Infant Stool Research Articles

A novel mobile phone application for infant stool color recognition: An easy and effective tool to identify acholic stools in newborns.

Early diagnosis of biliary atresia is essential to improve long-term outcomes. Newborn screening with an infant stool color card allows early recognition of biliary atresia patients. Our aim was to develop and validate a mobile phone application (PopòApp) able to identify acholic stools. An intuitive app was developed for iOS and Android smartphones. A learning machine process was used to generate an algorithm for stools color recognition based on the seven colors of the infant stool color card, which were considered as the gold standard. Consecutive images of stools were taken by the PopòApp, directly into the diapers of children aged ≤6 months. The PopòApp classified the photographs as "normal", "acholic" or "uncertain". To validate the PopòApp, four doctors independently classified all images, and only those for which all doctors agreed were included. The sensitivity, specificity, positive/negative predictive values, and accuracy of the PopòApp were evaluated. Of 165 images collected, 160 were included in the study. All acholic stools were recognized by the PopòApp. The PopòApp sensitivity was 100% (95% CI:93.9%-100%) with no false negatives, regardless of the brand of phone. The specificity was 99.0% (95% CI:94.6%-99.9%). The accurancy of the PopòApp was 99.4% (95% CI:96.6%-99.9%), with a positive predictive value of 98.4% (95% CI:89.8%-99.8%). The current study proved, in a large cohort, that the PopòApp is an accurate and easy tool for recognition of acholic stools. The mobile App may represent an effective strategy for the early referral of children with acholic stools, and potentially could improve the outcomes of biliary atresia.

Indole-3-lactic acid associated with Bifidobacterium-dominated microbiota significantly decreases inflammation in intestinal epithelial cells

BackgroundBifidobacterium longum subsp. infantis (B. infantis) is a commensal bacterium that colonizes the gastrointestinal tract of breast-fed infants. B. infantis can efficiently utilize the abundant supply of oligosaccharides found in human milk (HMO) to help establish residence. We hypothesized that metabolites from B. infantis grown on HMO produce a beneficial effect on the host.ResultsIn a previous study, we demonstrated that B. infantis routinely dominated the fecal microbiota of a breast fed Bangladeshi infant cohort (1). Characterization of the fecal metabolome of binned samples representing high and low B. infantis populations from this cohort revealed higher amounts of the tryptophan metabolite indole-3-lactic acid (ILA) in feces with high levels of B. infantis. Further in vitro analysis confirmed that B. infantis produced significantly greater quantities of the ILA when grown on HMO versus lactose, suggesting a growth substrate relationship to ILA production. The direct effects of ILA were assessed in a macrophage cell line and intestinal epithelial cell lines. ILA (1-10 mM) significantly attenuated lipopolysaccharide (LPS)-induced activation of NF-kB in macrophages. ILA significantly attenuated TNF-α- and LPS-induced increase in the pro-inflammatory cytokine IL-8 in intestinal epithelial cells. ILA increased mRNA expression of the aryl hydrogen receptor (AhR)-target gene CYP1A1 and nuclear factor erythroid 2–related factor 2 (Nrf2)-targeted genes glutathione reductase 2 (GPX2), superoxide dismutase 2 (SOD2), and NAD(P) H dehydrogenase (NQO1). Pretreatment with either the AhR antagonist or Nrf-2 antagonist inhibited the response of ILA on downstream effectors.ConclusionsThese findings suggest that ILA, a predominant metabolite from B. infantis grown on HMO and elevated in infant stool high in B. infantis, and protects gut epithelial cells in culture via activation of the AhR and Nrf2 pathway.

Degree of concordance of Clostridioides difficile strains in adults with community-associated C. difficile infection and infants with C. difficile colonization.

