Nonexposed Infants Research Articles

Neonatal Antibiotic Exposure Alters Compositional Gut Microbiota Development During the First 6 Months of Life

ObjectiveTo investigate the impact of neonatal antibiotic exposure on gut microbiota development in infants born after 36 weeks of gestationMethodsA case‐control study of 6 neonates exposed to brief (<5 days) empirical antibiotics (penicillin G and gentamicin) during the first 72 hours of life, 6 neonates receiving a 7‐day course of the same antibiotics for documented infection and 24 matched healthy non‐exposed neonates. Gut microbiota composition was assessed at 1 and 6 months of age by qPCR, DGGE and 16S rRNA pyrosequencingResultsNeonatal antibiotic exposure resulted in a significant decrease in fecal bifidobacteria at 1 month of age (p=0.015), particularly in B. bifidum (p=0.0061). The bacterial richness of infants exposed to antibiotics was significantly lower compared to non‐exposed infants. The principal coordinates analysis (PCoA) formed separate clusters when compared between antibiotic‐exposed and non‐exposed infants at 6 months of age. In particular, an increased frequency of Firmicutes and a decrease in Bacteroidetes was observed in antibiotic‐exposed infantsConclusionsAberrant gut microbiota colonization is attributable to antibiotic exposure since it was observed also in antibiotic‐exposed neonates in whom infection was later ruled out. Decreased levels of both bifidobacteria and Bacteroidetes in early infancy have previously been linked to increased risk for non‐communicable disease in later life. Means of accurately detecting bacterial infections in neonates are needed to avoid unnecessary exposure to antibiotics during this vulnerable periodResearch supportFunctional Foods Forum, University of Turku

Methamphetamines and pregnancy outcomes.

Methamphetamine (MA) is one of the most commonly used illicit drugs in pregnancy, yet studies on MA-exposed pregnancy outcomes have been limited because of retrospective measures of drug use; lack of control for confounding factors; other drug use, including tobacco; poverty; poor diet; and lack of prenatal care. This study presents prospective collected data on MA use and birth outcomes, controlling for most confounders. This is a retrospective cohort study of women obtaining prenatal care from a clinic treating women with substance use disorders, on whom there are prospectively obtained data on MA and other drug use, including tobacco. Methamphetamine-exposed pregnancies were compared with non-MA exposed pregnancies and non-drug-exposed pregnancies, using univariate and multivariate analysis to control for confounders. One hundred forty-four infants were exposed to MA during pregnancy, 50 had first trimester exposure only, 45 had continuous use until the second trimester, 29 had continuous use until the third trimester, but were negative at delivery, and 20 had positive toxicology at delivery. There were 107 non-MA-exposed infants and 59 infants with no drug exposure. Mean birth weights were the same for MA-exposed and nonexposed infants (3159 g vs 3168 g; P = 0.9), although smaller than those without any drug exposure (3159 vs 3321; P = 0.04), infants with positive toxicology at birth (meconium or urine) were smaller than infants with first trimester exposure only (2932 g vs 3300 g; P = 0.01). Gestation was significantly shorter among the MA-exposed infants than that among nonexposed infants (38.5 vs 39.1 weeks; P = 0.045), and those with no drug exposure (38.5 vs 39.5; P = 0.0011), the infants with positive toxicology at birth had a clinically relevant shortening of gestation (37.3 weeks vs 39.1; P = 0.0002). Methamphetamine use during pregnancy is associated with shorter gestational ages and lower birth weight, especially if used continuously during pregnancy. Stopping MA use at any time during pregnancy improves birth outcomes, thus resources should be directed toward providing treatment and prenatal care.

Physiological reactivity during object manipulation among cigarette-exposed infants at 9 months of age

The purpose of this study was to examine the association between prenatal exposure to cigarettes and heart rate during an object manipulation task at 9months of age. Second-by-second heart rate was recorded for 181 infants who were prenatally exposed to cigarettes and 77 nonexposed infants during the manipulation of four standardized toys. A series of longitudinal multilevel models were run to examine the association of prenatal smoking on the intercept and slope of heart rate during four 90-second object manipulation tasks. After controlling for maternal age, prenatal marijuana and alcohol use, duration of focused attention and activity level, results indicated that the heart rates of exposed infants significantly increased during the object manipulation task. These findings suggest casual rather than focused attention and a possible increase in physiological arousal during object manipulation.

