Development of the preterm infant gut microbiome: a research priority.

The very low birth weight (VLBW) infant is at great risk for marked dysbiosis of the gut microbiome due to multiple factors, including physiological immaturity and prenatal/postnatal influences that disrupt the development of a normal gut flora. However, little is known about the developmental succession of the microbiota in preterm infants as they grow and mature. This review provides a synthesis of our understanding of the normal development of the infant gut microbiome and contrasts this with dysbiotic development in the VLBW infant. The role of human milk in normal gut microbial development is emphasized, along with the role of the gut microbiome in immune development and gastroenteric health. Current research provides evidence that the gut microbiome interacts extensively with many physiological systems and metabolic processes in the developing infant. However, to the best of our knowledge, there are currently no studies prospectively mapping the gut microbiome of VLBW infants through early childhood. This knowledge gap must be filled to inform a healthcare system that can provide for the growth, health, and development of VLBW infants. The paper concludes with speculation about how the VLBW infants' gut microbiome might function through host-microbe interactions to contribute to the sequelae of preterm birth, including its influence on growth, development, and general health of the infant host

Method of supplementing cytokine, chemokine and growth factors in donor human milk

Donor milk has become a standard of care for feeding preterm infants, particularly those with gestational ages of 34 weeks or less, whose mothers are not lactating or not producing sufficient milk quantities. However, prior to distribution, donor milk is required to undergo pasteurization, typically using the Holder method, which is believed to destroy immune proteins in the milk and denature many other proteins. Donor milk has been found to contain concentrations of chemokines, cytokines, and growth factors, evidencing the value of donor milk over formula. In light of the findings, donor milk is supplemented with chemokines, cytokines, and growth factors that are found to be lower in the donor milk as compared to mother\u27s own milk

Method of supplementing cytokine, chemokine and growth factors in donor human milk

Donor milk has become a standard of care for feeding preterm infants, particularly those with gestational ages of 34 weeks or less, whose mothers are not lactating or not producing sufficient milk quantities. However, prior to distribution, donor milk is required to undergo pasteurization, typically using the Holder method, which is believed to destroy immune proteins in the milk and denature many other proteins. Donor milk has been found to contain concentrations of chemokines, cytokines, and growth factors, evidencing the value of donor milk over formula. In light of the findings, donor milk is supplemented with chemokines, cytokines, and growth factors that are found to be lower in the donor milk as compared to mother\u27s own milk

Machine-based infants pain assessment tool

A system and method for measuring an infant\u27s pain intensity is presented. The method for assessing an infant\u27s pain intensity based on facial expressions is comprised of three main stages: detection of an infant\u27s face in video sequence followed by preprocessing operations including face alignment; expression segmentation; and expression recognition or classification. Also presented is a multimodal system for assessing an infant\u27s pain intensity using the following classifiers: facial expression classifier; vital sign classifier; crying recognition classifier; body motion classifier and state of arousal classifier. Each classifier generates an individual score, all of which are normalized and weighed to generate a total pain score that indicates pain intensity

Pain Assessment in Infants: Towards Spotting the Pain Expression Based on the Facial Strain

We report novel results of utilizing infant facial tissue distortion as a pain indicator in video-sequences of ten infants based on analysis of facial strain. Facial strain, which is used as the main feature for classification, is generated for each facial expression and then used to train two classifiers, k Nearest-Neighbors (KNN) and support vector machine (SVM) to classify infants\u27 expressions into two categories, pain and no-pain. The accuracy of binary classification for KNN and SVM was 96% and 94% respectively, based on ten video sequences. The results of this study are encouraging; they indicate that assessing pain based on facial displays is a promising area of investigation, and open new directions for future work

Automatic Infants’ Pain Assessment by Dynamic Facial Representation: Effects of Profile View, Gestational Age, Gender, and Race

Infants’ early exposure to painful procedures can have negative short and long-term effects on cognitive, neurological, and brain development. However, infants cannot express their subjective pain experience, as they do not communicate in any language. Facial expression is the most specific pain indicator, which has been effectively employed for automatic pain recognition. In this paper, dynamic pain facial expression representation and fusion scheme for automatic pain assessment in infants is proposed by combining temporal appearance facial features and temporal geometric facial features. We investigate the effects of various factors that influence pain reactivity in infants, such as individual variables of gestational age, gender, and race. Different automatic infant pain assessment models are constructed, depending on influence factors as well as facial profile view, which affect the model ability of pain recognition. It can be concluded that the profile-based infant pain assessment is feasible, as its performance is almost as good as that of the whole face. Moreover, gestational age is the most influencing factor for pain assessment, and it is necessary to construct specific models depending on it. This is mainly because of a lack of behavioral communication ability in infants with low gestational age, due to limited neurological development. To our best knowledge, this is the first study investigating infants’ pain recognition, highlighting profile facial views and various individual variables

Infants\u27 Pain Recognition Based on Facial Expression: Dynamic Hybrid Descriptions

Abstract The accurate assessment of infants\u27 pain is important for understanding their medical conditions and developing suitable treatment. Pediatric studies reported that the inadequate treatment of infants\u27 pain might cause various neuroanatomical and psychological problems. The fact that infants can not communicate verbally motivates increasing interests to develop automatic pain assessment system that provides continuous and accurate pain assessment. In this paper, we propose a new set of pain facial activity features to describe the infants\u27 facial expression of pain. Both dynamic facial texture feature and dynamic geometric feature are extracted from video sequences and utilized to classify facial expression of infants as pain or no pain. For the dynamic analysis of facial expression, we construct spatiotemporal domain representation for texture features and time series representation (i.e. time series of frame-level features) for geometric features. Multiple facial features are combined through both feature fusion and decision fusion schemes to evaluate their effectiveness in infants\u27 pain assessment. Experiments are conducted on the video acquired from NICU infants, and the best accuracy of the proposed pain assessment approaches is 95.6%. Moreover, we find that although decision fusion does not perform better than that of feature fusion, the False Negative Rate of decision fusion (6.2%) is much lower than that of feature fusion (25%)

Relationships of Feeding and Mother\u27s Own Milk with Fecal Calprotectin Levels in Preterm Infants

Objective: To describe longitudinal effects of feeding volume and type of milk on fecal calprotectin (f-CP) in very low–birth weight (VLBW) infants. Study Design: Prospective data were collected across Neonatal Intensive Care Unit (NICU) admission for 6 weeks or until discharge in 75 VLBW neonates. The mean gestational age on entry into the study was 29 weeks. Results: Seventy-four (99%) mothers provided expressed milk in varying amounts. Twenty-three mothers (31%) provided exclusive mother\u27s own milk (MOM) throughout. Preterm infant formula (PIF) and pasteurized donor milk were added to feedings of remaining infants. Pooled MOM was analyzed weekly for levels of a panel of cytokines, chemokines, and growth factors, and secretory Immunoglobulin A (sIgA) so that the exact amount of exposure to the gut of these milk bioactives could be estimated. f-CP levels ranged from 160 to 350 μg/g stool. Total feeding volume was positively associated with f-CP, controlling for infant weight, and f-CP levels rose across time. Exclusive MOM feedings for the entire measurement period were associated with rising levels of f-CP, but mixed feedings (MOM with added PIF or pasteurized donor milk (PDM) did not show this increase over time. Conclusion: The presence of f-CP may represent a response to milk volumes and MOM, which represents normal development rather than always implicating pathological inflammation in the VLBW infant