Neonatal Colonization Research Articles

Early Microbial-Immune Interactions and Innate Immune Training of the Respiratory System during Health and Disease.

Over the past two decades, several studies have positioned early-life microbial exposure as a key factor for protection or susceptibility to respiratory diseases. Birth cohorts have identified a strong link between neonatal bacterial colonization of the nasal airway and gut with the risk for respiratory infections and childhood asthma. Translational studies have provided companion mechanistic insights on how viral and bacterial exposures in early life affect immune development at the respiratory mucosal barrier. In this review, we summarize and discuss our current understanding of how early microbial–immune interactions occur during infancy, with a particular focus on the emergent paradigm of “innate immune training”. Future human-based studies including newborns and infants are needed to inform the timing and key pathways implicated in the development, maturation, and innate training of the airway immune response, and how early microbiota and virus exposures modulate these processes in the respiratory system during health and disease.

Group B streptococcus neonatal umbilical colonization managed by dry cord care in nurseries: A retrospective cohort study

Screening-based intrapartum antibiotic prophylaxis (IAP) has reduced the prevalence of early-onset group B Streptococcus (GBS) infection in newborns. Nevertheless, early-onset disease still occurs despite IAP, and IAP is not effective in preventing late-onset disease. This study aimed to determine the prevalence and risk factors of GBS neonatal umbilical colonization managed by dry cord care in Japan. Of 735 healthy newborns in the well-baby nursery at Saitama City Hospital, 353 from whom umbilical bacterial swabs were obtained before discharge were included in the analysis. Maternal and neonatal clinical characteristics were retrospectively reviewed. GBS was detected in 4.2% (15/353) of umbilical swabs; 13/15 (86.8%) were born to GBS-negative mothers. The median (IQR) age at umbilical swab collection was 4.0 (4.0-5.0) days. Comparison of clinical characteristics between GBS-positive and negative neonates revealed a significant difference in the proportion of vaginal deliveries (15/15 [100%] in GBS-positive neonates vs. 115/338 [34.0%] in GBS-negative neonates, p<0.0001). Of 15 GBS-positive neonates, 10 (66.7%) were also co-colonized with other enteric bacteria such as Escherichia coli. Vaginal delivery was a risk factor associated with GBS neonatal umbilical colonization in Japanese neonates. Co-colonization with multiple enteric bacterial species implicates vertical transmission of GBS from undetected carrier mothers during passage through the birth canal.

Carbapenemase-Producing Enterobacteriaceae (CPE) Newborn Colonization in a Portuguese Neonatal Intensive Care Unit (NICU): Epidemiology and Infection Prevention and Control Measures.

Infections due to carbapenemase-producing Enterobacterales (CPE) are increasing worldwide and are especially concerning in a neonatal intensive care unit (NICU). Risk factors for CPE gut colonization in neonates need to be clarified. In this work, we describe the epidemiological and clinical features of CPE-colonized newborns and the infection control measures in a Portuguese NICU. We performed a prospective, observational, longitudinal, cohort study for surveillance of CPE colonization. Maternal and neonatal features of colonized newborns and surveillance strategy were described. A statistical analysis was performed with SPSS23.0, and significance was indicated by p-value ≤ 0.05. Between March and November 2019, CPE was isolated in 5.8% of 173 admitted neonates. Carbapenemase-producing Klebsiella pneumoniae were the most frequently isolated. There was no associated infection. Birth weight, gestational age, length of stay, and days of central line were the identified risk factors for CPE colonization (bivariate analysis with Student’s t-test or Mann–Whitney U test, according to normality). No independent risk factors for CPE colonization were identified in the logistic regression analysis. CPE colonization risk factors are still to be determined accurately in the neonatal population. Active surveillance and continuous infection control measures restrained the current cluster of colonized newborns and helped to prevent infection and future outbreaks.

Early life administration of milk fat globule membrane promoted SCFA-producing bacteria colonization, intestinal barriers and growth performance of neonatal piglets.