Infants asymptomatically excrete Clostridioides difficile during their first year of life, suggesting that they may represent a source of infection for adults who acquire community-associated C. difficile infection (CA-CDI). The genetic relationship of C. difficile strains from asymptomatic infants and adults with CA-CDI is not well defined. In this study, 50 infants were recruited at birth, and stool samples were collected at routine well-child visits. Adult stool samples collected during the same period and geographical area from patients who were diagnosed with CA-CDI were selected for comparison. C. difficile was cultivated and probed by PCR for toxin genes and were typed by PCR fluorescent ribotyping. Isolates from adults and infants with shared ribotypes were subjected to whole-genome sequencing (WGS). Of these 50 infants, 36 were positive for C. difficile at least once in their first year of life, with a peak incidence at 6 months. Among 180 infant stool samples, 48 were positive. Of 48 isolates from positive stools, 29 were toxigenic by polymerase chain reaction (PCR) and 8 of 48 stool samples were positive for toxin by enzyme immunoassays (EIAs). Ribotypes F106 and F014-020 were present in both colonized infants and adults with CA-CDI. WGS identified 1 adult-infant pair that differed by 5 single-nucleotide polymorphisms (SNPs). Also, 4 additional adult-infant clusters differed by ≤16 SNPs. Infants that are colonized with C. difficile share ribotypes with adults from the same geographical region with CA-CDI. Selected isolates in the 2 populations show a genetic relationship by WGS.

Maternal fibre and gluten intake during pregnancy and risk of childhood celiac disease: the MoBa study

Maternal diet can influence the developing immune system of the offspring. We hypothesized that maternal fibre and gluten intake during pregnancy were associated with the risk of celiac disease in the child. In the Norwegian Mother, Father and Child Cohort Study (MoBa, n = 85,898) higher maternal fibre intake (median 29.5 g/day) was associated with a lower risk of celiac disease in the offspring (adjusted relative risk 0.90, 95% CI 0.83 to 0.98 per 10 g/d increase). Gluten intake during pregnancy (median 13.0 g/d) was associated with a higher risk of childhood CD (adjusted relative risk = 1.21, 95% CI 1.02 to 1.43 per 10 g/d increase). These results were largely unaffected by adjustment for the child’s gluten intake at 18 months. In an independent study of 149 mother/child dyads, maternal fibre intake did not predict concentrations of total or sub-types of short-chain fatty acids in repeated infant stool samples, or fecal microbiome diversity in the mother or child. Our results suggest that high fibre and low gluten intake during pregnancy could be protective factors for celiac disease, although the mechanism is unknown.

Activation of the G-protein coupled receptor GPR35 by human milk oligosaccharides through different pathways

Numerous benefits of breastfeeding over infant formula are fully established. The superiority of human milk over bovine milk-based formula is partly due to human milk oligosaccharides (HMOs), a family of over 100 molecules present specifically and substantially in human milk that resemble mucosal glycans. To uncover novel physiological functions and pathways of HMOs, we screened a panel of 165 G-protein coupled receptors (GPCRs) using a blend of 6 HMOs (3′-O-sialyllactose (3′SL), 6′-O-sialyllactose (6′SL), lacto-N-tetraose (LNT), lacto-N-neo-tetraose (LNnT), 2-O-fucosyllactose (2′FL), and difucosyllactose (diFL)), and followed up positive hits with standard receptor assays. The HMO blend specifically activated GPR35. LNT and 6′SL individually activated GPR35, and they showed synergy when used together. In addition, in vitro fermentation of infant stool samples showed that 2′FL upregulates the production of the GPR35 agonist kynurenic acid (KYNA) by the microbiota. LNT + 6′SL and KYNA showed additive activation of GPR35. Activation by 6′SL and LNT of GPR35, a receptor mediating attenuation of pain and colitis, is to our knowledge the first demonstration of GPCR activation by any HMO. In addition, we demonstrated a remarkable cooperation between nutrition and microbiota towards activation of a host receptor highlighting the close interplay between environment and host-microbe interactions.

Effect of milk fat-based infant formulae on stool fatty acid soaps and calcium excretion in healthy term infants: two double-blind randomised cross-over trials

