The Neonatal Microbiome: Implications for Neonatal Intensive Care Unit Nurses

Transforming neonatal nursing in India: challenges, opportunities, and the way forward

Neonatal care is essential for the well-being of newborns, particularly premature or critically ill patients. Despite advancements in medical technology and evidence-based practice, India faces significant challenges in neonatal nursing, including resource limitations, inconsistent training, and inadequate policy support. This paper examines the current state of neonatal nursing in India, highlighting disparities between urban and rural areas, and comparing them to global practices. It explores systemic issues affecting neonatal care, such as inadequate educational frameworks, a shortage of trained faculty, and insufficient clinical exposure. We outline a comprehensive approach to address these challenges, including the introduction of Neonatal Nurse Practitioner programs, enhancements in specialized training, promotion of evidence-based practices, and integration of technology. We also emphasize the need for stronger policy support and increased funding to improve the neonatal care infrastructure. By adopting these recommendations, India can make significant strides towards improving neonatal outcomes and aligning itself with global health targets.

Effect of Feeding Fresh or Frozen Breast Milk on the Gut Microbiota of Premature Infants: A Prospective Observational Study

BACKGROUND

Breast milk is essential for premature infants. It contains a variety of functional and protective nutrients that help to create a suitable microenvironment for intestinal development and maturation. This prospective and observational study was planned to examine the effects of feeding premature infants with fresh or frozen breastmilk on their gut microbiota.

MATERIALS AND METHODS

The study was carried out with a total of 40 infants, with a gestational age of 28-326 weeks, fed fresh (n = 20) or frozen (n = 20) breastmilk. Stool samples were stored at -80°C until analysis. Infants were included in groups based on the feed type, which accounted for more than 70% of their 10-day feeding. The Mann-Whitney U, Chi-square, and t-tests were used to evaluate the demographic data. Stool samples were analyzed by sequencing the V3--V4 region of the 16S rRNA gene from the extracted DNA for microbiota analysis.

RESULTS

Streptococcus and Enterobacteriales, the majority of which are considered human pathogens, in infants receiving frozen breastmilk (Streptococcus 69%, Enterobacteriales 79%) was higher than that in infants receiving fresh breastmilk (Streptococcus 16%, Enterobacteriales 49%). Further, the Lactobacillus and Bifidobacterium species were more abundant in infants who received fresh breastmilk (Lactobacillus 17%, Bifidobacterium 12%) than in infants who received frozen breastmilk (Lactobacillus 3%, Bifidobacterium 1%).

CONCLUSION

Thus, compared to frozen breast milk, fresh breastmilk has an effect on the diversity of preterm infants' gut microbiota.

Impact of intrapartum antibiotics on the infant gastrointestinal microbiome: a narrative review

BACKGROUND

The composition of the infant gastrointestinal (GI) microbiome has been linked to adverse long-term health outcomes and neonatal sepsis. Several factors are known to impact the composition of the microbiome, including mode of delivery, gestational age, feeding method and exposure to antibiotics. The impact of intrapartum antibiotics (IPAs) on the infant microbiome requires further research.

OBJECTIVE

We aimed to evaluate the impact of IPAs on the infant GI microbiome.

METHODS

We searched Ovid MEDLINE and Embase Classic+Embase for articles in English reporting on the microbiome of infants exposed to IPAs from the date of inception to 3 January 2021. Primary outcomes included abundance and colonisation of Bifidobacterium and Lactobacillus, as well as alpha and beta diversity.

RESULTS

30 papers were included in this review. In the first year of life, following exposure to IPAs, 30% (6/20) of infant cohorts displayed significantly reduced Bifidobacterium, 89% (17/19) did not display any significant differences in Lactobacillus colonisation, 21% (7/34) displayed significantly reduced alpha diversity and 35% (12/34) displayed alterations in beta diversity. Results were further stratified by delivery, gestational age (preterm or full term) and feeding method.

CONCLUSIONS

IPAs impact the composition of the infant GI microbiome, resulting in possible reductions Bifidobacterium and alpha diversity, and possible alterations in beta diversity. Our findings may have implications for maternal and neonatal health, including interventions to prevent reductions in health-promoting bacteria (eg, probiotics) and IPA class selection.