Milk fat globule membrane (MFGM) possesses various nutritional and biological benefits for mammals, whereas its effects on neonatal gut microbiota and barrier integrity remained unclear. This study investigated the effects of MFGM administration on microbial compositions and intestinal barrier functions of neonatal piglets. Sixteen newborn piglets were randomly allocated into a CON group or MFGM group, orally administered with saline or MFGM solution (1 g/kg body weight) respectively during the first postnatal week, and all piglets were breastfed during the whole neonatal period. The present study found that the MFGM oral administration during the first postnatal week increased the plasma immunoglobulin (Ig) G level, body weight and average daily gain of piglets (P < 0.05) on 21 d. Additionally, MFGM administration enriched fecal SCFA-producing bacteria (Ruminococaceae_UCG-002, Ruminococaceae_UCG-010, Ruminococaceae_UCG-004, Ruminococaceae_UCG-014 and [Ruminococcus]_gauvrearuii_group), SCFA concentrations (acetate, propionate and butyrate; P < 0.05) and their receptor (G-protein coupled receptor 41, GPR41). Furthermore, MFGM administration promoted intestinal villus morphology (P < 0.05) and barrier functions by upregulating genes of tight junctions (E-cadherin, claudin-1, occludin and zonula occludin 1 [ZO-1]), mucins (mucin-13 and mucin-20) and interleukin (IL)-22 (P < 0.05). Positive correlation was found between the beneficial microbes and SCFA levels pairwise with the intestinal barrier genes (P < 0.05). In conclusion, orally administrating MFGM during the first postnatal week stimulated SCFA-producing bacteria colonization and SCFA generation, enhanced intestinal barrier functions and consequently improved growth performance of neonatal piglets on 21 d. Our findings will provide new insights about MFGM intervention for microbial colonization and intestinal development of neonates during their early life.

Ascertaining the Prevalence of Group B Streptococcal Infection in Patients with Preterm Premature Rupture of Membranes: A Cross-Sectional Analysis from Pakistan.

IntroductionLiterature has shown varying results regarding the presence of group B Streptococcal (GBS) infection in pregnant females with preterm premature rupture of membranes (PPROM). The infection can be detrimental to maternal and neonatal well-being. There is a lack of studies that showed the extent of this problem in the local population of Pakistan. Our study aims to determine the frequency of GBS infection in females with PPROM.MethodsThis cross-sectional study was conducted at the Department of Obstetrics & Gynecology, Lahore General Hospital, Pakistan for six months. Informed consent was obtained from each patient. Demographic data were also recorded. Then the amniotic fluid sample was taken during a vaginal examination and was sent to the laboratory of the hospital for assessment of the presence or absence of GBS. Reports were assessed for GBS infection. Baseline demographics including age, body mass index (BMI), parity, and gestational age were presented as mean and standard deviation. Categorical data like parity and GBS infection were presented as frequency and percentage.ResultsThe mean age of women was 30.04 ± 6.75 years. The mean gestational age of patients was 34.51 ± 1.75 weeks. Among 150 women, GBS infection was diagnosed in 24 (16%) patients. The occurrence of GBS infection was significantly associated with the age and parity status of women (p < 0.05). However, it was not significantly associated with gestational age and BMI of women (p > 0.05).ConclusionOur study showed a low prevalence of GBS infection in females presenting with PPROM. Nonetheless, the presence of infection can lead to detrimental outcomes including neonatal and maternal sepsis. The rate and risk factors of maternal and neonatal GBS colonization may vary in different communities. These rates, as well as the incidence of neonatal disease, need to be thoroughly evaluated to develop appropriate strategies for prevention.

NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit

BackgroundContamination of the hospital environment contributes to neonatal bacterial colonization and infection. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings.MethodsA quasi-experimental study was conducted to assess the impact of a multimodal cleaning intervention for surfaces and equipment in a 30-bed neonatal ward. The intervention included cleaning audits with feedback, cleaning checklists, in-room cleaning wipes and training of staff and mothers in cleaning methods. Cleaning adequacy was evaluated for 100 items (58 surfaces, 42 equipment) using quantitative bacterial surface cultures, adenosine triphosphate bioluminescence assays and fluorescent ultraviolet markers, performed at baseline (P1, October 2019), early intervention (P2, November 2019) and late intervention (P3, February 2020).ResultsEnvironmental swabs (55/300; 18.3%) yielded growth of 78 potential neonatal pathogens with Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii predominating. Highest aerobic colony counts were noted from moist surfaces such as sinks, milk kitchen surfaces, humidifiers and suction tubing. The proportion of surfaces and equipment exhibiting no bacterial growth increased between phases (P1 = 49%, P2 = 66%, P3 = 69%; p = 0.007). The proportion of surfaces and equipment meeting the ATP “cleanliness” threshold (< 200 relative light units) increased over time (P1 = 40%, P2 = 54%, P3 = 65%; p = 0.002), as did the UV marker removal rate (P1 = 23%, P2 = 71%, P3 = 74%; p < 0.001).ConclusionRoutine environmental cleaning of this neonatal ward was sub-optimal at baseline but improved significantly following a multimodal cleaning intervention. Involving mothers and nursing staff was key to achieving improved environmental and equipment cleaning in this resource-limited neonatal unit.

Predominance of III/ST19 and Ib/ST10 Lineages With High Multidrug Resistance in Fluoroquinolone-Resistant Group B Streptococci Isolates in Which a New Integrative and Conjugative Element Was Identified.

Fluoroquinolone (FQ)-resistant Group B Streptococcus (GBS) has been reported with considerable cross-resistance, worsening the crisis of multidrug-resistant (MDR) GBS in clinical settings. However, national epidemiological data on FQ-resistant GBS in mainland China have not been well-characterized. This study aimed to determine the prevalence of FQ resistance among GBS from neonatal invasive infections and maternal colonization in northern and southern China, to investigate the serotyping, multilocus sequence typing, and antibiotic cross-resistance, and to characterize the mutations in gyrA and parC genes in quinolone resistance-determining region (QRDR). In order to provide a comprehensive view of the location and structure of resistance genes, whole-genome sequencing on III/ST19 MDR isolates were performed. Among 426 GBS, 138 (32.4%) were FQ resistant, with higher prevalence in northern China than in southern China in both neonates (57.8%, 37/64 vs. 21.7%, 39/180) and pregnant women (50.9%, 29/57 vs. 26.4%, 33/125). Serotypes were distributed as III (48.5%), Ib (39.9%), V (6.5%), and Ia (5.1%). Sequence types were mainly ST19 (53.6%) and ST10 (39.1%), followed by ST12 (1.4%), ST17 (1.4%), ST23 (1.4%), and 0.7% each of ST27, ST188, ST197, and ST597. ST19 isolates were more prevalent in southern China than in northern China in both neonates (64.1%, 25/39 vs. 27.0%, 10/37) and pregnant women (81.8%, 27/33 vs. 41.4%, 12/29), whereas ST10 isolates were more common in northern China than in southern China in both neonates (64.9%, 24/37 vs. 20.5%, 8/39) and pregnant women (58.6%, 17/29 vs. 15.2%, 5/33). Serotype III isolates were mainly ST19 (89.6%, 60/67), while Ib isolates were largely ST10 (94.5%, 52/55). Sequencing data revealed several mutations in QRDR, including Ser81Leu in gyrA (99.2%, 130/131), Ser79Phe or Tyr in parC (76.2%, 48/63), and a previously unreported Ile218Thr and Ile219Phe double mutation pattern (49.2%, 31/63) in parC. ST10 isolates were associated with Ser79Phe (84%, 21/25), while ST19 isolates were limited to Ser79Tyr (95.7%, 22/23). A new integrative and conjugative element (ICE) harboring tetM and gyrA genes was identified in a III/ST19 isolate. This study investigates the molecular characteristics of FQ-resistant GBS in northern and southern China, emphasizing the need for continuous surveillance geographically and further research to characterize the mechanisms of ICE transfer.