BackgroundPalmitic acid (PA) is predominantly esterified at the SN-2 position of triacylglycerols in human milk. PA at the SN-2 position is more efficiently absorbed and results in reduced formation of PA soaps, as well as reduced fatty acid (FA) and calcium malabsorption. Bovine milk fat (MF), a natural source of SN-2-palmitate, was used in the fat blend of infant formulae (IF) in the current study to investigate its effect on stool fatty acid soaps, calcium excretion and stool characteristics.MethodsTwo double-blind, randomised cross-over trials (CS1, CS2) were conducted in parallel with healthy term, formula-fed infants aged 9–14 weeks. After a two-week run-in period, infants in CS1 (n = 17) were randomly allocated to receive either a 50% MF-based formula (50MF) or a 100% vegetable fat (VF) formula; in CS2 (n = 18), infants received either a 20% MF-based formula (20MF) or the VF formula, in a 2 × 2-week cross-over design. At the end of each two-week intervention period, stool samples were collected for FA, FA soaps and calcium excretion analysis and stool consistency was assessed according to the Amsterdam Infant Stool Scale (AISS).ResultsMF-based groups showed no significant difference in PA in stools compared to VF group, although reduced stool PA soaps (CS1: 111.28 ± 18.33 vs. 220.25 ± 29.35 mg/g dry weight, p < 0.0001; CS2: 216.24 ± 25.16 vs. 233.94 ± 35.12 mg/g dry weight, p = 0.0023), total FA soaps and calcium excretion (CS1: 46.40 ± 5.27 vs. 49.88 ± 4.77 mg/g dry weight, p = 0.0041; CS2: 46.20 ± 4.26 vs. 50.47 ± 6.71 mg/g dry weight, p = 0.0067) were observed. Furthermore, the 50MF group showed a favourable lower mean stool consistency score compared to the VF group (1.64 ± 0.49 vs. 2.03 ± 0.19, p = 0.0008).ConclusionsWhile the use of bovine MF in IF did not affect PA concentrations in stool, lower excretion of palmitate soaps, total FA soaps and calcium was seen in healthy term infants. 50MF formula also showed improved stool consistency. The use of MF in IF could be an interesting approach to improve gut comfort and stool characteristics in infants, warranting further research.Trial registrationNetherlands Trial Registry Identifier: NTR6702. Date registered: December 01, 2017.

Lactose-reduced infant formula with added corn syrup solids is associated with a distinct gut microbiota in Hispanic infants

ABSTRACT Infant formula feeding, compared with human milk, has been associated with development of a distinct infant gut microbiome, but no previous study has examined effects of formula with added sugars. This work examined differences in gut microbiota among 91 Hispanic infants who consumed human milk [at breast (BB) vs. pumped in bottle (BP)] and 2 kinds of infant formula [(traditional lactose-based (TF) vs. lactose-reduced with added sugar (ASF)]. At 1 and 6 months, infant stool was collected to characterize gut microbiota. At 6 months, mothers completed 24-hour dietary recalls and questionnaires to determine infant consumption of human milk (BB vs. BP) or formula (TF vs. ASF). Linear regression models were used to determine associations of milk consumption type and microbial features at 6 months. Infants in the formula groups exhibited a significantly more ‘mature’ microbiome than infants in the human milk groups with the most pronounced differences observed between the ASF vs. BB groups. In the ASF group, we observed reduced log-normalized abundance of Bifidobacteriaceae (TF-BB Mean Difference = −0.71, ASF-BB Mean Difference = −1.10), and increased abundance of Lachnospiraceae (TF-BB Mean Difference = +0.89, ASF-BB Mean Difference = +1.20). We also observed a higher Community Phenotype Index of propionate, most likely produced by Lachnospiraceae, in the ASF group (TF-BB Mean Difference = +0.27, ASF-BB Mean Difference = +0.36). This study provides the first evidence that consumption of infant formula with added sugar may have a stronger association than birth delivery mode, infant caloric intake, and maternal BMI on the infant’s microbiome at 6 months of age.

Systemic and mucosal levels of lactoferrin in very low birth weight infants supplemented with bovine lactoferrin.

