.1 pg/ml), IFNγ (2.9 ± 4.2 vs 5.9 ± 9.1 pg/ml) and TNF (2.2 ± 0 5 vs 5.4 ± 7.1 pg/ml) was lower, although differences were only significant for IL-10 (p = 0.02). Conclusions The results suggest a possible relationship between human milk IL-10 content and atopic dermatitis in infants. However, wide variability in cytokine concentration means the sample size must be increased to draw definitive conclusions.

Development of intestinal flora in breastfed newborns exposed to intrapartum antibiotic prophylaxis

Objective: Intrapartum antibiotic prophylaxis (IAP) currently represents the most effective strategy to prevent the early-onset Group B Streptococcus (GBS) neonatal disease. We aimed to investigate the effect of IAP on the development of gut microbiota in breastfed term infants.

Effects of direct interaction between fermented milk and rice novel dietary products with human enterocytes on cell growth and innate immunity peptides production

s / Digestive and Liver Disease 46 (2014) e85–e127 e97 MS was made according to modified Criteria of American Hearth Association. Dietary habits were assessed by a dietician, using the one week alimentary diary. Results: We divided our population in: group A children with WHtR≥0.62 (193pts, age 9.4±2.4 yrs, BMI z-score 2.5±0.5), group B childrenwithWHTR<0.62 (204 pts, age 9.5±2.3 yrs, BMI z-score 1.9±0.3). Total Energy Intake was 1843±459kcal/day in group A and 1723.6±402kcal/day in group B (p=0.008). No difference was recorded between intake (%) of proteins, carbohydrates and fats, but Group A presented an intake by commercial foods greater than Group B (442±265.2 kcal/day vs 383±209.8 kcal/day, p=0.014). The prevalence rate of MS was 19.7% in group A and 4.4% in group B (p<0.001). Conclusions: Obese children at higher risk for MS eat larger quantities of commercial foods. A correct nutritional education is required to reduce cardiovascular risk. http://dx.doi.org/10.1016/j.dld.2014.07.084 EFFECTS OF DIRECT INTERACTION BETWEEN FERMENTED MILK AND RICE NOVEL DIETARY PRODUCTS WITH HUMAN ENTEROCYTES ON CELL GROWTH AND INNATE IMMUNITY PEPTIDES PRODUCTION Lorella Paparo1,∗, Rosita Aitoro2, Rita Nocerino2, Ylenia Maddalena2, Simona Caprio2, Francesco Amato2, Vincenza Pezzella2, Linda Cosenza2, Andrea Budelli 3, Francesca Fasano3, Carmen Di Scala2, Roberto Berni Canani2 1 Department of Translational Medical Science-Pediatric Section and European Laboratory for the Investigation of Food Induced Diseases, University of Naples “Federico I“, Naples, Italy 2 Department of Translational Medical Science-Pediatric Section and European Laboratory for the Investigation of Food Induced Diseases, University of Naples “Federico II”, Naples, Italy 3 RD LL-37, +7400%, vs control p< .05; fermented rice: HBD2, +620%; LL-37, +11150% vs control, p< .05). The maximal effective doseswere 115mg/ml for HBD2 and 1.15mg/ml for LL37. Themaximal effective dose on cell growth was 115mg/ml. The effect of fermented milk product on cell growth derived from fully thermostable component/s, the effects of fermented rice product on LL-37 synthesis and on cell growth derived from fully thermo-stable component/s and the effects of fermented rice product on HBD-2 synthesis derived at least in part from heat-stable component/s. Conclusions: Through a direct interaction with the enterocyte fermentedmilk and rice products are able to significantly stimulate cell growth and innate immunity peptides synthesis. These results open theway for a fast characterization of components responsible for the observed clinical effects. http://dx.doi.org/10.1016/j.dld.2014.07.085 DEVELOPMENT OF INTESTINAL FLORA IN BREASTFED NEWBORNS EXPOSED TO INTRAPARTUM ANTIBIOTIC PROPHYLAXIS Giacomo Tonti1,∗, Silvia Martini1, Luigi Corvaglia1,∗, Irene Aloisio2, Giuseppe Mazzola2, Diana Di Gioia2, Bruno Biavati2, Giacomo Faldella1 1 Azienda Ospedaliera Universitaria Sant’Orsola-Malpighi U.O. Neonatologia e Terapia Intensiva Neonatale, Universita di Bologna, Bologna, Italy 2 Dipartimento di Scienze Agrarie Area di Microbiologia Agroambientale, Universita di Bologna, Bologna, Italy Objective: Intrapartum antibiotic prophylaxis (IAP) currently represents the most effective strategy to prevent the early-onset Group B Streptococcus (GBS) neonatal disease. We aimed to investigate the effect of IAP on the development of gut microbiota in breastfed term infants. Methods: Term newborns, vaginally delivered and receiving ≥50% of own mother’s milk, were recruited on day 2 of life and allocated into two groups. Group 1: infants born to mothers with GBS-positive vaginal swab, IAP-exposed. Group 2: infants born to mothers with GBS-negative vaginal swab, unexposed to IAP. Two fecal samples for each infant were collected on day 7 and 30. Bifidobacterium spp., Bacteroides fragilis group and Lactobacillus spp. counts were detected by real-time PCR and compared between the two groups. Results: Seventy-six newborns were recruited (Group 1=41, Group 2=35). On day 7 (Table 1), the count of Bifidobacterium spp. was significantly lower in Group 1 compared to Group 2 (p<0.05), while no difference was detected on day 30 (Table 2). Consistently, Group1 showeda significant increase inBifidobacterium spp. count on day 30 compared to day 7 (p<0.05). No differences were detected on days 7 and 30 between Group 1 and 2 in the number of Bacteroides fragilis group and Lactobacillus spp. Conclusions: IAPaffects theearlyneonatalmicrobiotaby reducing Bifidobacterium spp. levels. Breastfeeding, which promotes