Characterisation of CandidaColonisation in Neonates

Introduction: The occurrence of invasive fungal infections has increased significantly worldwide, premature infants in Neonatal Intensive Care Unit (NICU) along with other risk factors are at particular risk of these invasive fungal infections which lead to fungal septicaemia in newborns. Candidaemia is the most common form of invasive candidiasis associated with an unacceptably high mortality rates. Candida colonisation in neonates is considered the first step towards developing neonatal sepsis. Aim: To determine the prevalence of Candida colonisation and its characterisation among neonates admitted in NICU. Materials and Methods: The present study was a prospective cross-sectional study with 150 neonates included in the study. Swabs were taken from four different sites of each neonate and inoculated on Chocolate agar and Sabouraud’s Dextrose Agar (SDA) and incubated at 37°C for seven days. Candida species isolated were confirmed by gram stain, germ tube test, growth on Chromogenic (CHROM) agar and cornmeal agar. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 11.0. Results: A total of 32 (21.3%) neonates had Candida colonisation. Twenty two (68.7%) were low birth weight and 24 (75%) were born premature. Perineum was the most common (56%) site of colonisation. Among Candida isolates, Candida tropicalis(63%) was the commonest followed by Candida parapsilosis(25%) and Candida glabrata and Candida albicans (6%). The risk factors identified were low birth weight, premature birth, use of antibiotics. Conclusion: Colonisation of preterm and low birth weight neonates by Candida species is a major risk factor and needs attention to avoid dissemination and life threatening infection.

Intestinal Inflammation Breaks Established Immune Tolerance to a Skin Commensal

Author(s): Merana, Geil Ramvielle | Advisor(s): Lowell, Clifford | Abstract: The gut and skin are major barrier tissues that house microbial communities capable of influencing host immunity. Under homeostatic conditions, resident microbes at each of these two sites are thought to have a dominant impact on local immune cell function. However, the prevalence of neutrophilic skin disorders among patients with Inflammatory Bowel Disease suggests that this compartmentalized control may not hold under disease conditions. We hypothesized that an altered immune response to gut-resident microbes during colitis may facilitate excessive inflammation directed at skin commensals. Using an established model, wherein neonatal colonization by Staphylococcus epidermidis facilitates development of adaptive immune tolerance and enrichment in S. epidermidis-specific CD4+ regulatory T cells (Tregs), we asked whether this tolerance to skin bacteria can be perturbed in the context of gut inflammation. Induction during adulthood of either chemically or genetically-mediated colitis, but not systemic inflammation alone, led to reduced percentages of S. epi-specific Tregs in skin and skin-draining lymph nodes (LN) and an increase in skin neutrophils. Intestinal presence of S. epidermidis and reduced percentages of S. epidermidis-specific Tregs at this site during colitis suggested initiation of this altered response in the gut. Consistent with this, adoptive transfer and photoconversion experiments revealed a colitis-induced increase in CD4+ T cell trafficking from gut-draining LN to skin-draining LN. Recovery in the percentage of S. epidermidis-specific Tregs in colitic Cd4creIl1r1fl/fl mice further indicated a role for circulating IL-1 cytokines in shifting the CD4+ skin commensal response during colitis. Collectively, these results identify a context in which there is breakdown in homeostatic separation of skin and gut host-microbe interactions and provide mechanistic insight into observed connections between inflammatory skin and intestinal diseases.