Lactoferrin supplementation may help prevent infections in preterm infants, but the efficacy has varied with different doses and products. We assessed the absorption and excretion of bovine lactoferrin (bLF) in 31 infants receiving 100, 200, or 300 mg·kg-1·day-1 of enteral bLF for 30 days. bLF and human lactoferrin (hLF) in infant saliva, blood, urine, and stool, as well as expressed (EBM) or donor breast milk (DBM) that were collected (i) before the treatment was initiated, (ii) at study day 22, and (iii) one week after treatment cessation, were measured using ELISA. During treatment, bLF was absorbed from the gastrointestinal tract and detected in plasma, saliva, and urine, as well as excreted in stool. Levels of bLF in the saliva and stool began to decline within 12 h after dosing, and bLF was undetectable in all samples one week after treatment. The concentrations of hLF exceeded those of bLF across sample types and time-points. Infants receiving EBM demonstrated higher levels of hLF in the saliva and stool than those receiving DBM. Neither bLF nor hLF levels varied by patient characteristics, bLF dosage, or infection status. This is the first study demonstrating bLF absorption into the bloodstream and distribution to saliva and urine in preterm infants. Future studies should further explore LF pharmacokinetics because higher and more frequent dosing may improve the clinical benefit of LF supplementation.

Effect of donor human milk on host-gut microbiota and metabolic interactions in preterm infants

Human milk is the gold standard for infant nutrition. Preterm infants whose mothers are unable to provide sufficient own mother's milk (OMM), receive pasteurized donor human milk (DHM). We studied metabolic signatures of OMM and DHM and their effect on the interplay of the developing microbiota and infant's metabolism. Metabolic fingerprinting of OMM and DHM as well as infant's urine was performed using liquid chromatography-mass spectrometry and the infant's stool microbiota was analyzed by 16S rRNA sequencing. Significant differences in the galactose and starch and sucrose metabolism pathways when comparing OMM and DHM, and alterations of the steroid hormone synthesis and pyrimidine metabolism pathways in urine were observed depending on the type of feeding. Differences in the gut-microbiota composition were also identified. The composition of DHM differs from OMM and feeding of DHM has a significant impact on the metabolic phenotype and microbiota of preterm infants. Our data help to understand the origin of the observed changes generating new hypothesis: i) steroid hormones present in HM have a significant influence in the activity of the steroid hormone biosynthesis pathway in preterm infants; ii) the pyrimidine metabolism is modulated in preterm infants by the activity of gut-microbiota. Short- and long-term implications of the observed changes for preterm infants need to be assessed in further studies.

Human Milk Bacteria: Seeding the Infant Gut?

Human milk harbors its own microbiota, but whether the microbes seed the infant gut and are modified by breastfeeding practices is unresolved. In this issue, Fehr etal. (2020) sequence breastmilk and infant stool samples from mother-infant dyads to investigate the co-occurrence of milk-gut bacteria and the impact of breastfeeding practices.

Bacteriological and Molecular Characterization of Diarrheagenic Escherichia Coli Pathotypes From Children in Duhok City, Iraq

Background: A variety of diarrheagenic E coli (DEC) are responsible for causing different types of diarrhea in children especially in developing courtiers.&#x0D; Objectives: This study was primarily aimed to isolate and bacteriological characterizing of E coli from diarrheic infant stool and to investigate their antibiotic resistance patterns and then using molecular identification of DEC pathotypes for better discrimination.&#x0D; Methods: Total of 400 fresh stools specimens were collected from children with diarrhea in Heevi Hospital in Duhok city, Iraq. The samples were cultured on selective media such as (MacConkey and MacConkey sorbitol agar). Colonies were identified through biochemical reaction and VITEK 2 system and then antibiotic susceptibility profiles were determined.&#x0D; Results: A total of 349(87.2%) samples were yielded positive for growth of E coli. Out of these, 50 phenotypically-identified E coli were then subjected to PCR assay targeting certain virulence factors (alt, eae, sxt1 and sxt2) for discrimination of pathotyes. 13/50(26%) Enterotoxigenix E. coli (ETEC) was detected, 5/50(10%) Enterohemorrhagic E coli EHEC was detected, while no Enteropathogenic E coli (EPEC) was detected. All pathotypes were more frequent in samples from male children aged between 2-3 years that were artificial feeding pattern. Moreover, all pathotypes expressed high resistant to ampicillin, cephalosporin and tetracycline while little resistance to imipenem was observed. Conclusion: The study concludes presence of diarrheagenic E coli pathotypes in our community causing diarrhea in children and emphasize on using of PCR assay for best discrimination.

Impact of pertussis-specific IgA, IgM, and IgG antibodies in mother's own breast milk and donor breast milk during preterm infant digestion.

