Review of the Relationships Between Maternal Characteristics and Preterm Breastmilk Immune Components

2011 ◽  
Vol 14 (2) ◽  
pp. 207-216 ◽  
Author(s):  
Shelley Thibeau ◽  
Karen D’Apolito
Keyword(s):  
Preterm Infant ◽  
Necrotizing Enterocolitis ◽  
Nosocomial Infections ◽  
Infant Health ◽  
Immunoglobulin A ◽  
The United States ◽  
Term Infants ◽  
Mortality And Morbidity ◽  
Maternal Characteristics ◽  
The Impact

The immune properties of breastmilk are the most effective preventative means of reducing infant mortality through both passive and active immunity. Breastmilk for term infants has been linked to decreased incidence of respiratory and ear infections and gastrointestinal distress. This protection is even more important for the preterm infant. Prematurity is one of the leading causes of infant death in the United States. Hospitalized infant outcomes associated with consumption of breastmilk are shorter length of stay and decreased incidence of nosocomial infections and necrotizing enterocolitis (NEC). The presence of nosocomial infections and necrotizing enterocolitis increases risk of preterm mortality and morbidity as well as healthcare expenditures. However, breastmilk immunological components such as secretory immunoglobulin A, lactoferrin (LFT), and cytokines provide a framework of immunity that, in conjunction with nutritional support, significantly improves neonatal health. The relationship between maternal characteristics and breastmilk immune properties is central to further the understanding of the impact of breastmilk on preterm infant morbidity and mortality. The purpose of this article is to review the numerous immune components in breastmilk, the moderators of the immune components, and the relevance of these components to preterm/infant health. Exploration of the complexity of breastmilk immune components may direct future development of interventions to improve and sustain the immunological benefits of preterm breastmilk.

scholarly journals More Than Shelter: Housing for Urban Maternal and Infant Health

2021 ◽  
Vol 18 (7) ◽  
pp. 3331
Author(s):  
Jason Reece
Keyword(s):  
Public Health ◽  
Maternal Health ◽  
Health Outcomes ◽  
City Planning ◽  
Infant Health ◽  
The United States ◽  
Housing Quality ◽  
Housing Discrimination ◽  
Maternal Health Outcomes ◽  
The Impact

Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary “pathways” by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.

scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

scholarly journals Diverse local epidemics reveal the distinct effects of population density, demographics, climate, depletion of susceptibles, and intervention in the first wave of COVID-19 in the United States

2020 ◽  
Author(s):  
Niayesh Afshordi ◽  
Benjamin Holder ◽  
Mohammad Bahrami ◽  
Daniel Lichtblau
Keyword(s):  
United States ◽  
Population Density ◽  
The United States ◽  
Effective Response ◽  
Susceptible Population ◽  
Local Climate ◽  
Climate Conditions ◽  
Mortality And Morbidity ◽  
Social Distancing ◽  
The Impact

The SARS-CoV-2 pandemic has caused significant mortality and morbidity worldwide, sparing almost no community. As the disease will likely remain a threat for years to come, an understanding of the precise influences of human demographics and settlement, as well as the dynamic factors of climate, susceptible depletion, and intervention, on the spread of localized epidemics will be vital for mounting an effective response. We consider the entire set of local epidemics in the United States; a broad selection of demographic, population density, and climate factors; and local mobility data, tracking social distancing interventions, to determine the key factors driving the spread and containment of the virus. Assuming first a linear model for the rate of exponential growth (or decay) in cases/mortality, we find that population-weighted density, humidity, and median age dominate the dynamics of growth and decline, once interventions are accounted for. A focus on distinct metropolitan areas suggests that some locales benefited from the timing of a nearly simultaneous nationwide shutdown, and/or the regional climate conditions in mid-March; while others suffered significant outbreaks prior to intervention. Using a first-principles model of the infection spread, we then develop predictions for the impact of the relaxation of social distancing and local climate conditions. A few regions, where a significant fraction of the population was infected, show evidence that the epidemic has partially resolved via depletion of the susceptible population (i.e., “herd immunity”), while most regions in the United States remain overwhelmingly susceptible. These results will be important for optimal management of intervention strategies, which can be facilitated using our online dashboard.