Prenatal tobacco exposure and infant stress reactivity: role of child sex and maternal behavior.

This study examined the association between prenatal tobacco exposure (PTE) and infant cortisol reactivity at 9 months of infant age. Child sex and maternal parenting behavior were hypothesized moderators. The sample included 217 (148 tobacco-exposed, 69 non-exposed) mother-child dyads. Data used were obtained from pregnancy assessments, mother-infant feeding interactions at 2 months, and salivary cortisol at four time points in response to frustration at 9 months. Results indicated a significant association between PTE and infant cortisol that was moderated by infant sex and maternal intrusiveness. That is, PTE boys had lower cortisol than control boys, but there was no association between PTE and cortisol among girls. There was a significant association between PTE and cortisol among infants of intrusive mothers, but not among infants with non-intrusive mothers. Thus, PTE was associated with cortisol hypo-reactivity such that boys and non-exposed infants experiencing high maternal intrusiveness were at greater risk.

Effects of Antenatal Corticosteroids on Cortisol and Heart Rate Reactivity of Preterm Infants.

Administration of glucocorticoids (GCs) during pregnancy is an established practice for reducing morbidity and mortality of fetuses at risk of preterm delivery. However, preliminary research indicates that exposure to exogenous GCs in utero may be associated with suppressed hypothalamic-pituitary-adrenal axis activity. The aim of this study was to determine whether preterm neonates who are exposed to antenatal corticosteroids show evidence of a suppressed stress-response system during their first few weeks of life, in contrast to infants who are not exposed. The sample (51% female) included 57 neonates, with 74% exposed to steroids. Mean gestational ages (GAs) were 32.6 weeks for exposed and 34.7 weeks for nonexposed infants. Although neonates in the two groups differed in gender, birth weight, and morbidity, these factors were controlled for in data analyses. Infants' salivary cortisol and heart rate (HR) were measured before and after they received a standardized caregiving "stressor" while in the newborn intensive care unit. Infants exposed to GCs in utero had lower basal cortisol levels and higher HRs than their nonexposed peers. In contrast to infants who received no GCs, they also exhibited minimal HR or cortisol reactivity to the stressor. Findings suggest that preterm infants who were exposed to antenatal corticosteroids experience a suppressed response to stress. As preterm children develop, this dysregulation has numerous implications for later development of stress-related cardiovascular and mental health problems. Further research is needed to determine whether these postnatal effects of antenatal corticosteroids persist over time.

Conséquences potentielles de la consommation de tabac, de cannabis et de cocaïne par la femme enceinte sur la grossesse, le nouveau-né et l’enfant : revue de littérature

Substance use has increased worldwide. Based on these data, we may think that substance use has also increased during pregnancy, but epidemiological data are scarce in this population. The potential consequences of tobacco, cocaine or cannabis use during pregnancy are a major public health concern. The combined use of different substances during pregnancy may have serious consequences on the pregnancy and on child development. In this paper, we will describe the potential consequences for the newborn, child and adolescent after being exposed to tobacco, cannabis and cocaine in utero. For this purpose, we will review all retrospective and prospective studies (in English and French) referenced in PubMed reporting on the somatic or psychiatric consequences of alcohol, tobacco and drug consumption by pregnant women on newborn and children. Consumption during pregnancy was assessed in these studies using simple questionnaires, biomarkers analysis or both. Generally speaking, these pregnancies are at high risk for both the mother and the foetus: for example, an increased risk of miscarriage or of reduced length of gestation, an increased risk of uterine apoplexy and placenta praevia, more premature births and/or hypotrophy were reported. The occurrence of a newborn's withdrawal syndrome may be misdiagnosed. Many consequences on child development may be observed such as growth disorders, learning or motor disorders, language disorders, cognitive disorders (attention, memory, executive functions), attention deficit disorders with impulsivity or with hyperactivity (ADHD), and memory disorders. The prevalence of depressive or anxiety disorders may also be increased in these children. The risk of addictive disorders or schizophrenia in children exposed in utero to illicit drugs or tobacco is still unknown. The combined use of different substances increases, consequently it is difficult to disentangle the consequences on child development of each of the drugs used during pregnancy owing to potential interactions between these drugs. The consequences on child development will also depend on the dose and on the time of drug use during pregnancy. The National Institute of Drug Abuse reported that 75% of the infants exposed in utero to one or more substances will present medical problems during childhood, as compared to only 27% of the non-exposed infants. However, the medical consequences are still a matter of controversies. Methodological biases, such as the use of different rating scales among studies, and the heterogeneity of the populations included are main limitations. Further studies are needed using larger cohorts and longer follow-up periods.

