The preterm gut microbiota: changes associated with necrotizing enterocolitis and infection

Aim: To describe gut colonization in preterm infants using standard culture and 16S gene rRNA profiling, exploring differences in healthy infants and those who developed NEC/late onset sepsis (LOS). Methods: Ninety‐nine stools from 38 infants of median 27‐week gestation were cultured; 44 stools from 27 infants had their microbial profiles determined by 16S. Ordination analyses explored effects of patient variables on gut communities. Results: Standard microbiological culture identified a mean of two organisms (range 0–7), DGGE 12 (range 3–18) per patient. Enterococcus faecalis and coagulase negative staphylococci (CONS) were most common by culture (40% and 39% of specimens). Meconium was not sterile. No fungi were cultured. Bacterial community structures in infants with NEC and LOS differed from healthy infants. Infants who developed NEC carried more CONS (45% vs 30%) and less Enterococcus faecalis (31% vs 57%). 16S identified Enterobacter and Staphylococcus presence associated with NEC/LOS, respectively. Conclusions: Important differences were found in the gut microbiota of preterm infants who develop NEC/LOS. The relationship of these changes to current practices in neonatal intensive care requires further exploration.     

Interventions for alcohol-related brain damage (ARBD): Do specific approaches restrict the evolution of comprehensive patient care?

Aims: The prevalence of alcohol-related brain damage (ARBD) is recognized to be increasing in the Western world. The aim of this article is to review the evidence concerning interventions in ARBD. Design and methods: Systematic review. Findings: About 469 papers were identified of which 49 were suitable for inclusion. About 20 concerned neuropsychological interventions; 5 detailed psychosocial interventions; and 24 focussed on pharmacological interventions. The findings suggest that a range of cognitive rehabilitation strategies can facilitate new learning and improve memory functioning, while psychosocial interventions and supported accommodation can improve mental and physical health. Conclusions: This review demonstrates the need for a comprehensive approach to ARBD rehabilitation and indicates that the management of this condition has not been investigated in a holistic manner.