Cardiac Disease in Pregnancy

2018 ◽  
Vol 29 (3) ◽  
pp. 295-302 ◽  
Author(s):  
Stephanie Martin ◽  
Julie Arafeh
Keyword(s):  
Cardiac Disease ◽  
Management Strategy ◽  
Pregnant Patient ◽  
The United States ◽  
Patient Treatment ◽  
Physiological Changes ◽  
Mortality And Morbidity ◽  
Disease Management Strategy ◽  
Maternal Mortality And Morbidity ◽  
The Impact

In the United States, cardiac disease is a leading contributor to maternal mortality and morbidity. This review addresses the impact of cardiac disease on management of pregnancy and how the physiological changes of pregnancy complicate patient treatment. Approaches to assessing risk in pregnant women with cardiac disease are reviewed. Key elements of a successful disease management strategy are reviewed. Management of cardiac arrest in a pregnant patient is discussed.

scholarly journals The Impact in the United States of the Baby-Friendly Hospital Initiative on Early Infant Health and Breastfeeding Outcomes

2016 ◽  
Vol 11 (5) ◽  
pp. 222-230 ◽  
Author(s):  
Allison C. Munn ◽  
Susan D. Newman ◽  
Martina Mueller ◽  
Shannon M. Phillips ◽  
Sarah N. Taylor
Keyword(s):  
United States ◽  
Infant Health ◽  
The United States ◽  
Baby Friendly Hospital Initiative ◽  
Early Infant ◽  
The Impact

scholarly journals The Microbiome and Metabolome of Preterm Infant Stool Are Personalized and Not Driven by Health Outcomes, Including Necrotizing Enterocolitis and Late-Onset Sepsis

mSphere ◽  
2018 ◽  
Vol 3 (3) ◽  
Author(s):  
Stephen Wandro ◽  
Stephanie Osborne ◽  
Claudia Enriquez ◽  
Christine Bixby ◽  
Antonio Arrieta ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Preterm Infant ◽  
Preterm Infants ◽  
Necrotizing Enterocolitis ◽  
Gut Microbiome ◽  
Infant Health ◽  
Late Onset ◽  
Bacterial Composition ◽  
Fecal Samples ◽  
Late Onset Sepsis

ABSTRACTThe assembly and development of the gut microbiome in infants have important consequences for immediate and long-term health. Preterm infants represent an abnormal case for bacterial colonization because of early exposure to bacteria and frequent use of antibiotics. To better understand the assembly of the gut microbiota in preterm infants, fecal samples were collected from 32 very low birth weight preterm infants over the first 6 weeks of life. Infant health outcomes included health, late-onset sepsis, and necrotizing enterocolitis (NEC). We characterized bacterial compositions by 16S rRNA gene sequencing and metabolomes by untargeted gas chromatography-mass spectrometry. Preterm infant fecal samples lacked beneficialBifidobacteriumspp. and were dominated byEnterobacteriaceae,Enterococcus, andStaphylococcusorganisms due to nearly uniform antibiotic administration. Most of the variance between the microbial community compositions could be attributed to the baby from which the sample derived (permutational multivariate analysis of variance [PERMANOVA]R2= 0.48,P< 0.001), while clinical status (health, NEC, or late-onset sepsis) and overlapping times in the neonatal intensive care unit (NICU) did not explain a significant amount of variation in bacterial composition. Fecal metabolomes were also found to be unique to the individual (PERMANOVAR2= 0.43,P< 0.001) and weakly associated with bacterial composition (Mantel statisticr= 0.23 ± 0.05,P< 0.05). No measured metabolites were found to be associated with necrotizing enterocolitis, late-onset sepsis, or a healthy outcome. Overall, preterm infant gut microbial communities were personalized and reflected antibiotic usage.IMPORTANCEPreterm infants face health problems likely related to microbial exposures, including sepsis and necrotizing enterocolitis. However, the role of the gut microbiome in preterm infant health is poorly understood. Microbial colonization differs from that of healthy term babies because it occurs in the NICU and is often perturbed by antibiotics. We measured bacterial compositions and metabolomic profiles of 77 fecal samples from 32 preterm infants to investigate the differences between microbiomes in health and disease. Rather than finding microbial signatures of disease, we found that both the preterm infant microbiome and the metabolome were personalized and that the preterm infant gut microbiome is enriched in microbes that commonly dominate in the presence of antibiotics. These results contribute to the growing knowledge of the preterm infant microbiome and emphasize that a personalized view will be important to disentangle the health consequences of the preterm infant microbiome.

scholarly journals Changes in Census Data Will Affect Our Understanding of Infant Health

2021 ◽  
Vol 7 ◽  
pp. 237802312110236
Author(s):  
Alexis R. Santos-Lozada
Keyword(s):  
Infant Mortality ◽  
Infant Health ◽  
Census Data ◽  
Differential Privacy ◽  
The United States ◽  
Mortality Rates ◽  
Census Bureau ◽  
Health Statistics ◽  
Health Dynamics ◽  
The Impact