1378. Reservoirs of Transmission of Resistant Gram-negative Pathogens Responsible for Neonatal Sepsis among Hospitalized Neonates in Pune, India

BackgroundNeonatal infections with resistant Gram-negative (GN) organisms are associated with high rates of mortality, with limited antibiotic treatment options. The role of maternal colonization and environmental GN organisms as reservoirs for transmission to neonates has not been well described.MethodsWe performed a prospective cohort study from October 12, 2018, until October 31, 2019, to describe the role of maternal and environmental GN colonization in BSI among neonates admitted to the neonatal intensive care unit (NICU) at a tertiary care center in Pune, India. Women admitted to Labor & Delivery with risk factors for neonatal sepsis who provided consent were enrolled and their neonates were followed until hospital discharge. For neonates who developed bloodstream infection (BSI), colonization with resistant GN organisms was assessed in their mothers from frozen vaginal and rectal swabs collected at enrollment and at delivery and in the neonates from frozen skin swabs and peri-rectal swabs collected at day of life (DOL) 0, 3, 7, and weekly until discharge. Environmental colonization was assessed with weekly sampling of unit sinks and the immediate neonatal care environment. Colonization samples were processed to identify organisms that matched neonatal blood culture isolates.Results953 women were enrolled, of whom 741 (78%) received antepartum antibiotics. Among 987 live born neonates, 12 (1%) died in the delivery room and 257 (26%) required NICU admission. Among neonates admitted to the NICU, 143 (56%) had at least one blood culture, of which 28 (20%) were positive; 21 (75%) had a GN BSI. The most common cause of neonatal BSI was Klebsiella pneumoniae, and 8 (38%) GN BSI were due to a carbapenem-resistant organism. No organism isolated from maternal samples matched organism and resistance pattern from neonatal blood culture. Matching strains were found in unit sinks and neonatal rectal and skin samples (Figure 1).Organism recovery from swabs and match to bloodstream isolate by sample source and time of collection from birth ConclusionAmong neonates born to mothers with risk factors for neonatal sepsis, GN organisms were the most common cause of neonatal BSI. Environmental and neonatal colonization may represent important reservoirs of transmission for these pathogens among neonates hospitalized in a tertiary care NICU in Pune, India.Disclosures All Authors: No reported disclosures

Neonatal Oral Colonization with Candida in Jos, North-Central Nigeria

Candida tropicalis exists as part of the community of fungi that colonize the oral cavity. The acquisition of the oral colonizers may be altered by factors such as pregnancy events and outcomes, mode of delivery. This pilot study aimed to determine the Candida species that colonize the oral cavity of neonates and some maternal/neonatal factors that affect neonatal oral colonization. This was a cross sectional study in three tertiary health care facility in Jos, North-Central Nigeria. Oral swab samples were collected from the neonates and processed using both phenotypic and molecular techniques. The rate of neonatal oral colonization was 6.9%. The four Candida species isolated and characterized were Candida tropicalis as confirmed by sequencing and phylogenetic analysis. Candida tropicalis is one of the major neonatal oral colonizers. This pilot study emphasizes the need for routine determination of common agents of oral colonization to predict the impact on adult health.

Neonatal gut colonization by Bifidobacterium is associated with higher childhood cytokine responses

ABSTRACT The gut microbiota is a major stimulus for the immune system, and late acquisition of bacteria and/or reduced complexity of the gut flora may delay adaptive immune maturation. However, it is unknown how the gut bacterial colonization pattern in human infants is related to T cell activation during early childhood. We followed 65 Swedish children in the FARMFLORA cohort, from birth up to 3 years of age. In fecal samples collected at several time points during the first year of life, the gut colonization pattern was investigated with the use of both 16S rRNA next generation sequencing (NGS) and culture-based techniques. This was related to production of IL-13, IL-5, IL-6, TNF, IL-1β and IFN-γ by PHA-stimulated fresh mononuclear cells and to proportions of CD4+ T cells that expressed CD45RO at 36 months of age. Both NGS and culture-based techniques showed that colonization by Bifidobacterium at 1 week of age associated with higher production of IL-5, IL-6, IL-13, TNF and IL-1β at 36 months of age. By contrast, gut colonization by Enterococcus, Staphylococcus aureus or Clostridium in early infancy related inversely to induced IL-13, IL-5 and TNF at 3 years of age. Infants with elder siblings produced more cytokines and had a larger fraction of CD45RO+ T cells compared to single children. However, controlling for these factors did not abolish the effect of colonization by Bifidobacterium on immune maturation. Thus, gut colonization in early infancy affects T cell maturation and Bifidobacterium may be especially prone to induce infantile immune maturation.