Outcomes of Very-Low-Birth-Weight Infants Exposed to Maternal Clinical Chorioamnionitis: A Multicentre Study

Background: Chorioamnionitis is a recognized risk factor of preterm delivery; however, controversy still persists concerning the relationship between maternal inflammation and neonatal morbidity and mortality. Objective: To determine the incidence of clinical chorioamnionitis and its relationship to morbidity and mortality among very-low-birth-weight (VLBW) infants. Methods: This was a retrospective analysis of prospectively collected data of VLBW neonates ≤32 weeks' gestational age (GA) admitted to collaborating units in the Spanish SEN1500 Network between January 2008 and December 2011. Clinical chorioamnionitis was defined by obstetricians based on clinical findings, and neonatal outcomes were compared between exposed and non-exposed infants by multivariate logistic regression analysis. Results: During the study period, 11,464 VLBW newborns were admitted to our units and 10,026 were ≤32 weeks' GA. Among them, 8,330 (83.1%) had complete data and were included. Of these, 1,480 (17.8%) were exposed to maternal clinical chorioamnionitis. The incidence was higher at lower GA and, after adjusting for confounding factors, exposed infants had higher risks of early-onset neonatal sepsis (EONS) (10.0 vs. 2.8%; aOR 3.102; 95% CI 2.306-4.173; p < 0.001) and necrotizing enterocolitis (NEC) (11.2 vs. 7.7%; aOR 1.300; 95% CI 1.021-1.655; p < 0.033), but lower risks of patent ductus arteriosus (PDA) (43.2 vs. 34.9%; aOR 0.831; 95% CI 0.711-0.971; p < 0.02) and late-onset bacterial sepsis (LONS) (36.6 vs. 32.5%; aOR 0.849; 95% CI 0.729-0.989; p < 0.035). There were no differences in mortality between the groups. Conclusions: The incidence of maternal clinical chorioamnionitis is inversely related to GA at delivery, and in VLBW infants ≤32 weeks' GA it is associated with higher risks of EONS and NEC, but lower risks of PDA and LONS. We did not found differences in survival.

Morbidity and Mortality Among Very-low-birth-weight Infants Born to Mothers with Clinical Chorioamnionitis

Controversy exists about the relationship between maternal inflammation and the development of different morbidities and mortality in the newborn. We aimed to establish the incidence of clinical chorioamnionitis in our Neonatal Intensive Care Unit and its relation to morbidity and mortality among very-low-birth-weight infants. This was an observational study of a cohort of very-low-birth-weight neonates admitted to our Neonatal Intensive Care Unit, between January 2008 and December 2012. Demographic characteristics and outcomes were analyzed and a comparison between exposed and non-exposed infants was carried out. During the study period, 451 very-low-birth-weight infants were admitted toourNeonatal Intensive Care Unit, and 31 (6.87%) were exposed to maternal clinical chorioamnionitis. The incidence was higher at lower gestational ages: 13.2% (23-26weeks), 8.1% (27-30weeks), and 2.6% (31-34weeks) (p=0.022). After correcting by gestational age and birth weight, early-onset neonatal sepsis (adjusted relative risk=6.13; 95% confidence interval=1.67-22.58; p=0.006) and periventricular leukomalacia (adjusted relative risk=24.62; 95% confidence interval=1.87-324.28; p=0.015) were significantly associated with maternal clinical chorioamnionitis. There were no differences in mortality or in survival without major morbidity. Clinical chorioamnionitis confers an increased risk of early-onset neonatal sepsis and periventricular leukomalacia to exposed very-low-birth-weight infants.

Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis.

BackgroundIt is assumed within the accumulated literature that children born of pregnant opioid dependent mothers have impaired neurobehavioral function as a consequence of chronic intrauterine opioid use.MethodsQuantitative and systematic review of the literature on the consequences of chronic maternal opioid use during pregnancy on neurobehavioral function of children was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched Cinahl, EMBASE, PsychINFO and MEDLINE between the periods of January 1995 to January 2012.ResultsThere were only 5 studies out of the 200 identified that quantitatively reported on neurobehavioral function of children after maternal opioid use during pregnancy. All 5 were case control studies with the number of exposed subjects within the studies ranging from 33–143 and 45–85 for the controls. This meta-analysis showed no significant impairments, at a non-conservative significance level of p < 0.05, for cognitive, psychomotor or observed behavioural outcomes for chronic intra-uterine exposed infants and pre-school children compared to non-exposed infants and children. However, all domains suggested a trend to poor outcomes in infants/children of opioid using mothers. The magnitude of all possible effects was small according to Cohen’s benchmark criteria.ConclusionsChronic intra-uterine opioid exposed infants and pre-school children experienced no significant impairment in neurobehavioral outcomes when compared to non-exposed peers, although in all domains there was a trend to poorer outcomes. The findings of this review are limited by the small number of studies analysed, the heterogenous populations and small numbers within the individual studies. Longitudinal studies are needed to determine if any neuropsychological impairments appear after the age of 5 years and to help investigate further the role of environmental risk factors on the effect of ‘core’ phenotypes.

Reactivity and regulation of motor responses in cocaine-exposed infants

Effects of prenatal exposure to cocaine on the reactivity and regulation of the motor system of 825 four-month-old infants enrolled in the Maternal Lifestyle Study were examined. Videotaped assessments of 338 cocaine-exposed (CE) infants and 487 non-exposed comparison infants were coded by examiners masked to exposure status. Exposure status was determined by meconium assay and maternal self-report of prenatal cocaine use. Infants were presented with a series of 17 visual, auditory and tactile stimuli for 30-s each. Intensity and latency of limb movement responses on a subset of items were analyzed to test the following hypotheses: CE infants are more active in general; CE infants exhibit increased movement levels for a larger proportion of time in response to stimulation; the motor systems of CE infants are more reactive to stimulation (e.g., shorter latencies to respond); and CE infants are poorer regulators of the motor system. ResultsCE infants were not more active in general and data do not indicate a more highly reactive motor system. However, CE infants exhibited increased movement levels for a larger proportion of time in response to stimulation. Additional analysis of movement exhibited during three tactile items found increased movement lability in CE infants and different patterns of responding, suggesting that the effects of prenatal cocaine exposure on the motor system may vary by context. Covariate effects for tobacco, alcohol, and marijuana are also reported.

Treatment with oral beta‐blockers during pregnancy complicated by maternal heart disease increases the risk of fetal growth restriction

To investigate the effect on fetal growth of treatment with oral beta-blockers during pregnancy in women with congenital or acquired heart disease. Historical matched cohort study. Centre for Pregnant Women with Heart Disease, Copenhagen University Hospital, Denmark. A cohort of 175 women with heart disease, grouped according to beta-blocker treatment, and a cohort of 627 women from the overall population matched on seven birthweight-determining factors. Differences between groups were tested by simple descriptive statistics and assessed using standard hypothesis tests. Associations were estimated by correlational analysis and multivariable regression. Proportion of infants born small for gestational age (SGA). More of the infants exposed to beta-blockers were SGA compared with non-exposed infants (29.4 versus 15.3%; P < 0.05). After adjustment for birthweight-determining factors, beta-blocker treatment and maternal body mass index (BMI) were the only factors independently associated with SGA (the relative difference in expected birthweight was -8.6%; 95% CI -13.3 to -3.9%; P = 0.0004). After adjustment for BMI, beta-blocker treatment was associated with an increased risk of SGA (OR 2.65; 95% CI 1.15-6.10; P = 0.02). In a subgroup with isolated tachyarrhythmias, SGA infants were more frequent in the beta-blocker exposed group compared with the non-exposed group (31 versus 10%; P < 0.005). Beta-blocker treatment was the only independent predictor of SGA, adjusting for several factors influencing fetal growth (the relative difference in expected birthweight was -12.2%; 95% CI -19.9 to -3.9%; P = 0.001). In a historical cohort of pregnancies complicated by maternal heart disease, treatment with beta-blockers was found to be independently associated with an increased risk of delivering an SGA infant.

