Gut microbiota development of preterm infants hospitalised in intensive care units

2019 ◽  
Vol 10 (6) ◽  
pp. 641-651 ◽  
Author(s):  
H. Tauchi ◽  
K. Yahagi ◽  
T. Yamauchi ◽  
T. Hara ◽  
R. Yamaoka ◽  
...  
Keyword(s):  
Intensive Care ◽  
Individual Differences ◽  
Gut Microbiota ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Infant Health ◽  
Rrna Gene ◽  
Term Infants ◽  
Gut Microbe

Gut microbiome development affects infant health and postnatal physiology. The gut microbe assemblages of preterm infants have been reported to be different from that of healthy term infants. However, the patterns of ecosystem development and inter-individual differences remain poorly understood. We investigated hospitalised preterm infant gut microbiota development using 16S rRNA gene amplicons and the metabolic profiles of 268 stool samples obtained from 17 intensive care and 42 term infants to elucidate the dynamics and equilibria of the developing microbiota. Infant gut microbiota were predominated by Gram-positive cocci, Enterobacteriaceae or Bifidobacteriaceae, which showed sequential transitions to Bifidobacteriaceae-dominated microbiota. In neonatal intensive care unit preterm infants (NICU preterm infants), Staphylococcaceae abundance was higher immediately after birth than in healthy term infants, and Bifidobacteriaceae colonisation tended to be delayed. No specific NICU-cared infant enterotype-like cluster was observed, suggesting that the constrained environment only affected the pace of transition, but not infant gut microbiota equilibrium. Moreover, infants with Bifidobacteriaceae-dominated microbiota showed higher acetate concentrations and lower pH, which have been associated with host health. Our data provides an in-depth understanding of gut microbiota development in NICU preterm infants and complements earlier studies. Understanding the patterns and inter-individual differences of the preterm infant gut ecosystem is the first step towards controlling the risk of diseases in premature infants by targeting intestinal microbiota.

scholarly journals Neonatal intensive care unit (NICU) exposures exert a sustained influence on the progression of gut microbiota and metabolome in the first year of life

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Polly Soo Xi Yap ◽  
Chun Wie Chong ◽  
Azanna Ahmad Kamar ◽  
Ivan Kok Seng Yap ◽  
Yao Mun Choo ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Early Time ◽  
16S Rrna Gene Sequencing ◽  
Resonance Spectroscopy ◽  
Rrna Gene ◽  
Microbial Composition ◽  
Term Infants ◽  
Rrna Gene Sequencing

AbstractEmerging evidence has shown a link between the perturbations and development of the gut microbiota in infants with their immediate and long-term health. To better understand the assembly of the gut microbiota in preterm infants, faecal samples were longitudinally collected from the preterm (n = 19) and term (n = 20) infants from birth until month 12. 16S rRNA gene sequencing (n = 141) and metabolomics profiling (n = 141) using nuclear magnetic resonance spectroscopy identified significant differences between groups in various time points. A panel of amino acid metabolites and central metabolism intermediates significantly correlated with the relative abundances of 8 species of bacteria were identified in the preterm group. In contrast, faecal metabolites of term infants had significantly higher levels of metabolites which are commonly found in milk such as fucose and β-hydroxybutyrate. We demonstrated that the early-life factors such as gestational age, birth weight and NICU exposures, exerted a sustained effect to the dynamics of gut microbial composition and metabolism of the neonates up to one year of age. Thus, our findings suggest that intervention at this early time could provide ‘metabolic rescue’ to preterm infants from aberrant initial gut microbial colonisation and succession.

scholarly journals The Effects of Genetic Relatedness on the Preterm Infant Gut Microbiota

2021 ◽  
Vol 9 (2) ◽  
pp. 278
Author(s):  
Shen Jean Lim ◽  
Miriam Aguilar-Lopez ◽  
Christine Wetzel ◽  
Samia V. O. Dutra ◽  
Vanessa Bray ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Preterm Infant ◽  
Neonatal Intensive Care ◽  
Genetic Relatedness ◽  
Bovine Milk ◽  
Alpha Diversity ◽  
Neonatal Intensive Care Units ◽  
Rrna Gene ◽  
Microbial Composition ◽  
Operational Taxonomic Units

The preterm infant gut microbiota is influenced by environmental, endogenous, maternal, and genetic factors. Although siblings share similar gut microbial composition, it is not known how genetic relatedness affects alpha diversity and specific taxa abundances in preterm infants. We analyzed the 16S rRNA gene content of stool samples, ≤ and >3 weeks postnatal age, and clinical data from preterm multiplets and singletons at two Neonatal Intensive Care Units (NICUs), Tampa General Hospital (TGH; FL, USA) and Carle Hospital (IL, USA). Weeks on bovine milk-based fortifier (BMF) and weight gain velocity were significant predictors of alpha diversity. Alpha diversity between siblings were significantly correlated, particularly at ≤3 weeks postnatal age and in the TGH NICU, after controlling for clinical factors. Siblings shared higher gut microbial composition similarity compared to unrelated individuals. After residualizing against clinical covariates, 30 common operational taxonomic units were correlated between siblings across time points. These belonged to the bacterial classes Actinobacteria, Bacilli, Bacteroidia, Clostridia, Erysipelotrichia, and Negativicutes. Besides the influence of BMF and weight variables on the gut microbial diversity, our study identified gut microbial similarities between siblings that suggest genetic or shared maternal and environmental effects on the preterm infant gut microbiota.