Background:The survival of antibody isotypes specific to pertussis toxin (PT) and filamentous hemagglutinin (FHA) from mother’s own milk (MBM) and donor breast milk (DBM) during preterm infant digestion was investigated.Methods:Feed, gastric and stool samples were collected from 20 preterm mother-infant pairs at 8–9 days and 21–22 days postpartum. Samples were analyzed via ELISA for anti-FHA or anti-PT immunoglobulin A (IgA), IgM and IgG.Results:Anti-PT IgA, anti-FHA IgG and anti-PT IgG were lower in MBM than DBM at 8–9 days postpartum, whereas anti-FHA IgM was higher in MBM than DBM. Anti-PT IgA, anti-PT IgG and anti-FHA IgG in DBM decreased in gastric contents at both postpartum times but those antibodies in MBM were stable or increased during gastric digestion. Anti-FHA specific IgA and IgM were higher in gastric contents from infants fed MBM than that fed DBM at 8–9 days. All pertussis antibodies were detected in infant stools at both postpartum times.Conclusion:Pertussis-specific antibodies from MBM were stable during infant digestion, whereas anti-pertussis IgA and IgG from DBM decreased in gastric contents. The constant region and variable region of antibodies and maternal immunization appear to be the critical factors for their stability to proteolytic digestion and pasteurization.

Can a probiotic supplement in pregnancy result in transfer to the neonatal gut: A systematic review.

The establishment of the neonatal gut microbiome is a crucial step that may have lifelong health implications. We aimed to systematically review evidence on maternal probiotic supplementation during pregnancy and vertical transfer of the corresponding strain to the infant gut. Medline, CINAHL, Embase, Web of Science, and OVID were searched from inception to September 2018. Studies of maternal probiotic supplementation for a minimum duration of 2weeks and analyses of neonatal stool samples were included. The primary outcome was presence of the specific probiotic strain in the infant stool. Electronic databases were searched for relevant studies and references were cross-checked. Risk of bias among included studies was assessed and data were extracted independently by two authors. Three studies were included in the review. Only one study was identified involving prenatal maternal probiotic supplementation alone. Neonatal colonization with the maternally administered probiotic was not demonstrated but supplementation with the probiotic influenced levels of a bacterial strain other than that found in the probiotic product. The other two studies identified included both prenatal and postnatal supplementation of either mother or infant. All three studies reported employing strain-specific isolation methodology to isolate the supplemented bacterial strain in infant stool but none used whole metagenome shotgun sequencing. Few studies investigating transfer of a specific probiotic bacterial strain from mother to infant were identified, showing inconclusive evidence of vertical transfer.

Bacterial Co-Occurrence Patterns Between Human Milk and Microbial Sites of Breastfeeding Dyads

Abstract Objectives The human milk (HM) microbiota is predicted to originate from the maternal gastrointestinal tract, saliva and breast skin, and infant saliva. Though compositionally distinct, these habitats are strongly associated during breastfeeding. Vertical microbial transmission from mother to infant has been documented, but complex microbial interactions between sites are less clear. Herein, ecological networks between HM bacteria and other microbial sites of breastfeeding dyads were assessed to investigate the origin of the HM microbiota and how it may shape the infant gut microbiota. Methods DNA was extracted from maternal and infant saliva, HM, breast skin, and maternal and infant stool samples collected at 6 weeks postpartum from 33 mother-infant pairs. The V3-V4 region of the 16S rRNA gene was sequenced and taxonomy was assigned using QIIME 2. Co-occurrence patterns among genus-level abundance data were analyzed in CoNet (Cytoscape 3.0). Results Twenty-one significant co-presence relationships were identified between HM and other microbial communities. Associations spanned from six nodes in HM including Corynebacterium, Cutibacterium, Gemella, Rothia, Veillonella, and Actinomyces. Co-presence between Cutibacterium, Veillonella, Actinomyces, and Corynebacterium on skin and HM were identified, supporting breast skin as a principal contributor to the HM microbiota. Interestingly, Bifidobacterium in infant saliva was associated with Gemella and Rothia in HM. The greatest number of relationships existed between HM and infant stool. HM Gemella, Actinomyces, and Corynebacterium were associated with Bacteroides in infant stool; HM Actinomyces was also associated with infant fecal Escherichia-Shigella and Eggerthella. Additional relationships were identified between HM and maternal saliva and fecal microbiota. Conclusions Several unique ecological relationships exist between HM and microbial sites of breastfeeding dyads. Whether these relationships are indicative of proximity, mutualism, or are biomarkers of other host-microbe interactions remains to be determined. These data will be useful to uncover mechanisms driving microbial community organization and potential targets for microbial modulation in this population. Funding Sources National Dairy Council, NIH, The Gerber Foundation, The Doris Kelley Christopher Foundation.