Fatores associados ao estabelecimento da microbiota intestinal neonatal – um estudo de evidências

RESUMO: O trato intestinal de um indivíduo é formado por inúmeros microrganismos que, em conjunto, formam a microbiota intestinal, e que atuam auxiliando em diversas funções metabólicas e imunológicas. Dessa forma, sua formação se inicia muito antes do nascimento e continua se fixando ao longo da vida, especialmente durante a infância, período em que as funções intestinais ainda são imaturas. O presente trabalho teve como objetivo analisar os fatores associados ao estabelecimento da microbiota intestinal de neonatos. Foi realizado um estudo do tipo descritivo, tipo revisão integrativa de literatura, com busca de artigos, em janeiro de 2020, nas bases de dados LILACS, MEDLINE e biblioteca eletrônica SciELO, por meio dos termos "Growth &amp; Development", "Gastrointestinal Microbiome" e Newborn. Dos noventa e cinco artigos resgatados, incluíram-se dezessete estudos com publicação entre 2014 e 2019. Esses estudos revelaram que fatores, tais como tipo de parto, dieta infantil, suplementação com probióticos e prebióticos, uso de antibióticos e idade gestacional, estão associados ao processo de estabelecimento da microbiota intestinal neonatal. Ao analisar esses fatores, infere-se que colonização intestinal neonatal adequada está associada ao aleitamento materno exclusivo, parto normal, suplementação com prebióticos e probióticos, enquanto o parto cirúrgico, uso de fórmulas, antibióticos e maior tempo de internação hospitalar, contribuem para uma microbiota rica em microrganismos potencialmente patogênicos.&#x0D; PALAVRAS-CHAVE: Microflora Intestinal; Neonatos; Crescimento e Desenvolvimento.

Bathing or Not Bathing: Which Is Better for Umbilical Cord Separation Time and Bacterial Colonization in Neonates?

Background: Sepsis is the third cause of death in the first month of life, and the umbilical cord is an important source for sepsis Objectives: We compared the effects of bathing or not bathing on bacterial colonization and cord separation time. Methods: A quasi-experimental study assessed term newborns at Golestan hospital, Tehran, Iran, from 2019 to 2020 in three groups. Bath (B) group included neonates who were bathed with tub water every two days (n = 90). Clean product (CP) group neonates were bathed with cleaners every two days (n = 87). Dry care cord (D) group neonates were not bathed during the first 10 days (n = 63). Periumbilical cord swabs were collected on the 10th day and cultured in blood agar and Eosin methylene blue agar. Bacterial sensitivity tests were done by disk diffusion. Results: The average time to cord separation was 8.2 ± 1.74 days (group B: 9.1 ± 2.1 days, group CP: 8.7 ± 1.82 days, group D: 6.8 ± 1.3 days), which was shorter in group D (P= 0.048). The positive culture rates were 77.8% in group B, 78.1% in group CP, and 74.6% in group D, which were not significantly different between the groups (P = 0.073). Staphylococcus aureus was the most common isolated species. Staphylococcus epidermis and Escherichia coli were the other most common species. Conclusions: Bathing with or without cleaners is safe. No-bath and water bath with or without cleaners had no difference in the rate and type of bacterial culture in umbilical cord but the cord separation time was shorter in the no-bath group. Therefore, in the first week, if a mother does not believe in bathing her baby, she should not be denounced and told that she did something wrong with cord hygiene.

Association of Obesity With Maternal and Cord Blood Penicillin Levels in Women With Group B Streptococcus Colonization.