Descriptions of the effect of the implementation of a new disclosure avoidance system (DAS), which relies on differential privacy, emphasize the impact of our understanding of contemporary social and health dynamics. However, focusing on overall population may obscure important changes in subpopulation indicators such as age-specific rates resulting from this implementation. The author provides a visualization that compares infant mortality rates calculated using 2009–2011 county-level average death counts and denominators derived from the traditional and proposed DASs. Death counts come from the National Center for Health Statistics and denominators come from the first U.S. Census Bureau demonstration products. These visualizations indicate that infant mortality rates produced using the proposed DAS are different from those produced using the traditional methods, with higher variation observed for nonmetropolitan counties and areas with smaller populations. These findings suggest that the proposed DAS will hinder our ability to understand contemporary health dynamics in the United States.

scholarly journals The Impact of Homogenization on Donor Human Milk and Human Milk-Based Fortifiers and Implications for Preterm Infant Health

2021 ◽  
Author(s):  
Sarah M Reyes ◽  
Biranchi Patra ◽  
Melinda J Elliott
Keyword(s):  
Human Milk ◽  
Preterm Infant ◽  
Milk Fat ◽  
Infant Health ◽  
Cow Milk ◽  
Published Data ◽  
Donor Human Milk ◽  
Milk Fat Globule ◽  
Health Complications ◽  
The Impact

Abstract An exclusive human milk diet (EHMD) has been shown to reduce health complications of prematurity in infants born weighing ≤1250 grams compared to cow milk-based diets. Accordingly, the number of available human milk (HM)-based nutritional products continues to increase. Newly available products, and those reportedly soon to enter the market include homogenized donor human milk (DHM) and homogenized HM–based fortifiers. Existing literature demonstrating the benefits of an EHMD, however, is limited to non-homogenized HM-based products. Herein, we summarize existing evidence on the impact of homogenization on HM, with a particular focus on changes to the macromolecular structure of the milk fat globule and its subsequent impact on digestion kinetics. We use these published data to create a conceptual framework for the potential implications of homogenized HM-based nutritional products on preterm infant health. Importantly, we underscore that the safety and efficacy of homogenized HM-based products warrant investigation.

Guidelines for Prevention of Group B Streptococcal (GBS) Infection by Chemoprophylaxis

PEDIATRICS ◽  
1992 ◽  
Vol 90 (5) ◽  
pp. 775-778 ◽  
Author(s):  
Keyword(s):  
Pregnant Women ◽  
Early Onset ◽  
Late Onset ◽  
The United States ◽  
Geographic Region ◽  
Culture Methods ◽  
Term Infants ◽  
Mortality And Morbidity ◽  
Young Infants ◽  
Group B

BACKGROUND For two decades streptococci classified serologically as Lancefield group B Streptococcus agalactiae (GBS) have been a leading cause of perinatal infections. In neonates and young infants these infections include congenital pneumonia, sepsis, or meningitis; in pregnant women they include urinary tract infection, chorioamnionitis, early postpartum endometritis, postcesarean section febrile morbidity, and—less frequently—pelvic thrombophlebitis or endocarditis. Although the incidence varies somewhat by geographic region, 12 000 infants and 50 000 pregnant women in the United States are estimated to develop GBS-associated morbidity or mortality annually.1 Overall mortality for early-onset (less than 7 days of age) and late-onset (7 days to 3 months of age) infant disease is approximately 15% and 10%, respectively.2-4 Gestational age significantly correlates with mortality among early-onset cases and is approximately 25% to 30% in preterm infants and 2% to 8% in term infants. Thus, every year approximately 1 600 infants die and an equal number have permanent neurologic sequelae following meningitis.1 This substantial GBS-associated perinatal mortality and morbidity make prevention strategies imperative. Among proposed strategies, including chemoprophylaxis and immunoprophylaxis, only intrapartum maternal chemoprophylaxis has been evaluated for safety and efficacy. EPIDEMIOLOGY GBS are frequently harbored in the genitourinary and lower gastrointestinal tracts of adults. When sensitive culture methods are used for their detection (ie, antibiotic-containing or selective broth media) and both lower vaginal and anorectal sites are sampled, GBS are found in 15% to 40% of pregnant women.5-8 Direct plating of swabs from body surfaces onto solid media or sampling of the cervix as a single genital tract site fails to identify as many as 50% of women who are culture-positive for GBS.4

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