Neuroinflammation in the fetus exposed to maternal obsessive–compulsive disorder during pregnancy: A comparative study on cord blood tumor necrosis factor-alpha levels

ObjectiveThe relationship between maternal psychiatric disorders and fetal neurodevelopment is unclear. Obsessive–compulsive disorder (OCD) is relatively frequent during pregnancy. The study aimed to investigate whether maternal OCD during pregnancy affects fetal circulating tumor necrosis factor-alpha (TNF-α) levels, an important pro-inflammatory cytokine, by comparing cord blood TNF-α levels in newborn infants of women with and without OCD. MethodsThe study sample included 7 women with OCD and 30 healthy women. OCD and other psychiatric diagnoses were screened by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The blood sample for the determination of TNF-α level was obtained from the umbilical cord during delivery. ResultsCord blood TNF-α levels in newborn infants exposed to maternal OCD were significantly higher compared to non-exposed infants. Maternal anxiety symptom level was found to positively correlate with cord blood TNF-α levels in newborn infants of women with OCD. ConclusionThe study results imply that maternal OCD during pregnancy may lead to neuroinflammation in the developing fetal brain through higher levels of circulating TNF-α.

Probiotics, feeding tolerance, and growth: A comparison between HIV-exposed and unexposed very low birth weight infants

ObjectiveThe aim of this study was to compare the effect of administration of probiotics on feeding tolerance and growth outcomes of HIV-exposed (but uninfected) versus HIV non-exposed preterm infants. The null hypothesis of this study states that there will be no difference in the feeding tolerance and growth outcomes for both probiotic-exposed and unexposed premature very low birth weight infants. MethodsA randomized, double-blind, placebo-controlled trial was conducted during the period from July 2011 to August 2012. HIV-exposed and non-exposed premature (<34 wk gestation) infants with a birth weight of ≥500 g and ≤1250 g were randomized to receive either a probiotic mixture or placebo. The multispecies probiotic mixture consisted of 1 × 109 CFU, Lactobacillus rhamnosus GG and Bifidobacterium infantis per day and was administered for 28 d. Anthropometrical parameters, daily intakes, and feeding tolerance were monitored. ResultsSeventy-four HIV-exposed and 110 unexposed infants were enrolled and randomized (mean birth weight 987 g ± 160 g, range, 560–1244 g; mean gestational age 28.7 wk). In all 4227 probiotic doses were administered (mean 22.9/infant). There was no difference in the average daily weight gain for treatment groups or HIV exposure. The HIV-exposed group achieved significantly higher z scores for length and head circumference at day 28 than the unexposed group (P < 0.01 and P = 0.03, respectively). There were no differences in the incidence of any signs of feeding intolerance and abdominal distension between the groups. ConclusionProbiotic supplementation did not affect growth outcomes or the incidence of any signs of feeding intolerance in HIV exposure.

A systematic review of thyroid dysfunction in preterm neonates exposed to topical iodine

ObjectiveTo determine whether maternal exposure to iodine or neonatal exposure to topical iodine-containing solutions increases the risk of transient thyroid dysfunction in neonates born <32 weeks’ gestation or <1.5 kg.DesignSystematic...

