β-lactam antibiotic resistance in aerobic commensal fecal flora of newborns

BACKGROUND: The purpose of the present paper was to prospectively determine the rate of beta-lactam antibiotic resistance in commensal fecal flora of newborns and the risk factors leading to this colonization. METHODS: One hundred and eighteen newborns in the neonatal intensive care unit (NICU) group (n = 38), the neonatal ward group (n = 36), and the control group (n = 44) were enrolled. Three or four stool samples were obtained from each infant, 15 days apart. Bacterial growth in Eozin Methylene Blue (EMB) agar + 10 microg ampicillin/mL was considered to be ampicillin-resistant bacteria, and antibiotic susceptibility and extended spectrum beta-lactamases (ESBL) production was investigated in those bacteria. RESULTS: Colonization with ampicillin-resistant commensal fecal flora microorganisms was determined in 75.2% of 367 stool samples. Klebsiella spp. and Escherichia coli were identified in 59% and 41% of the samples, respectively. The lowest rate of ampicillin-resistant bacterial colonization was determined in the NICU group. Microorganisms producing ESBL were identified in 33.7% of 367 stool samples. Fifty-one and 73 of ampicillin-resistant E. coli and Klebsiella spp. isolates were determined to produce ESBL, respectively. There was no difference with respect to colonization with ESBL-producing microorganisms between the three groups. When risk factors related to colonization with ESBL-producing microorganisms in stool samples were evaluated through the whole study period, very low birthweight, vaginal delivery, infant antibiotic usage, maternal antibiotic usage, male sex and premature rupture of membranes were determined as risk factors, while feeding with nasogastric tube was identified as a protective factor. When the risk factors related to colonization with ESBL-producing bacteria in stool samples after discharge from the hospital were evaluated, failure to feed breast milk was determined as the only risk factor. CONCLUSIONS: To decrease mortality and morbidity due to infection caused by resistant microorganisms colonized in the intestine flora of the infant, protection of normal non-pathogenic bacterial colonization is important. This can be provided by feeding neonates with breast milk, application of infection control measures efficiently, and limitation of antibiotic usage only to strict clinical indications.     

Food and microbiological problems in the newborn: data and practice

We have reviewed the relationships of food, nutrition and feeding practices to various infections in the newborn. Tentative conclusions are made: (a) the initial use of human milk (raw or pasteurized) continues to offer advantages in the care of babies in intensive care; (b) attempts to mimic the microbiological effects of breast milk by manipulation of the composition of infant formulas have so far achieved little success, but this is a rapidly developing field; (c) we are wary of the widespread use of breast milk "fortifiers" until there is evidence that they do not adversely affect the protective properties of breast milk; (d) the doubtful advantages of nasojejunal feeding need to be weighed against the increased bacterial contamination of the upper small bowel; (e) systems monitoring in milk kitchens and the handling of feeds in the neonatal unit are an integral part of comprehensive neonatal care; (f) to limit nosocomial infection, particular attention to the faecal-food-oral route is necessary since there is potential for multiplication of initial contamination of food.     

Progress in the Prevention of Iron Deficiency in Infants

ABSTRACT. Our present success in preventing iron deficiency in infants is based on a gradual growth in our understanding of iron nutrition. It became recognized that full term infants only become vulnerable to iron deficiency after about 5 months of age, and to a lesser degree if they are breast-fed. The specific foods in which iron is provided during infancy were found to be more important in determining iron absorption than the actual amount of iron in the diet. Experience has also shown that fortification of infant foods is more reliable and cost effective than providing iron medication. Our current approaches to preventing iron deficiency in infants include: 1) maintaining breast feeding for at least 6 months, if possible; 2) using an iron-fortified infant formula if a formula is used and using formula in preference to cow's milk; 3) using iron-fortified infant cereal as one of the first solid foods; and 4) providing supplemental iron for low birth weight infants.     

Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on the infant faecal flora

The development of the infant faecal flora was studied over the first three months of life in infants receiving breast milk, a modern adapted formula and adaptations of this formula. Breast-fed infants developed a flora rich in Bifidobacterium sp. Facultative anaerobes were ubiquitous, but in relatively small numbers within the diet group. Other obligate anaerobes, such as Clostridium sp. and Bacteriodes sp. were rarely isolated. Standard formula produced a flora rich in bifidobacteria, but the growth of facultative organisms was not suppressed by this diet. Clostridium sp. and Bacteroides sp. were more common in this feeding group. After the addition of lactoferrin at 10 mg/100 ml to the formula diet, a flora similar to that of the standard formula-fed babies was achieved. Lactoferrin at 100 mg/100 ml was able to establish a "bifidus flora" in half of the babies given this formula, but only at age three months. Clostridium sp. and Bacteroides sp. were common faecal isolates from babies receiving both the lactoferrin diets.     

Development of the intestinal flora in very low birth weight infants compared to normal full-term newborns

Development of faecal flora was studied in seven very low birth weight (VLBW) infants, who were fed on human milk and whose birth weights ranged from 810–1350 g. The intestine of the VLBW infants was first colonised by enterobacteria and streptococci, as it was in full-term infants. VLBW infants differed, however, from full-term infants in that both types of organism continued to be predominant for a longer period, and establishment of bifidobacterial flora was retarded. Bifidobacteria first appeared in the stools of VLBW infants at a mean age of 10.6±2.7 days and became predominant at a mean of 19.8±8.9 days, in contrast to full-term, breast-fed infants in whom bifidobacterial flora appeared at as early as 4 days of age. The delay seemed to be related to the low milk intake of the VLBW infants.The number of viable staphylococci in the stools of VLBW infants was generally higher than that in full-term infants. Although emergence of Bacteroides, Clostridium and lactobacilli was delayed compared with full-term infants, differences in their occurrence and prevalence between VLBW and fullterm infants were not remarkable.Abbreviation VLBW very low birth weight     

Quantitative study of aerobic and anaerobic fecal flora in necrotizing enterocolitis of the newborn infant

A quantitative study of the fecal flora was carried out in 21 neonates with necrotizing enterocolitis (NEC), (4 infants being born at term) and 57 control infants (30 born at term and 27 born before term). In the population as a whole Klebsiella was detected more frequently in NEC than in the controls. This was especially true in premature infants where Klebsiella was found in 65% of the affected infants versus 33% of the controls (p less than 0,05), while no Klebsiella was detected in the 4 term infants with NEC and in 87% of the term controls. These data suggest that Klebsiella could play a role in the pathogenesis of NEC, especially in the premature infant. Therefore, it seems required to avoid the artificial selection of Klebsiella in the neonate.     

Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants

The establishment of the faecal flora of 39 full-term infants fed exclusively on breast milk (n = 20) or with two different modern adapted cow's milk formulas (n = 19) was studied during the first 3 months of life. One formula investigated was based on 100% bovine casein as the protein source whereas the other formula contained bovine milk proteins with a whey/casein ratio of 60:40. A faecal flora rich in bifidobacteria was found in all study groups; the growth of putrefactive bacteria (especially Bacteroides spp.), however, was limited. In formula-fed infants, significantly higher bacterial counts of enterococci and Clostridia were detected compared to breast milk-fed infants. Similarities and differences due to the feeding regimen were particularly reflected in the pattern of the anaerobic bacterial species. Bifidobacterium bifidum, B. infantis and B. breve constituted the majority of the bifidobacterial flora independent of the type of milk feeding. Other bifidobacterial species such as B. longum, B. adolescentis, B. parabifidum and B. pseudo-catenulatum were detected in high numbers and at low frequencies in breastfed infants. The latter three were observed in infants fed the whey/casein formula as well. It seems that infants fed a casein formula develop a faecal flora more like that of breastfed infants concerning Lactobacillus spp. (especially L. fermentum and L. brevis).     