Maternal Adherence to a Dairy-free Mediterranean Diet and Symptoms of Colic and Allergy in Exclusively Breastfed Infants: A Randomized-Controlled Study

Abstract Objectives Colic and allergy symptoms are problems encountered in the exclusively-breastfed newborn and are thought to be triggered by inflammatory responses in the gut. Maternal diet, especially cow's milk intake, has been associated with infantile colic and allergies, but no study examined the effect of Mediterranean diet. Thus, this study aims to investigate whether maternal adherence to a dairy-free Mediterranean diet, known for is anti-inflammatory properties, reduces colic and allergy symptoms in exclusively-breastfed infants. Methods Exclusively breastfeeding healthy primiparous women were recruited during their pregnancy third trimester and were randomly assigned to receive an education on dairy-free Mediterranean diet or no education (control group). Mother-infant pairs were followed up for 2 months postpartum and adherence to the diet was confirmed through 24 hour recalls. Data on infant fussing &amp; crying using validated “Daily Crying Diary” (Barr, et al., 1988) and allergy symptoms using validated CDC's “Breastfeeding and Infant Feeding Practices postnatal questionnaire” (Centers for Disease Control and Prevention, 2017) were collected on weeks 2, 4 and 7 postpartum. Infant stool samples were also collected to test for blood, pH, and eosinophil cationic protein as estimates of the degree of inflammation in the gut. Results Preliminary data from 10 mother-infant pairs showed that there was no group differences in the weights of the mothers and infants and number of allergy symptoms throughout the study. Colic (defined by the “Wessel Criteria” as crying episodes that last for &amp;gt;3 hours per day, for ≥3 days per week and for ≥3 weeks) was not observed in any infant. Findings from “Daily Crying Diaries” revealed that maternal adherence to dairy-free Mediterranean diet was associated with significantly lower average daily crying compared to controls (0.28 vs. 1.10 hours/d) in infants. Results on infant stool blood, pH, and eosinophil cationic protein are still pending. Conclusions Maternal adherence to a dairy-free Mediterranean diet did not affect allergy symptoms but decreased fussing and crying in exclusively breastfed infants. Mechanisms of action still remain to be determined. Funding Sources Lebanese American University.

Stool Composition and GI Tolerance in Infants Fed a Term Infant Formula with a New Lipid Blend and Lactobacillus reuteri (L.reuteri): A Randomized Controlled Trial