Kernicterus in Preterm Infants; Lest We Forget (To Turn on the Lights)

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 757-759
Author(s):  
N. KEVIN IVES
Keyword(s):  
Intensive Care ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Neonatal Jaundice ◽  
Current Issue ◽  
Historical Review ◽  
Term Infants ◽  
Turn On ◽  
Treatment Thresholds ◽  
One Act

Watchko and Oski have a reputation for stimulating debate on the topic of neonatal jaundice. As scriptwriters of "Vigintiphobia: a one-act play,"1 they questioned the `standard practice' applied to the management of jaundice in otherwise healthy term infants. In the current issue of Pediatrics2 they again court controversy by turning their attention to treatment thresholds and the risk of kernicterus in jaundiced preterm infants. We are provided with a thoroughly researched historical review of the risk of kernicterus in the preterm infant from 1950 to the 1990s. The story is presented as a journey of experience from the pre-intensive care era, through the so-called `low bilirubin kernicterus era' (1965 through 1982), to the present.

scholarly journals Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

2020 ◽  
Author(s):  
Xin Liu ◽  
Zhankui Li ◽  
Xiaohui Chen ◽  
Bei Cao ◽  
Shaojie Yue ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Intervention Program ◽  
Infant Health ◽  
Kangaroo Mother Care ◽  
Respiratory Support ◽  
Neonatal Intensive Care Units ◽  
Cross Sectional

Abstract Background To understand the feasibility and method of adoption of KMC in the context of China's NICUs. Describe the utilization of kangaroo mother care (KMC) in eight self-selected neonatal intensive care units (NICUs) participating in premature birth and infant’s intervention program. Methods A cross-sectional study of preterm infants discharged from eight NICUs in April 2018 . For infants was collected this included postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC. Results 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. Conclusion After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest to continue to promote parents KMC education enhancing preterm infant health.

scholarly journals Utilization pattern of kangaroo mother care after introduction in eight selected neonatal intensive care units in China

2020 ◽  
Author(s):  
Xin Liu ◽  
Zhankui Li ◽  
Xiaohui Chen ◽  
Bei Cao ◽  
Shaojie Yue ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Infant Health ◽  
Kangaroo Mother Care ◽  
Respiratory Support ◽  
Neonatal Intensive Care Units ◽  
Cross Sectional ◽  
Parental Experience

Abstract Background: Kangaroo mother care (KMC) is an evidence-based and cost-effective intervention that could prevent severe complications for preterm babies, however it has not been widely adopted in China. In this study, we aim to investigate the feasibility and parental experience of adopting KMC in a Chinese context by studying the implementation of a KMC program in eight self-selected neonatal intensive care units (NICUs).Methods: A cross-sectional study of 135 preterm infants discharged from eight NICUs in April 2018. For infants information was collected on postnatal day and corrected gestational age (GA) at KMC initiation, frequency and duration of KMC provision and whether the infant was receiving respiratory support. A nurse-administered questionnaire on parents’ knowledge and experience of KMC provision was administered to parents providing KMC.Results: 135 preterm infants received KMC, 21.2% of all preterm infants discharged. 91.1% of those who received KMC were below 34 weeks GA, 91.1% had a birth weight below 2000g, and 20.7% needed respiratory support at KMC initiation. Average KMC exposure was greater in infants born at GA <28 weeks that babies born at greater GA. 94.8% of parents that participated in the parental survey indicated that KMC was positively accepted by their family members; 60.4% of the parents claimed that KMC could relieve anxiety, 57.3% claimed it prompted more interactions with medical staff and 69.8% suggested it increased parental confidence in care for their infants.Conclusions: After advocacy, training and promotion, intermittent KMC was initiated on more immature and high-risk infants, and well-accepted by parents. We suggest continuing to promote KMC education to parents and enhancing preterm infant health.