Antibiotic Prophylaxis Trials in Obstetrics: A Call for Pediatric Collaboration

Surgical site infections are common complications of cesarean delivery. Many recent studies, including meta-analyses, have assessed the efficacy of antibiotic prophylaxis. Those articles have demonstrated that preincision antibiotic prophylaxis reduces the incidence of surgical site infections postcesarean, and that the use of adjunctive azithromycin further reduces infection after nonelective cesarean deliveries. However, long-term effects of fetal exposure to antibiotic prophylaxis-including asthma, obesity, and alterations in microbiota-have also been demonstrated. We suggest that while studies of optimal antibiotic regimens proceed, considerations of the potential risks to the neonate should be factored into discussions of benefits and burdens.

Efficacy and safety of applying a neonatal early-onset sepsis risk calculator in China

AIM

To evaluate and compare the performance of the early-onset sepsis (EOS) risk calculator with procalcitonin (PCT), complete blood count (CBC) and C-reactive protein (CRP) for predicting neonatal EOS.

METHODS

This was a retrospective case-control study of neonates who were ≥34 weeks of gestation and ≤12 h of age at admission to our hospital between January 2017 and December 2018. Neonates with strictly defined EOS and those without evidence of infection were included in this study. We reviewed and collected the laboratory data and medical charts of the included neonates. The EOS risk scores for all neonates were calculated using the EOS risk calculator, and the results were analysed and compared with blood biomarkers.

RESULTS

A total of 501 neonates, including 353 infected and 148 uninfected infants, met the inclusion criteria for the study. Comparing these predictors, PCT had the best predictive value (sensitivity: 87.5%, specificity: 95.5%), closely followed by the EOS risk calculator (sensitivity: 81.16%, specificity: 93.92%). Multivariate logistic regression found that risk scores calculated by the EOS risk calculator had strong associations with EOS as an independent risk factor (odds ratio: 57.37, P < 0.05). The combination of the EOS risk calculator, PCT, CBC and CRP could increase the predictive value of the model and reach an area under the receiver operating characteristic curve of 0.987 for predicting EOS.

CONCLUSIONS

In this pilot study, applying the EOS calculator in China, the EOS risk calculator and PCT showed good predictive value compared to CBC and CRP. Risk scores from the EOS risk calculator strongly correlated with EOS, and the EOS risk calculator offered increased predictive value when used in combination with blood biomarkers.

Development and Function of the Intestinal Microbiome and Potential Implications for Pig Production

Simple Summary

Piglet preweaning mortality is a major economic loss and welfare concern for the global pork industry, with the industry average sitting at approximately 15%. As such, novel methods for reducing this mortality are needed. Since research into the intestinal microbiota has provided advances in human health, in particular the impact of early life factors, it was the logical next step to synthesise the existing literature to determine the potential relevance to the pig industry. It is evident from the literature that this area of research provides promising results. However, a large gap within the literature currently exists within the lactation period in pigs. Since optimal development within early life is proving to be critical for human infants, it is crucial that further research is invested into understanding the impact of early life events on a piglet’s microbiome. It is hoped that this review will enable access to critical information for those interested in the microbiome and its potential for improving herd health on the farm.

Abstract

The intestinal microbiota has received a lot of attention in recent times due to its essential role in the immune system development and function. Recent work in humans has demonstrated that the first year of life is the most critical time period for microbiome development with perturbations during this time being proven to have long term health consequences. In this review, we describe the literature surrounding early life events in humans and mice that contribute to intestinal microbiota development and function, and compare this to piglets predominantly during their lactation period, which focuses on the impact lactation management practices may have on the intestinal microbiota. Although extensive research has been conducted in this area in humans and mice, little research exists in pigs during perceivably the most critical time period of development, which is the lactation period. The research reviewed outlines the importance of appropriate intestinal microbiota development. However, further research is needed in order to understand the full extent routine farm practices have on a piglet’s intestinal microbiota.