To compare maternal and cord blood penicillin concentrations in women with and without obesity who are receiving intrapartum group B streptococcus (GBS) prophylaxis. We performed a prospective cohort study of term women receiving intrapartum penicillin prophylaxis for GBS colonization (determined by antenatal rectovaginal culture). The following outcomes were compared between obese (body mass index [BMI] 35 or higher at delivery) and nonobese (BMI less than 30 at delivery) groups: penicillin concentration in maternal blood (after two penicillin doses) and umbilical cord blood, GBS rectovaginal colonization status on admission and after two completed doses, and neonatal GBS colonization (using a postnatal ear swab). Fifty-five women were needed to detect a 0.75 SD difference in cord blood penicillin concentrations. Fifty-five women were enrolled and had all specimens collected; 49 had complete data for analysis (obese n=25, nonobese n=24). There was no difference in the median maternal penicillin concentration between groups (obese 4.2 micrograms/mL vs nonobese 4.0 micrograms/mL, P=.58). There was, however, a 60% lower median cord blood penicillin concentration in the obese compared with the nonobese group (2.7 micrograms/mL vs 6.7 micrograms/mL, respectively, P<.01), with no significant difference in time from last penicillin dose to delivery (obese 2.9 hours vs nonobese 1.7 hours, P=.07). The difference in cord blood concentrations remained significant after adjustment for nulliparity, hypertensive disorders, and time from last penicillin dose to delivery. Only 59.6% of women tested positive for GBS by rectovaginal culture on admission (obese 60.9% vs nonobese 58.3%, P=.86). The median cord blood penicillin concentration was 60% lower in neonates born to women with obesity compared with those born to women without obesity. However, all concentrations exceeded the minimum inhibitory concentration. Maternal penicillin levels were not significantly different between groups. More than 40% of women who previously tested positive for GBS by antenatal culture tested negative for GBS on admission for delivery.

Maternal supplementation with combined galactooligosaccharides and casein glycomacropeptides modulated microbial colonization and intestinal development of neonatal piglets

• Dietary GC supplementation during only late gestation modulated microbiota of sows. • Maternal GC supplementation shaped the microbial colonization of piglets. • Maternal impacted microbiota contributed to better gut integrity and barrier of piglets. • The modified intestinal barrier functions were associated with improved growth performance of piglets. This study aimed to investigate the maternal effects of the combination (GC) of galactooligosaccharides (GOS) and casein glycomacropeptides (CGMP) on their offspring. Twenty-two multiparous sows were divided into CON group (basal diet) and GC group (basal diet plus GC, 10 g/d with a ratio of 2: 1). Our results indicated that GC supplementation elevated the litter’s characteristics, faecal Prevotella , Fusobacterium and unclassified_f__Prevotellaceae of sows. Maternal GC supplementation also enriched norank_f__Ruminococcaceae , Christensenellaceae_R-7_group , Ruminococcaceae_UCG-005 and Ruminococcaceae_UCG-010 , elevated their piglets’ body weight on day 21 and enhanced intestinal barrier functions by upregulating mRNA transcript levels of tight junctions and mucins. Positive correlations of the enriched microbes and intestinal barrier parameters were found by the spearman correlation analysis. Collectively, maternal GC intervention modulated the neonatal microbiota colonization, which potentially promoted the gut development and growth performance of the piglets. Our findings will provide an insight for future application of GC in maternal-foetal nutrition.

Bacterial colonisation of the endotracheal tube in ventilated very preterm neonates: A retrospective cohort study.

