Fecal Bacterial Communities Differ by Lactation Status in Post-Partum Women and Their Infants

Background: Previous research examined effects of human milk on the infant gut microbiota, but little attention has been given to the microbiota of lactating women. Research Aim: To determine associations between exclusive human milk feeding and gut microbiota characteristics in mothers and infants at 6-weeks postpartum. Methods: A sample of mother–infant dyads ( N = 24) provided fecal samples and questionnaire responses at 6-weeks postpartum as part of the Pregnancy, EAting & POstpartum Diapers study. Deoxyribonucleic acid was extracted from stool samples, followed by (V4) 16S ribosomal ribonucleic acid gene amplicon sequencing. Alpha and beta diversity, in addition to taxa differences, were compared by human milk exposure status, exclusive versus non-exclusive. A subset of dyads (those exclusively fed human milk; n = 14) was analyzed for shared bifidobacterial species using polymerase chain reaction. Results: Alpha diversity was significantly lower in exclusively human milk-fed infants. Maternal lactation status (exclusive vs. partial) and Shannon diversity were associated in univariate analysis but were no longer associated in multivariable regression including body mass index category in the model. Beta diversity (Sorensen dissimilarity) of fecal samples from women and infants was significantly associated with human milk feeding. Of six infants with Bifidobacterium longum subspecies longum in their fecal samples, all their mothers shared the same species. Conclusion: Maternal gut microbiotas differ by lactation status, a relationship potentially confounded by body mass index category. Further research is needed to identify whether lactation directly influences the maternal gut microbiota, which may be another mechanism by which lactation influences health.

Characteristics of Surgical Necrotizing Enterocolitis: Is It Different from Medical Necrotizing Enterocolitis? A Single-Center Retrospective Study

(1) Background: Necrotizing enterocolitis (NEC) is one of the leading causes of death in newborns despite improvements in the care of critically ill neonates. Approximately 50–70% of the cases are managed by medical therapy. However, the remaining patients require surgical intervention. The purpose of our study was to analyze the factors associated with patients requiring surgical treatment compared to patients requiring only medical treatment; (2) Method: Patients diagnosed with necrotizing enterocolitis over a period of 14 years (January 2003–December 2016) in a single tertiary referral children’s hospital were retrospectively enrolled. Demographics and clinical data were collected through the medical record and were analyzed using Pearson’s χ2 test, t-tests, and linear regression; (3) Results: A total of 189 NEC patients were analyzed. In the surgical NEC group, gestational age was lower (p = 0.018), body weight at birth was lower (p = 0.034), comorbidity with respiratory distress syndrome (RDS) was higher (p = 0.005), the days of antibiotic use were greater (p = 0.014), the percentage of breast milk feeding was lower (p = 0.001), and the length of hospital stay was longer (p < 0.000). The in-hospital mortality between the two groups was not significantly different (p = 0.196). In multivariate logistic analysis, breast milk feeding remained less associated with surgical NEC (OR = 0.366, 95% CI: 0.164–0.817), whereas the length of hospital stay was more associated with surgical NEC (OR = 1.010, 95% CI: 1.001–1.019); (4) Conclusion: Comparing medical and surgical NEC, a significantly lower percentage of surgical NEC patients were fed breast milk and their hospital stays were longer.

Early Nutrition among Infants Admitted to the NICU with Cleft Lip and Palate

Objective The objective of this study was to examine differences in human milk feeding outcomes among infants admitted to a neonatal intensive care unit (NICU) with and without cleft lip and palate (CLP). Method Data were used from a sample of infants admitted to the NICU with and without CLP from the 2018 National Vital Statistics System. For baseline comparisons, Chi-square tests of independence were used to compare categorical variables, and independent samples t tests were used for continuous variables. Logistic regression models were performed to determine the odds of human milk feeding at discharge in infants admitted to the NICU with CLP. Results The total sample included 345,429 infants admitted to the NICU, of which 660 had CLP. Significant differences were found among the following variables when baseline comparisons were made between infants admitted to the NICU with and without CLP: mother's race, mother's education, maternal smoking record, childbirth delivery method, presence of maternal pre-pregnancy diabetes, five-minute APGAR score, multiparity record (having more than one baby at birth), gestational age, and gestational weight. After controlling for baseline differences, results indicated reduced odds of human milk feeding at discharge in infants admitted to the NICU with CLP compared to those without CLP (OR = .543; 95% CI.455,.648). Conclusion Results suggest reduced odds of human milk feeding at discharge among infants admitted to the NICU with CLP compared to those without CLP. These findings emphasize the necessity of awareness and facilitation of human milk feeding in this population.

Type of Milk Feeding and Introduction to Complementary Foods in Relation to Infant Sleep: A Systematic Review

Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. This study aimed to systematically review the existing literature on infant sleep and its relation to the timing of introduction to complementary foods and type of milk feeding to better understand their role(s) in infant sleep. Cohort, longitudinal, cross-sectional studies, and controlled trials were identified using online searches of five databases up to April 2020. Twenty-one articles with a total of 6225 infants under 12 months-of-age were eligible. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies (67%) reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies (>65%) reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (<12 months-of-age). Future studies using standardized methodologies and definitions, transdisciplinary expertise, and longitudinal design are required to better understand the complex role of feeding on sleep.

Recurrent late-onset neonatal sepsis traced to breast milk: A case report

Breast milk feeding is an important late-onset sepsis reduction strategy in the Neonatal Intensive Care Unit (NICU). However, multiple studies have reported transfer of bacteria-contaminated breast milk to infants. We describe a case of culture-positive breast milk resulting in persistent Enterococcus bacteremia in an infant. Beyond the development of an infant’s innate and specific immunity as well as colonization of the gastrointestinal (GI) tract with commensal organisms, the risk of bacterial translocation from the GI tract into the bloodstream is shaped and modified by maternal health, birth history, and an infant’s NICU course. While freezing and/or pasteurizing breast milk reduces or eliminates its bacterial load, it also diminishes its immunologic and nutritional benefits.