The Nutritional Role of Breast-Milk IgA and Lactoferrin

ABSTRACT. The nutritional enigma concerning the extent to which breast-milk immune proteins are digested has been investigated by measuring the intakes and faecal outputs of IgA and lactoferrin over 7 days in 10 exclusively breast-fed (BF) and 9 formula-fed (FF) fullterm infants at 6 and 12 weeks post-partum. BF outputs (mg/day) greatly exceeded FF values ( p <0.001): at 6 weeks secretory-IgA BF=160±28, FF=14±2, lactoferrin BF=M±2, FF=0.9±0.1; at 12 weeks secretory-IgA BF=94±17, FF=25±5, lactoferrin BF=7±1, FF=1±0.3. Secretory-IgA represented 42% and 27% of BF faecal protein at 6 and 12 weeks compared with 6% for FF infants at both ages. BF secretory-IgA outputs were highly correlated with intakes ( r =0.83, p <0.001). IgA and lactoferrin outputs and the presence of faecal secretory-IgA fragments in BF and FF infants were influenced by defaecation rate, suggesting that partial degradation occurred in the large intestine. By 6 weeks post-partum only 1% lactoferrin and 17% secretory-IgA intakes appeared in the faeces and 95% breast-milk protein could be regarded as nutritionally available. The elevated BF outputs of IgA and lactoferrin relative to endogenous excretion suggest, however, that breast-milk may still make a considerable contribution to intestinal defence mechanisms after the neonatal period despite the small proportion of daily intake which escapes digestion. The protective action of IgA and lactoferrin may also depend on their site of degradation and the nature of fragments.     

Supplementation of an adapted formula with bovine lactoferrin. 2. Effects on serum iron, ferritin and zinc levels

Breast milk provides an excellent supply of most nutrients for newborn infants. Infant formulae should be nutritionally comparable to breast milk especially with regard to critical nutrients like iron and other trace elements. Infant formulae supplemented with various amounts of bovine lactoferrin were given to two groups of infants. These infants were compared with infants receiving unsupplemented formula and breast-fed infants. The effects of these diets on levels of haemoglobin, haematocrit, serum iron, ferritin and zinc were examined for a study period of 150 days. At birth, concentrations of iron, haemoglobin, haematocrit and zinc were comparable in all four feeding groups. The fact that the serum zinc level was not altered by lactoferrin supplementation appears to rule out an in-vivo effect of lactoferrin on zinc nutrition of infants. Ferritin levels of breast-fed infants were significantly higher than in non-supplemented formula-fed infants at day 30 and day 90. This difference was seen only at day 30, when comparing breast-fed infants to lactoferrin-supplemented formula-fed infants. Comparing the infants receiving formulae, the formula supplemented with the higher amount of bovine lactoferrin induced significantly higher serum ferritin levels compared to the unsupplemented formula at day 90 and day 150. These observations favour the idea that lactoferrin may be involved in iron absorption. Since this effect was pronounced only after 90 days, it has to be discussed as to whether this effect is a convincing argument for supplementing infant formulae with bovine lactoferrin.     

Hypoxia-induced free iron release in the red cells of newborn infants*

Heparinized blood samples were obtained at birth from 164 newborn infants (101 full term; 63 preterm). Intra-erythrocyte free iron concentration and hypoxanthine plasma levels were determined by high-pressure liquid chromatography. Intra-erythrocyte free iron concentration was higher in preterm than in full term babies (p < 0:0001) and adults (p < 0:0001). Statistically significant correlations were observed between intra-erythrocyte free iron concentration and hypoxanthine levels (r = 0:66; p= 0:0001), pH (r = - 0:76; p = 0:0001), base excess (r = - 0:79; p= 0:0001), and gestational age (r = - 0:44; p= 0:0001) in both infant populations. Multiple regression analysis between intra-erythrocyte free iron concentration in cord blood, as an independent variable, and Apgar score at 1 min, pH, base excess, hypoxanthine values, FiO₂ needed for resuscitation immediately after delivery, and gestational age, as dependent variables, identified hypoxanthine levels (p= 0:0003; partial F-test = 15.4) as the best single predictor of intra-erythrocyte free iron concentration. In conclusion, hypoxia induces intra-erythrocyte free iron release, and therefore enhances the risk of oxidative injury due to hydroxyl radical generation.     