Infant neurodevelopment followingin uteroexposure to antidepressant medication

To examine the impact of pregnancy exposure to antidepressants on infant neurodevelopment. A prospective, longitudinal study in which antidepressant-exposed (n=35) and nonexposed (n=23) infants were administered the Bayley Scales of Infant Development (BSID-III) at 18months, which measures neurodevelopment across five domains. Data on obstetric and perinatal complications, maternal IQ, presence of mood disorder in pregnancy and up to and including 18months, and psychosocial status were also collected. Almost 90% of infants were exposed throughout the second and third trimesters to therapeutic antidepressant doses. Bivariate analysis showed no difference between exposed and unexposed infants in any of the neurodevelopmental outcomes. Maternal depression around birth or up to time of developmental testing was not associated with neurodevelopmental outcomes. Our results suggest that pregnancy antidepressant exposure (mostly serotonin reuptake inhibitors) is not associated with poorer cognitive, motor or language development outcomes in infants at 18months. This information supports earlier studies and adds into the available data used by clinicians and mothers making key decisions around the use of antidepressants in pregnancy. However, given the small sample size, and some degree of heterogeneity in terms of antidepressant exposure, these results need to be treated with caution.

Early Neurological Outcome of Young Infants Exposed to Selective Serotonin Reuptake Inhibitors during Pregnancy: Results from the Observational SMOK Study

BackgroundUse of selective serotonin reuptake inhibitors (SSRI) during pregnancy is common while the effect on the infant’s neurological outcome is unknown. Our objective was to determine the effects of prenatal SSRI-exposure on the infants’ neurological functioning, adjusted for maternal mental health.MethodsA prospective observational study from May 2007 to April 2010. The study groups comprised 63 SSRI-exposed infants (SSRI group) and 44 non-exposed infants (non-SSRI group). Maternal depression and anxiety were measured using questionnaires. The main outcome measures during the first week after birth and at three to four months were the quality of the infants’ general movements (GMs) according to Prechtl and a detailed motor optimality score. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for abnormal GM quality in the SSRI and non-SSRI groups, and adjusted for maternal depression, anxiety, and other confounders. The study was registered under 53506435 in the ISRCTN.FindingsAll infants were born around term. During the first week, abnormal GMs occurred more frequently in the SSRI group than in the non-SSRI group (59% versus 33%) and the median MOS was lower (13 versus 18). The OR for abnormal GMs in the SSRI versus the non-SSRI group was 3·0 (95% CI, 1.3 to 6.9) and increased after adjustment for confounders. At three to four months, more SSRI-exposed infants had monotonous movements (48% versus 20%) with lower median MOSs (26 versus 28). The OR for monotonous movements was 3·5 (95% CI, 1.5 to 8.6) and increased after adjusting for confounders.InterpretationPrenatal exposure to SSRI had an adverse effect on early neurological functioning as reflected by GM quality, irrespective of maternal depression and anxiety, and other confounders. Physicians should take this into account in consultation with parents.

Infant developmental outcomes following prenatal exposure to antidepressants, and maternal depressed mood and positive affect

BackgroundPrenatal exposure to serotonin reuptake inhibitor (SRI) antidepressants has been associated with delays in early developmental milestones, but there remains uncertainty. Even among a subset of studies examining the Bayley Scales of Infant Development (BSID), some have reported normal mental and psychomotor development while others have suggested a delay in motor development. Given an increasing number of infants exposed to SRIs, furthering our understanding of the possible developmental implications of SRI exposure in utero is critical. AimsTo examine the effects of prenatal serotonin reuptake inhibitor exposure and maternal mood on infant developmental outcomes at 10months of age. Study designProspective study of mothers and their 10-month-old infants. SubjectsWe examined 31 mother–child pairs exposed prenatally to SRIs and 52 mother–child pairs who were nonexposed. Outcome measureThe Bayley Scales of Infant Development (third edition) scores. ResultsInfants exposed prenatally to SRIs scored significantly lower than nonexposed infants on gross motor (P=0.03), social–emotional (P=0.04) and adaptive behavior (P=0.05) subscales of the BSID-III, controlling for pre- and postnatal maternal depressed mood, smoking and alcohol use during pregnancy. No significant differences in any of the BSID-III subscales were observed between infants exposed and infants nonexposed to pre and postnatal maternal depressed mood (P>0.05). Increased levels of maternal positive affect at 10months predicted increased social–emotional scores (P=0.03). ConclusionsInfants prenatally exposed to SRIs score significantly lower on the gross motor, social–emotional and adaptive behavior subscales of the BSID-III, and this was not explained by underlying maternal depression.