Auditory Brainstem Response in Preterm Infants in the Neonatal Intensive Care Unit

2020 ◽  
pp. 019459982095518
Author(s):  
Diogo Raposo ◽  
João Orfão ◽  
Marco Menezes ◽  
Mafalda Trindade-Soares ◽  
Ana Guimarães ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Preterm Infants ◽  
Auditory Brainstem Response ◽  
Neonatal Intensive Care ◽  
Auditory Brainstem ◽  
Term Infants ◽  
Congenital Cytomegalovirus ◽  
Brainstem Response

Objective To analyze auditory brainstem response (ABR) findings of preterm and term infants in the neonatal intensive care unit (NICU) with perinatal problems. Study Design Case series with chart review. Setting Secondary care hospital. Methods Analysis consisted of a consecutive series of 101 infants (69 preterm and 32 term) admitted in the NICU of Hospital Fernando Fonseca between 2016 and 2018 with perinatal problems who underwent an ABR evaluation. Results The major perinatal problems identified were hyperbilirubinemia, intravenous gentamicin >5 days, mechanical ventilation >5 days, congenital cytomegalovirus infection, meningitis, and periventricular hemorrhage. Gentamicin use significantly increased the absolute latency of wave I in preterm infants (95% CI, 0.01-0.37; P = .037). Mechanical ventilation significantly decreased the latency of wave V and intervals I-V and III-V in preterm infants (95% CI, −0.35 to −0.22; P = .026; 95% CI, −0.33 to −0.00; P = .001; 95% CI, −0.46 to 0.12; P = .049). Congenital cytomegalovirus significantly decreased interval III-V in preterm infants (95% CI, −0.36 to −0.01; P = .042). Multivariate analysis revealed that gentamicin use, lower gestational age, and lower birth weight predicted an increased ABR threshold in preterm infants (95% CI, 1.64-15.31; P = .016; 95% CI −1.72 to −0.09; P = .030; 95% CI, −14.55 to −0.63; P = .033). ABR measurements in term infants were not significantly altered, with the exception of an increased latency of wave III with a lower gestational age (95% CI, −0.49 to −0.01; P = .038). Conclusions These findings suggest that perinatal problems in the NICU significantly impair the ABR threshold and the auditory pathway maturational process in preterm but not term infants.

87 Validation of a Costing Algorithm in the Neonatal Intensive Care Unit and Identification of Cost Drivers for Neonates

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e62-e64
Author(s):  
Elias Jabbour ◽  
Sharina Patel ◽  
Juan David Rios ◽  
Petros Pechlivanoglou ◽  
Prakesh Shah ◽  
...  
Keyword(s):  
Intensive Care ◽  
Real Time ◽  
Preterm Infants ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Case Mix ◽  
P Value ◽  
Term Infants ◽  
Time Costs ◽  
Financial Software

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Neonatal Intensive Care Units (NICUs) account for over 35% of pediatric in-hospital clinical costs, thus implying that a better understanding of care expenditures within these units is the first step for improving efficiency of care. The Canadian Neonatal Network (CNN) algorithm is the first to provide case-specific costs based on resource usage among preterm infants born &lt; 37 weeks but has not yet been validated for other populations in the NICU. Objectives To validate the CNN costing algorithm in six case-mix categories with real-time costs obtained from hospital-specific financial software (CPSS) in a tertiary-level NICU and assess the variations in proportion of cost centers across case-mixes. Design/Methods A retrospective cohort study of all patients admitted within 24h of birth to a Level 3 medico-surgical NICU 2016-2019. Patient demographics, clinical information and CNN predicted costs were obtained from the CNN database. Real-time costs were obtained from the hospital financial software (CPSS). Total and daily costs were compared between sources using Pearson correlation coefficient (r) and paired Student’s t-test. Costs were adjusted to account for inter-institutional and -provincial price variations using the Cost of Standard Hospitalization Stay from the Canadian Institute for Health Information. Proportions of each cost center across the different case-mix categories were compared using Chi-square analyses. Results Among the 1795 live infants admitted into the NICU, 167 (9.3%) were &lt; 29 weeks gestational age (GA), 193 (11%) were 29-32 weeks GA, 457 (25.5%) were 33-36 weeks GA, 144 (8%) had major congenital anomalies, 179 (10%) were term infants diagnosed with Hypoxic-Ischemic Encephalopathy (HIE) and 672 (37%) were term infants with no HIE or major congenital anomalies. Median NICU costs varied according to each case-mix from $10,025 for term infants without HIE or congenital anomaly to $180,145 for infants born &lt; 29 weeks (Figure 1). Despite high variation in total NICU costs, there were small variations in median daily costs (range: $1,312-$1,941). Overall, the CNN algorithm strongly correlated with CPSS total costs across all 6 case-mix categories (r range 0.90-1.00, p-value &lt; 0 .01) (Figure 2). We report a consistent strong predictive performance of the algorithm in 5/8 pre-specified cost centers among preterm infants (r range 0.77-0.99, p-value &lt; 0 .01). Unit producing personnel (nurses and physicians) consistently comprised the largest proportion of total costs (64-78%) for all case-mix categories. Conclusion The CNN algorithm accurately predicts NICU total costs for six case-mix categories. Costs per day were comparable across different case-mix categories, and unit producing personnel represented the highest proportion of costs suggesting that reductions in length of stay would be the most efficient method to reduce NICU costs.

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