Factors influencing gastrointestinal tract and microbiota immune interaction in preterm infants

The role of microbial colonization is indispensable for keeping a balanced immune response in life. However, the events that regulate the establishment of the microbiota, their timing, and the way in which they interact with the host are not yet fully understood. Factors such as gestational age, mode of delivery, environment, hygienic measures, and diet influence the establishment of microbiota in the perinatal period. Environmental microbes constitute the most important group of exogenous stimuli in this critical time frame. However, the settlement of a stable gut microbiota in preterm infants is delayed compared to term infants. Preterm infants have an immature gastrointestinal tract and immune system which predisposes to infectious morbidity. Neonatal microbial dynamics and alterations in early gut microbiota may precede and/or predispose to diseases such as necrotizing enterocolitis (NEC), late-onset sepsis or others. During this critical period, nutrition is the principal contributor for immunological and metabolic development, and microbiological programming. Breast milk is a known source of molecules that act synergistically to protect the gut barrier and enhance the maturation of the gut-related immune response. Host-microbe interactions in preterm infants and the protective role of diet focused on breast milk impact are beginning to be unveiled.M.C. acknowledges a “Rio Hortega” Research Fellowship Grant (CM13/0017) and M.V. acknowledges grants PI11/0313 and RD12/0026/0012 (Red SAMID) from the Instituto Carlos III (Spanish Ministry of Economy and Competitivity). M.C.C. and G.P-M. were supported by the grant AGL2013-47420-R from the Spanish Ministry of Science and Innovation.Peer reviewe

Perfil das mães de neonatos com controle glicêmico nas primeiras horas de vida Perfil de las madres de neonatos con control glucémico en las primeras horas de vida Profile of mothers of newborns with blood glucose control in the first hours of life

Alguns fatores maternos associados ao quadro de hipoglicemia neonatal indicam a monitoração dos níveis glicêmicos nas primeiras 24 horas de vida. O estudo objetivou descrever as características sócio-demográficas e obstétricas de mães de neonatos com controle de glicemia capilar nas primeiras 24 horas de vida, internadas em Alojamento Conjunto de um Hospital Amigo da Criança. Estudo descritivo-exploratório que analisou dados de 380 prontuários médicos de mães internadas entre julho e dezembro de 2006, na unidade de Alojamento Conjunto do Hospital Universitário da Universidade de São Paulo. Diabetes gestacional foi verificado em 18 (5,6%) mães; nenhuma tratou com hipoglicemiante oral; 53 (16,2%) tiveram hipertensão arterial na gestação, e 17 (32,1%) fizeram uso de anti-hipertensivo; 215 (56,6%) receberam soro glicosado, 5% no trabalho de parto e parto. Estudos correlacionais analisando variáveis maternas e ocorrência de hipoglicemia neonatal devem ser realizados, objetivando identificar os fatores preditores desta morbidade neonatal.<br>Algunos factores maternos asociados al cuadro de hipoglucemia neonatal indican la monitorización de los niveles de glucemia en las primeras 24 horas de vida. El estudio tuvo como objetivo describir las características sociodemográficas y obstétricas de madres de neonatos con control de glucemia capilar en las primeras 24 horas de vida, internadas en Alojamiento Conjunto de un Hospital Amigo de la Niñez. Estudio de tipo descriptivo exploratorio que analizó datos de 380 historias clínicas de madres internadas entre julio y diciembre de 2006 en la Unidad de Alojamiento Conjunto del Hospital Universitario de la Universidad de San Pablo. Se verificó diabetes gestacional en 18 madres (5,6%), ninguna recibió tratamiento con hipoglucemiantes orales, 53 de ellas (16,2%) tuvieron hipertensión arterial durante la gestación y 17 (32,1%) hicieron uso de antihipertensivos; 215 (56,6%) recibieron suero glucosado al 5% durante el trabajo de parto y el parto en sí. Deben ser efectuados estudios correlacionales, analizando variables maternas y ocurrencia de hipoglucemia neonatal, con el objetivo de identificar los factores predictores de esta patología neonatal.<br>Some maternal factors associated with neonatal hypoglycemia justify monitoring blood glucose levels in the first 24 hours of life. The objective of this study was to describe the socio-demographic and obstetric characteristics of mothers to newborns undergoing capillary blood glucose control in the first 24 hours of life, hospitalized in a rooming-in maternity ward of a Baby Friendly Hospital. This is a descriptive exploratory study which involved the analysis of data from 380 medical records of mothers hospitalized from July to December, 2006 at the maternity ward of the University of São Paulo Teaching Hospital. It was found that 18 (5.6%) mothers developed gestational diabetes, none of them were treated with oral hypoglycemic agents, 53 (16.2%) had hypertension during pregnancy and 17 (32.1%) used anti-hypertensive medication, 215 (56.6%) received glucose 5% continuous infusion during labor and delivery. Correlation studies linking maternal variables and neonatal hypoglycemia are needed to identify the predicting factors of this neonatal morbidity