Program considerations for integration of nutrition and family planning: Beliefs around maternal diet and breastfeeding within the context of the nutrition transition in Egypt

In Egypt, rising maternal overweight and obesity is consistent with the transition to westernized diets and a growing reliance on energy‐dense, low nutrient foods. Although the first 1,000 days of life are the focus of many programmes designed to prevent many forms of malnutrition, little attention has been paid to maternal dietary practices and weight gain during pregnancy. This study used in‐depth interviews with pregnant women (N = 40), lactating women (N = 40), and nonlactating women (N = 40) to gain an understanding of behaviours, perceptions, and cultural beliefs in relation to maternal dietary intake during pregnancy, lactation, and nonlactation; weight gain during pregnancy; birth spacing; and family planning. Study findings reveal that food choice was driven by affordability, favoured foods, or foods considered appropriate for a specific life stage (pregnant, lactating, and nonlactating). Knowledge of weight gain during pregnancy is limited, especially with regards to excessive weight gain during pregnancy. Diet is often modified during lactation to support breast milk production, and a normal diet resumed when breastfeeding ceases. Within the context of breastfeeding, the lactational amenorrhea method provides an opportunity to improve exclusive breastfeeding practices, maternal diet during lactation, and the transition to other family planning methods by 6 months postpartum. Health care providers should discuss limiting maternal consumption of low nutrient foods such as junk foods, soda, and teas during pregnancy and postpartum. Dietary counselling should accompany information on appropriate weight gain during pregnancy and exercise to prevent excessive weight gain, in the context of the nutrition transition.     

Dietary iron intake and iron status in adolescents

The aim of this study was to evaluate the dietary iron intake of 15-year-old adolescents from two different regions of Sweden, in relation to their iron status. The study comprised 185 boys and 209 girls, randomly selected from the official population register. The iron intake was calculated from a 7-day record, and varied between 7 and 35 and 6 and 27 mg per day for boys and girls, respectively. The daily median intakes in boys and girls were 18.7 and 14.2 mg, respectively. S-ferritin, s-iron, and s-transferrin saturation, measured in all the subjects, did not differ significantly between the two regions. However, the mean serum ferritin concentration was significantly higher in the boys (36.4μgl^-1) than in the girls (29.4μgl^-1)( p < 0.001). Low s-ferritin levels, defined as s-ferritin < 12 μgl^-1 were found in seven boys (3.7%) and in 29 girls (13.9%). None of the adolescents had iron deficiency anaemia, defined as Hb< 110gl^-1 in combination with s-ferritin < 12μgl^-1. Regression and correlation analyses did not show any significant correlation between dietary iron intake and s-ferritin, or between s-ferritin and haemoglobin (Hb), MCH and MCHC. A significant correlation was found, however, between s-ferritin and transferrin saturation ( p < 0.005) in both sexes. When the adolescents who still had s-ferritin < 12μgl^-1 at a second blood examination were given a 6 weeks trial with oral iron therapy, all of them showed an increase both in s-ferritin and in blood Hb. The 95% confidence intervals of s-ferritin for 15-year-old Swedish boys and girls were defined as 11-90 and 7 85 μ.gl^-1, respectively.     

Effects of bifidobacterium breve supplementation on intestinal flora of low birth weight infants

BACKGROUND: It is known that the bifidobacteria flora play important roles in mucosal host defense and can prevent infectious diseases. Because bacterial populations develop during the first day of life, the authors examined whether the early administration of bifidobacteria has a positive effect on the health of low birth weight infants. METHODS: The effects of oral administration of Bifidobacterium breve (B. breve) supplements were studied in a controlled trial with low birth weight infants (average birth weight 1489 g). The infants were divided into three groups: Group A and B received a dose of 1.6 x 10(8) cells of B. breve supplement twice a day, commencing either from several hours after birth (group A) or 24 h after birth (group B). Group C, the control group, received no supplement. RESULTS: There were no significant differences in birth weight, treatment with antibiotics, and the starting time of breast-feeding among the three groups. A Bifidobacterium-predominant flora was formed at an average of 2 weeks after birth in group A and at an average of 4 weeks after birth in group B, while no Bifidobacterium was isolated in eight out of 10 infants in group C during the observation period of 7 weeks. In comparison between group A and B, Bifidobacterium was detected significantly earlier in group A, and the number of Enterobacteriaceae present in the infants at 2 weeks after birth was significantly lower in group A. CONCLUSION: The results of the present study suggest that very early administration of B. breve to low birth weight infants is useful in promoting the colonization of the Bifidobacterium and the formation of a normal intestinal flora.     