The early administration of Lactobacillus reuteri DSM 17938 controls regurgitation episodes in full-term breastfed infants

Forty breastfed full-term infants were randomly, double blind assigned to receive orally Lactobacillus reuteri (L. reuteri) DSM 17938, 5 drops/daily (108 colony-forming units), for 4 weeks (n = 20) or an identical placebo (n = 20), starting before third day of life. They underwent basal and final visit to monitor growth parameters and gastrointestinal (GI) disease. Parents registered daily: crying minutes, stool frequency and consistency, numbers of regurgitations, adverse events. Secretory IgA (sIgA) has been measured in saliva on 28th day. Treated infants demonstrated a reduction in daily regurgitations at the end of treatment (p = 0.02), three neonates in the placebo group only needed simethicone for GI pain, sIgA level was similar in both groups. Random casualty produced an unbalanced gender distribution in the groups, but this bias did not affect the results. Therefore, early administration of L. reuteri DSM 17938 resulted beneficial in preventing regurgitation episodes during the first month of life.

Identifying term breast-fed infants at risk of significant hyperbilirubinemia

The aim of this study was to establish a model to identify term breast-fed infants who are at risk of developing significant neonatal hyperbilirubinemia. A prospective study was designed to investigate the effects of birth weight, mode of delivery, cephalohematoma, glucose-6-phosphate dehydrogenase (G6PD) deficiency, predischarge total serum bilirubin, variant uridine 5'diphospho-glucuronosyltransferase 1A1 (UGT1A1) gene, and hepatic solute carrier organic anion transporter 1B1 (SLCO1B1) gene on significant hyperbilirubinemia in term breast-fed neonates. Significant hyperbilirubinemia was defined as a bilirubin level exceeding the hour-specific phototherapy treatment threshold recommended by the American Academy of Pediatrics in 2004. Of 240 exclusively breast-fed term neonates, 26 (10.8%) had significant hyperbilirubinemia. The predischarge total serum bilirubin on the third day (odds ratio (OR) = 2.63; 95% confidence interval (CI): 1.87-3.70; P < 0.001) and the variant UGT1A1 gene at nucleotide 211 (OR = 5.00; 95% CI: 1.08-23.03; P < 0.05) were significant risk factors. The area under the receiver operating characteristic (ROC) curve of the predictive probability was 0.964 (95% CI: 0.932-0.984; P < 0.0001). Combining the total serum bilirubin on the third day and the variant UGT1A1 gene at nucleotide 211 can predict hyperbilirubinemia well in term breast-fed infants.

Bacterial community structure and functional contributions to emergence of health or necrotizing enterocolitis in preterm infants

BackgroundPreterm infants represent a unique patient population that is born functionally immature and must accomplish development under the influence of a hospital environment. Neonatal necrotizing enterocolitis (NEC) is an inflammatory intestinal disorder affecting preterm infants. The purpose of this study was to evaluate the progression of intestinal microbiota community development between preterm infants who remained healthy compared to preterm infants who developed NEC.ResultsWeekly fecal samples from ten preterm infants, five with NEC and five matched healthy controls were obtained. Bacterial DNA from individual fecal samples was subjected to sequencing of 16S rRNA-based inventories using the 454 GS-FLX platform. Fecal samples from control infants demonstrated a temporal pattern in their microbiota, which converged toward that of a healthy full term breast-fed infant. Microbiota development in NEC patients diverged from controls beginning three weeks prior to diagnosis. Shotgun metagenomic sequencing was performed to identify functional differences in the respective microbiota of fecal samples from a set of twins in which one twin developed NEC and one did not. The majority of the differentially abundant genes in the NEC patient were associated with carbohydrate metabolism and mapped to members of the family Enterobacteriaceae. This may indicate an adaptation of the community to an altered profile of substrate availability for specific members as a first step towards the development of NEC. We propose that the microbial communities as a whole may metabolize milk differently, resulting in differential substrate availability for specific microbial groups. Additional differentially represented gene sets of interest were related to antibiotic resistance and vitamin biosynthesis.ConclusionsOur results suggest that there is a temporal component to microbiome development in healthy preterm infants. Thus, bacteriotherapy for the treatment or prevention of NEC must consider this temporal component of the microbial community in addition to its taxonomic composition and functional content.