Perinatal Pet Exposure, Faecal Microbiota, and Wheezy Bronchitis: Is There a Connection?

Background. The hygiene hypothesis suggests that high hygiene standards have led to an immune dysfunction and an increase in allergic diseases. Farming-related exposures are associated with a decreased risk of asthma. Since the gut microbiota may be a pivotal component in the hygiene hypothesis, we studied whether perinatal exposure to pets, doctor's diagnosed wheezy bronchitis (WB), and compositional changes in the gut microbiota are interrelated among urban infants. Methods. Data were collected prospectively from a mother-infant nutrition study. Data on perinatal pet ownership, WB, and the microbiota composition of faecal samples of the infants assessed by quantitative PCR at 1 month were compared. Results. None of the 30 infants exposed to pets had suffered from WB by 24 months, whereas 15 of the 99 (15%) nonexposed infants had had WB (P = 0.03). The counts of Bifidobacterium longum were higher in samples (n = 17) from nonwheezing infants with pet exposure compared to those (n = 10) in wheezing infants without pet exposure (8.59/10.44 versus 5.94/9.86, resp. (median/upper limit of range, bacteria(log)/g of stool); P = 0.02). B. breve was more abundant in the wheezing infants (P = 0.02).

One-year outcomes of prenatal exposure to MDMA and other recreational drugs.

A widely used illicit recreational drug among young adults, 3,4-methylenedioxymethamphetamine (MDMA) or ecstasy, is an indirect monoaminergic agonist/reuptake inhibitor affecting the serotonin system. Preclinical studies found prenatal exposure related to long-term learning and memory impairments. There are no studies of sequelae of prenatal MDMA exposure in humans, despite potential harmful effects to the fetus. A total of 96 women in the United Kingdom (28 MDMA users; 68 non-MDMA) were interviewed about recreational drug use during pregnancy. Their infants were seen at 12 months using standardized assessments of cognitive, language, and motor development (Preschool Language Scale, Bayley Mental and Motor Development and Behavior Rating Scales [Mental Development Index, Psychomotor Development Index, Behavioral Rating Scale]). Mothers completed the Child Domain Scale of the Parenting Stress Index, The Home Observation of the Environment Scale (in interview), the Brief Symptom Inventory, and the Drug Abuse Screening Test. Women were primarily middle class with some university education, in stable partner relationships, and polydrug users. MDMA and other drug effects were assessed through multiple regression analyses controlling for confounding variables, and analysis of covariance comparing heavier versus lighter and nonexposed groups. Amount of prenatal MDMA exposure predicted poorer infant mental and motor development at 12 months in a dose-dependent manner. Heavily exposed infants were delayed in motor development. Lighter-exposed infants were comparable to nonexposed infants. There were no effects on language, emotional regulation, or parenting stress. Findings document persistent neurotoxic effects of heavier prenatal MDMA exposure on motor development through the first year of life.

Necrotizing Enterocolitis in HIV-Exposed and Nonexposed Infants: Clinical Presentation and Histopathological Features

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in neonates and is associated with significant morbidity and mortality. An association between HIV-positive maternal status and increased risk of NEC in preterm infants has been described, and antiretroviral therapy has been proposed as an independent risk factor. Our aim was to compare the clinical presentation and histopathological features of necrotizing enterocolitis in HIV-exposed and unexposed infants. A retrospective study of archival material from the National Health Laboratory Services Histopathology Laboratory in Tygerberg Hospital/Stellenbosch University from 1992 to 2008 was conducted. All surgical specimens from infants who presented to pediatric surgery for a laparotomy and bowel resection for NEC and in whom the HIV status was known were included in the study. In the 37 cases that fulfilled these criteria, male gender was overrepresented in the study population (67%). Nonsteroidal anti-inflammatory drugs appeared to play a significant role in the development of surgical NEC in infants who were not exposed to HIV, but HIV-exposed infants had a significantly poorer survival rate. There was no significant difference in the histopathology between HIV-exposed and nonexposed infants, and Cytomegalovirus infection was not identified in any of the cases studied.