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Postpartum Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Elena R. Magro-Malosso, Sarah K. Dotters-Katz, Daniele Di Mascio
Infants who are artificially fed face higher risks of infectious morbidity and chronic disease than infants who are breastfed. An Agency for Healthcare Research and Quality (AHRQ) meta-analysis of outcomes in developed countries found that artificially fed infants faced a 2.0-fold risk of otitis media, a 3.6-fold risk of pneumonia, and a 2.8-fold risk of gastrointestinal infection compared with infants who were exclusively breastfed [136]. Artificial feeding is also associated with a 1.8- to 3.7-fold risk of sudden infant death syndrome (SIDS), a 1.1- to 1.4-fold risk of child obesity, and a 1.5-fold risk of type 2 diabetes compared with breastfeeding. Artificial or mixed feeding is also associated with higher risks of asthma compared with exclusive breastfeeding. Among preterm infants, artificial feeding is associated with a 5% absolute increased risk of necrotizing enterocolitis compared with being fed mother’s milk [136].
The Genetic Basis of NEC Susceptibility
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Lovya George, Wei Yu, Alain Cuna, Venkatesh Sampath
Necrotizing enterocolitis (NEC) is a devastating inflammatory disease of the intestinal tract that affects 5% to 10% of premature infants born weighing less than 1500 g. It has a mortality of 20% to 35% (1), is associated with a prolonged hospital stay, and has significant long-term morbidity, including intestinal failure and neurodevelopmental disability. Despite tremendous advancements in neonatal care, outcomes for NEC have remained virtually unchanged and may even be worsening (2, 3). The pathogenesis of NEC is multifactorial, involving complex interactions between aberrant bacterial colonization in the gut and the immature gut immune system. While several risk factors have been identified, they cannot fully account for significant variability in the incidence and severity of disease. This has led to increasing recognition that genetic factors modulate susceptibility or severity of NEC (4–10). Several investigators have attempted to uncover the genetic basis of NEC using various strategies. In this chapter we will 1) discuss approaches to exploring genetic variation in NEC; 2) summarize the key findings, strengths, and limitations of published gene-association studies; and 3) discuss the challenges and future considerations for research in this area.
Gastroschisis
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marshall Z. Schwartz, Shaheen J. Timmapuri
A delayed complication is the development of necrotizing enterocolitis. The incidence of necrotizing enterocolitis in patients with gastroschisis has been reported to be as high as 20%. It generally has a delayed onset, usually 3–6 weeks after birth. The cause remains unknown, but associations have been made with total parenteral nutrition (TPN)-induced cholestasis, excessive or accelerated postoperative feeding. Necrotizing enterocolitis associated with gastroschisis can be mild or severe and can involve a significant portion of the bowel, resulting in a high mortality.
Infant gut microbiota restoration: state of the art
Published in Gut Microbes, 2022
Katri Korpela, Willem M. de Vos
Preterm infants represent a vulnerable group that are prone to intestinal infections among other complications and are often subject to microbiota-compromising treatments, such as C-section birth, antibiotics, and lack of maternal skin contact and breastfeeding. Their gut microbiota development differs from term-born infants, beginning the normal developmental pattern when they reach the gestational age of term birth,77 suggesting that the immature gut may not be able to sustain a normal microbiota prior to that. Because of this, birth mode has a less clear influence on the preterm infant gut microbiota.77 Various studies have shown the benefits of supplements of lactic acid bacteria or bifidobacteria in reducing the incidence of necrotizing enterocolitis and mortality in preterm infants, with multispecies products achieving the best outcomes.78 In addition, feeding breastmilk has long been known to reduce the incidence of necrotizing enterocolitis.79 Clearly, the gut microbiota is extremely important for the health and survival of prematurely born infants. However, restoration efforts should be specifically designed with their unique physiology and vulnerabilities in mind, accepting that term-like gut microbiota may not be biologically realistic or desirable. Because of this, we will focus the following analysis on microbiota restoration in term-born infants.
Experimental Modeling of Necrotizing Enterocolitis in Human Infant Intestinal Enteroids
Published in Journal of Investigative Surgery, 2022
Christie Buonpane, Guillermo Ares, Carrie Yuan, Camille Schlegel, Heather Liebe, Catherine J. Hunter
Necrotizing enterocolitis is a devasting gastrointestinal disease that typically afflicts premature infants. As many as 7% of all infants admitted to the neonatal intensive care unit may develop this disease. NEC remains a leading cause of short gut syndrome. Although the definitive cause(s) of NEC remain unknown, contributing factors include an immature intestine and the presence of bacteria which remain important in the pathophysiology of disease. Many different animal models have been developed to study NEC, including rat, mouse and pig models. The ability to study this disease directly in humans is limited given the typical vulnerable patient population that is affected. Enteroids generated from the “at risk” population of premature infants present an especially important model of study for these patients. We hypothesized that enteroids generated from premature infants and treated with LPS would function as a useful and novel model of NEC. Herein, we present data supporting a novel human infant enteroid model of NEC.
Trading Cultural Competency for Trauma Informed Care
Published in The American Journal of Bioethics, 2021
Uchenna Anani, Elizabeth Lanphier, Dalia Feltman
Framing lower rates of breastfeeding among Black mothers as a cultural difference does not appreciate systemic influences on breastfeeding rates as one of several health disparities affecting Black newborns. Black women are more likely to deliver prematurely, especially at extremely early gestational ages, and be at higher risk for prematurity-related comorbidities (Arnolds et al. 2020). One such complication, necrotizing enterocolitis, is higher in formula-fed premature infants, illustrating the value of addressing breastmilk feeding difficulties. By offering reading materials on breastfeeding and lactation support, the medical team assumes that merely providing more information will allow Vanessa to overcome her breastfeeding challenges, without addressing structural barriers she might be facing.