Abstract Objectives Differences in dietary fat and calcium absorption between breastfed and formula-fed infants may impact gastrointestinal (GI) tolerance and stooling patterns. We hypothesized that infant formula containing L. reuteri and a new lipid blend with low levels of long-chain saturated fatty acids (LCSFAs) (&amp;lt;13% of triacylglycerols [TAG]) in sn-1,3 positions would result in reduced stool calcium-fatty acid (Ca-FA) soaps and improved stool consistency. Methods Healthy term infants 21–28 days (d) of age were randomized in a double-blind manner to receive intact protein cow's milk-based experimental formula (EF, n = 70) with new lipid blend and L. reuteri at 1 × 10,7 CFU/g or control formula (CF, n = 70) without probiotic and containing a lipid blend with high levels of LCSFAs (∼25% of TAG) in sn-1,3 positions until 3 months (m) of age. A breastfed (BF, n = 75) reference group was also included. Co-primary endpoints were stool consistency (via 3-day diary using validated scale from 1 = watery to 5 = hard) and stool total Ca-FA soaps (expressed as mg/g dry stool weight). Overall GI tolerance was assessed using a validated Infant Gastrointestinal Symptoms Questionnaire (IGSQ) (score range: 13 [no GI distress] - 65 [extreme GI distress]). Results Of 215 enrolled infants, 206 completed the study. Infants fed EF had softer stools vs those fed CF by age 1.5 m (stool consistency score: 2.6 ± 0.1 vs 3.0 ± 0.1, P &amp;lt; .0001) and similar to BF (2.7 ± 0.1, P = .089). This positive effect was sustained until age 3 m (EF vs CF, P = .0006; EF vs BF, P = .373; CF vs BF, P = .014), without increased stool frequency in EF vs CF group throughout the study (1.48 vs 1.50 stools/d, P = .884). Infants fed EF (vs CF) had lower stool total Ca-FA soaps at 3 m of age (60.3 ± 10.1 vs 207.9 ± 10.1, P &amp;lt; .0001), largely explained by stool palmitate soaps which was 7 times lower in EF vs CF (20.7 ± 7.0 vs 142.5 ± 6.9 for CF, P &amp;lt; .0001). Mean IGSQ scores remained very low in EF (≤16.2) and CF (≤15.6) groups over the study period. Incidences of parent-reported GI symptoms and physician-confirmed GI adverse events (including diarrhea) were low and similar for EF and CF groups. Conclusions Infant formula containing L. reuteri and enhanced lipid blend with reduced LCSFAs in sn-1,3 positions reduces stool soaps and promotes softer stools closely resembling the stools of breastfed infants. Funding Sources Sponsored by Nestle Nutrition.

Maternal Pre-Pregnancy Body Mass Index and Gestational Weight Gain Are Associated with Differences in Infant Gut Microbiota: Results from Brazilian Prospective Birth Cohort

Abstract Objectives To evaluate the association of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on infant gut microbiota diversity and abundance and the role of breastfeeding on this association. Methods Prospective cohort conducted in Rio de Janeiro, Brazil. Maternal pre-pregnancy BMI (&amp;lt; 25; ≥ 25 kg/m², normal/excessive) and GWG adequacy (adequate; excessive) were the exposures and breastfeeding practice status (exclusively breastfeeding EBF; predominant/complementary feeding PCF) was analyzed as an effect modifier. Infant stool samples were collected for 56 infants between 26–45 days. Samples were sequenced using 16S rRNA gene sequencing (MiSeq). Analysis included alpha diversity indexes (Shannon, Faith-PD, and Observed species), beta diversity metrics and Wilcoxon-Mann-Whitney Test, linear regression, permutational multivariate analysis of variance and linear discriminant analysis effect size. Results A higher median alpha diversity in infants born from mothers with excessive GWG was observed (Mann-Whitney Test: P = 0.005) and infants born from mothers with excessive GWG were positively associated with alpha diversity (β = 0.351; SE = 0.146; p-value = 0.020). Gut microbiota of infants born from mothers with excessive pre-pregnancy BMI were enriched with Dialister genus and Lactobacillus Ruminis, Haemophilus Parainfluenzae and Veillonella Parvula species and those born from mother with excessive GWG had higher abundance of Staphylocococcus genus, Staphylococcaceae family, Bacillales order and Bacilli class. Infant gut microbiota diversity and abundance did not differ according to combined categories of pre-pregnancy BMI and breastfeeding status and GWG and breastfeeding. Conclusions Maternal gestational weight gain was associated with diversity of the infant gut microbiota. Breastfeeding did not an effect modifier in this association. Funding Sources Foundation for the Support of Research of the State of Rio de Janeiro, National Council for Scientific and Technological Development and Columbia University Grant.