To determine the rate, type and timing of bacterial endotracheal tube (ETT) colonisation in neonates born <32 weeks gestational age (GA); and if bacterial colonisation is associated with chronic lung disease (CLD), septicaemia, length-of-stay or mortality. All intubated newborns born <32 weeks GA were included. Endotracheal aspirates were routinely obtained three times-per-week. Cohort was divided into three colonisation groups: no growth, normal respiratory flora only, significant bacteria. Logistic regression was performed to identify if ETT bacterial colonisation was associated with CLD, septicaemia or mortality. A general linear model was fitted for length-of-stay. ETT aspirates were sent from 1054 infants: no growth n = 319, only normal respiratory flora n = 357, and significant bacteria n = 378. ETTs became colonised in 70%, most in the first week of life (82%). Most grew normal respiratory flora (642 infants). In those with significant bacteria, 40% grew Gram-negative species; Klebsiella in 34%. Staphylococcus aureus grew in 104 patients. Adjusted odds ratios for CLD (43% of cohort) compared with no growth were, for normal respiratory flora, 0.58 (95% confidence interval (CI) 0.34-0.99) and, for significant bacteria, 0.48 (95% CI 0.24-0.93). With no overall association between colonisation group and CLD in the adjusted model P = 0.07. The odds of septicaemia (10% of cohort) were 4.50 (95% CI 1.98-10.23, P < 0.001) times greater for significant bacteria compared with no growth. No significant associated was found with mortality or length-of-stay. Bacterial colonisation of ETTs is common. It is associated with more septicaemia. There was no significant association with CLD, longer admission or mortality.

Risk factors and intraoral breast milk application for methicillin-resistant Staphylococcus aureus colonization in surgical neonates.

Our previous study identified methicillin-resistant Staphylococcus aureus (MRSA) colonization as an independent risk factor for neonatal surgical site infection. Here we introduce intraoral breast milk application (IBMA) during a fasting state to prevent MRSA colonization. We aimed to evaluate both the risk factors for MRSA colonization and the efficacy of IBMA in neonatal surgical patients. A retrospective review was performed using admission data from 2007 to 2016. Neonatal patients who underwent surgery and were tested periodically for MRSA colonization were evaluated for an association between MRSA colonization and perinatal or perioperative factors. The overall incidence of MRSA colonization for the 159 patients enrolled in this study was 16.4%. Univariate analysis showed that MRSA colonization was significantly more frequent in the following patients: those with Down syndrome, those admitted on their day of birth, those in need of fasting immediately after birth, and those not receiving IBMA. Multivariate analysis showed that comorbid Down syndrome was an independent risk factor (hazard ratio: 4.6; 95% confidence interval: 1.2-19.5, P=0.03) and implementation of IBMA was an independent preventive factor for MRSA colonization (hazard ratio: 0.4; 95% confidence interval: 0.1-0.9, P=0.04). MRSA-positive patients admitted significantly earlier and stayed longer preoperatively than MRSA-negative patients. In neonates undergoing surgery, and patients with Down syndrome, early diagnosis after birth and a long waiting period before operation may be associated with MRSA colonization. Intraoral breast milk application may be beneficial for preventing MRSA colonization.

Gene of the month: GLIS1-3

The GLIS 1–3 genes belong to a family of transcription factors, the Krüppel-like zinc finger proteins. The GLIS proteins function primarily as activators of transcription (GLIS 1 and 3), while...

Group B streptococcal transmission rates as determined by PCR.

Background Group B Streptococcus (GBS) is a common cause of neonatal sepsis. GBS colonization of the newborn gastrointestinal tract (GIT) may be a critical precursor for late-onset infection. Assessment of the rate of neonatal GBS intestinal colonization has generally relied upon culture-based methods. We used polymerase chain reaction (PCR) and culture to determine the rate of GBS transmission to neonates. We hypothesized that PCR may enhance the detection of neonatal GBS colonization of the GIT, and that the rate will be higher when evaluated with PCR as compared to culture. Methods This was a cross-sectional study, in which mothers who were positive for GBS on routine screening and their healthy infants were eligible for recruitment. Newborn stool was collected after 24 h of life and before hospital discharge, and stored at -80°C for culture and PCR targeting the GBS-specific surface immunogenic protein (sip) gene. Results A total of 94 mother-infant pairs were enrolled; of these pairs, stool was collected from 83 infants. Based on PCR, the overall GBS transmission rate was 3.6% (3/83). The transmission rate was 2.4% (1/41) among vaginal deliveries and 4.8% (2/42) among cesarean deliveries. The results of culture-based transmission detection were identical. Conclusion These results indicate that the rate of GBS transmission is low and that detection may not be enhanced by PCR methods.