Scientific rationale and benefits of nucleotide supplementation of infant formula

The present review examines the role of dietary nucleotides in infants, and the scientific rationale and benefits of nucleotide supplementation of infant formula. The immunoprotective benefits of human milk, the biology of human milk nucleotides, and the immunological and gastrointestinal effects of dietary nucleotides in animal studies and in vitro experiments are examined. Clinical studies are reviewed, especially those examining the efficacy of nucleotide-supplemented infant formula in enhancing immunity and reducing the risk of sepsis. The presence of human milk cells, and a variety of immunoactive and trophic components of human milk, can explain the reduced incidence of sepsis in breastfed term and preterm infants. Nucleotides, believed to play an immunomodulatory role, are found in lower concentrations in infant formula. Animal studies have shown that dietary nucleotides enhance a number of immune responses and the growth, differentiation and repair of the gut. Several clinical studies have reported beneficial effects of nucleotide supplementation on gut microflora, diarrhoea and immune function, and one study has reported better catch-up growth in term infants with severe intrauterine growth retardation. More basic research studying the metabolism of nucleotides in neonates is encouraged. Additional randomized controlled trials are necessary to demonstrate the clinical benefits of nucleotide supplementation of infant formula, as it cannot be presumed that nucleotides produce the same benefits for the infant as human milk. Studies are especially necessary in high-risk neonatal situations, such as extreme prematurity, significant suboptimal nutrient intake before and after birth, and recovery from gut injury.     

Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%–46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%–77%). Women involved in home gardening significantly increased (73%–93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.     

肠道菌群的演进及与儿童哮喘的关系

哮喘是儿童常见的慢性疾病,危害儿童的健康,同时给社会和家庭带来很大的经济负担.肠道菌群与哮喘之间的关系是近几年研究的热点,微生态制剂对哮喘的预防和治疗作用也越来越受到重视.哮喘发病机制中"卫生假说"、Th1/Th2失衡学说、调节性T细胞(Treg)等机制推动了肠道菌群与哮喘关系之间的研究进展.该文就肠道菌群及对哮喘的预防和治疗相关研究进展作一综述.     

广谱抗生素疗程对极低出生体重儿粪便肠道菌群和短链脂肪酸影响的前瞻性研究

目的 探讨广谱抗生素疗程对极低出生体重儿粪便肠道菌群和短链脂肪酸的影响。 方法 前瞻性选取2020年6~12月重庆医科大学附属儿童医院新生儿诊治中心收治的29例极低出生体重儿为研究对象,根据抗生素疗程分为≤7 d组（n=9）和>7 d组（n=20）。采集患儿住院第14天和第28天的粪便标本,运用16S rDNA高通量测序法和气相色谱-质谱法分别分析粪便样本的菌群和短链脂肪酸。 结果 ≤7 d组和>7 d组早产儿第4周和第2周相比,肠道菌群的Chao指数均显著下降（P<0.05）。≤7 d组第4周菌群与第2周相比,厚壁菌门和狭窄梭菌属1的比例均显著升高,而变形菌门显著降低（P<0.05）。第4周时,>7 d组厚壁菌门和狭窄梭菌属1的比例较≤7 d组显著降低而变形菌门显著升高（P<0.05）;>7 d组异丁酸和戊酸含量较≤7 d组显著下降（P<0.05）。 结论 广谱抗生素疗程可影响极低出生体重儿肠道菌群的丰富度、定植和演化,以及其代谢产物短链脂肪酸的含量。临床上应该严格把握广谱抗生素适应证及疗程。     

Experimental milk formulae with reduced protein content and desialylated milk proteins: influence on the faecal flora and the growth of term newborn infants

We have assessed the growth, tolerance and the faecal flora composition in healthy infants on different feeding regimens. Four groups of infants were fed exclusively on mother's milk, a standard formula and two experimental formulae. The first experimental formula consisted of a milk with a reduced protein content (1.2 g/100 ml), the second in a formula with the same protein content and with milk proteins desialylated by mild acid hydrolysis. The aim of the study was to test whether lowering the protein content and/or modifying the proteins by desialylation would favour the development of a bifidus flora. A bifidus flora was detected in 60% of breastfed infants at 1 month of life. All formulae employed during the study failed to induce a prevalence of colonization with bifidobacteria at 1 month of age. The two experimental milk formulae were well tolerated, but the infant growth rate was slightly lower as compared to the breastfed infants and the infants fed the standard formula. The presence in milk formulae of pre-digested and desialylated proteins can offer some advantages in term of digestibility and mimic a physiological intestinal mechanism of the infant.