Bifidobacterium from infant stool: the diversity and potential screening

Abstract. Kusharyati DF, Pramono H, Ryandini D, Manshur TA, Dewi MA, Khatimah K, Rovik A. 2020. Bifidobacterium from infant stool: the diversity and potential screening. Biodiversitas 21: 2506-2513. Bifidobacteria spp. are a group of Lactic Acid Bacteria commonly found in the gastrointestinal tract of adults and infants. LAB are known as probiotics and have many health benefits. This research aimed to isolate Bifidobacteria from infant stool, identify, explore their diversity, and screen their potential as probiotics. Stool samples were collected from 3 healthy infants in Banyumas Regency. The potential screening included lysozyme resistance, antimicrobial activity, and exopolysaccharide production. A total of 7 Bifidobacterium species were isolated from infant stool: B. catenulatum, B. minimum, B. indicum, B. dentium, B. asteroides, B. galicum, and B. coerinum. B. indicum isolates (Bb3F and Bb1B) had the greatest inhibition activity against Escherichia coli and Candida albicans with 10.80 and 9.70 mm, respectively. Bifidobacteria isolates were resistant to lysozyme from egg whites up to 200 µg.mL-1. B. catenulatum Bb1A isolate had the highest yield of exopolysaccharide production with 74 mg.L-1. Among them, three Bifidobacterium strains (Bb1B, Bb2A, and Bb2E) were considered potentially as probiotics.

Fish oil supplementation reduces maternal defensive inflammation and predicts a gut bacteriome with reduced immune priming capacity in infants.

Habitual supplementation of fish oil is thought to provide benefits to the developing infant; however, the effects on infant microbial establishment and immune development are unknown. A 6-month observational cohort study was conducted where 47 out of 91 women self-administered dietary fish oil during breastfeeding. Infant stool and mothers' breast milk were collected each month over 6 months. Gas chromatography was used to quantify breast milk fatty acids and high-throughput sequencing was used to assess the infant fecal microbiota. Immune markers and parent-reported questionnaires were used to assess infant immunity and health up to 2 years. Our results reveal that fish oil supplementation decreased secretory immunoglobulin A and increased IL-10 production in lactating women along with increased breast milk eicosapentaenoic acid, and this corresponded to increased abundances of fecal Bifidobacterium and Lactobacillus spp. in their infants. Docosahexaenoic acid levels in breast milk aligned with decreases in infant gut bacterial richness and the predicted bacterial phenotypes suggested that fish oil lowers commensal traits involved in pathogen colonization resistance. Despite this, there were no differences in sickness incidence in toddlers. This study revealed that fish oil associates with decreases in breast milk defensive inflammatory responses and corresponds with infant fecal microbiota with anti-inflammatory potential.

Risk factors and transmission pathways associated with infant Campylobacter spp.prevalence and malnutrition: A formative study in rural Ethiopia.

Early infection from enteropathogens is recognised as both a cause and effect of infant malnutrition. Specifically, evidence demonstrates associations between growth shortfalls and Campylobacter infection, endemic across low-income settings, with poultry a major source. Whilst improvements in water, sanitation and hygiene (WASH) should reduce pathogen transmission, interventions show inconsistent effects on infant health. This cross-sectional, formative study aimed to understand relationships between infant Campylobacter prevalence, malnutrition and associated risk factors, including domestic animal husbandry practices, in rural Ethiopia. Thirty-five households were visited in Sidama zone, Southern Nations, Nationalities and Peoples' region. Infant and poultry faeces and domestic floor surfaces (total = 102) were analysed for presumptive Campylobacter spp. using selective culture. Infant anthropometry and diarrhoeal prevalence, WASH facilities and animal husbandry data were collected. Of the infants, 14.3% were wasted, 31.4% stunted and 31.4% had recent diarrhoea. Presumptive Campylobacter spp. was isolated from 48.6% of infant, 68.6% of poultry and 65.6% of floor surface samples. Compared to non-wasted infants, wasted infants had an increased odds ratio (OR) of 1.41 for a Campylobacter-positive stool and 1.81 for diarrhoea. Positive infant stools showed a significant relationship with wasting (p = 0.026) but not stunting. Significant risk factors for a positive stool included keeping animals inside (p = 0.027, OR 3.5), owning cattle (p = 0.018, OR 6.5) and positive poultry faeces (p<0.001, OR 1.34). Positive floor samples showed a significant correlation with positive infant (p = 0.023), and positive poultry (p = 0.013, OR 2.68) stools. Ownership of improved WASH facilities was not correlated with lower odds of positive stools. This formative study shows a high prevalence of infants positive for Campylobacter in households with free-range animals. Findings reaffirm contaminated floors as an important pathway to infant pathogen ingestion and suggest that simply upgrading household WASH facilities will not reduce infection without addressing the burden of contamination from animals, alongside adequate separation in the home.