The effect of cesarean delivery on the neonatal gut microbiome in an under-resourced population in the Bronx, NY, USA.

BACKGROUND: Neonatal and early-life gut microbiome changes are associated with altered cardiometabolic and immune development. In this study, we explored Cesarean delivery effects on the gut microbiome in our high-risk, under-resourced Bronx, NY population. RESULTS: Fecal samples from the Bronx MomBa Health Study (Bronx MomBa Health Study) were categorized by delivery mode (vaginal/Cesarean) and analyzed via 16 S rRNA gene sequencing at four timepoints over the first two years of life. Bacteroidota organisms, which have been linked to decreased risk for obesity and type 2 diabetes, were relatively reduced by Cesarean delivery, while Firmicutes organisms were increased. Organisms belonging to the Enterococcus genus, which have been tied to aberrant immune cell development, were relatively increased in the Cesarean delivery microbiomes. CONCLUSION: Due to their far-reaching impact on cardiometabolic and immune functions, Cesarean deliveries in high-risk patient populations should be carefully considered.

Building Relationships: Advanced Practice Providers and Fellows in Neonatal-Perinatal Medicine.

OBJECTIVE: Advanced practice providers (APPs) are a critical component of health care teams, especially in the neonatal intensive care unit. At times, APPs and neonatal-perinatal medicine (NPM) fellows may experience tension in their professional relationship. They may perceive the other's performance and abilities differently. We hypothesized that satisfaction with the APP-NPM fellow interprofessional relationship would be associated with higher perception of APP competence by NPM fellows. STUDY DESIGN: We surveyed 274 medical providers: NPM fellows (24.8%), NPM program directors (24.5%), and APPs (50.7%). APPs were defined as neonatal nurse practitioners, pediatric nurse practitioners, physician assistants, or neonatal hospitalists. We obtained demographic data, information about sources of conflict in the APP-NPM fellow relationship, level of satisfaction with the relationship, and targeted interventions for improvement. NPM fellow perception of APP competence as well as APP self-assessed competence were elicited. Statistical analyses were performed with chi-square tests and Fisher's exact tests. RESULTS: Overall, APPs and NPM fellows were generally satisfied with their relationship. All groups reported APP competence as equivalent to a third-year NPM fellow. NPM fellow perception of APP competence increased with year of fellow training. Higher perceived APP competence by NPM fellows correlated with higher relationship satisfaction scores. Difficulties with teamwork, communication and respect were associated with lower satisfaction within the APP-NPM fellow relationship. CONCLUSION: The professional working dynamic between these two groups is viewed positively by all. Satisfaction with the APP-NPM fellow relationship correlated with higher perception of APP competence by NPM fellows. Targeted interventions that increase NPM fellow perception of APP competence and ameliorate the difficulties encountered in the APP-NPM fellow relationship may improve this interprofessional relationship. KEY POINTS: · Advanced practice providers and NPM fellows may have similar responsibilities leading to challenges.. · NPM fellows with higher perceived competence of APPs had higher satisfaction with their relationship.. · Training APPs to teach, creating interprofessional education, and routine debrief sessions may help..

Premature infants with gestational age less than 25 weeks require increased ophthalmology resources for retinopathy of prematurity.

BACKGROUND: It is unclear how increasing survival of low gestational age (GA) infants affects ophthalmologic screening and treatment rates for retinopathy of prematurity (ROP). This study compared the examination and treatment rates of infants born at GA of <25 weeks and those born at GA of at least 25 weeks. METHODS: This was a retrospective study of patients who met institutional ROP screening criteria and were admitted to two neonatal intensive care units (NICUs) from January 2017 to June 2020. Variables analyzed were GA, birth weight, number of ophthalmology examinations, worst stage of ROP, presence of type 1 ROP, and comorbidities associated with ROP. The χ2, Fisher exact, and two-tailed t tests, as well as univariate and multivariable logistic regression, were used for statistical analysis. RESULTS: Compared to the GA≥25 group, the GA<25 group had a higher number of total exams (10 vs 4.3 [P < 0.001]), higher average worst stage of ROP (1.4 vs 0.3 [P < 0.001]) and higher rate of type 1 ROP (21% vs 1.4% [P < 0.001]), as well as higher mortality (37% vs 8.11% [P < 0. 001]). Multivariable logistic regression analysis controlling for GA, sepsis, and number of transfusions revealed that only GA was significantly associated with developing type 1 ROP. CONCLUSIONS: Infants with GA <25 weeks had more severe ROP and required significantly more ophthalmologic examinations than GA ≥25. It is important for ROP services to plan for this increased screening load, especially if the number of such lower-weight infants in their NICUs increases.

Immune tolerance attenuates gut dysbiosis, dysregulated uterine gene expression and high-fat diet potentiated preterm birth in mice.

BACKGROUND: Preterm delivery accounts for 85% of perinatal morbidity and mortality. Although the consumption of a high-fat diet leads to exaggerated proinflammatory responses and, in pregnant women, increased rates of spontaneous preterm birth, the underlying mechanisms remain unclear. OBJECTIVE: We sought to elucidate the mechanisms by which maternal consumption of a high-fat diet leads to a dysregulated immune response and, subsequently, spontaneous preterm birth. STUDY DESIGN: We performed 16S ribosomal RNA sequencing of DNA extracted and amplified from stool samples and compared the gut microbiomes of lipopolysaccharide-induced pregnant mice that were maintained on a high-fat diet compared to a normal control diet. Next, we sequenced the uterine transcriptomes of the mice. To test the effect of dampening of the immune response on the microbiome, transcriptome, and risk of spontaneous preterm birth, we induced immune tolerance with repetitive subclinical doses (0.2 mg/kg/week for 8 weeks) of endotoxin and performed 16S ribosomal RNA and uterine transcriptome sequencing on these immunotolerized mice. RESULTS: High-fat diet potentiates lipopolysaccharide-induced preterm birth by affecting the maternal gut microbiome and uterine transcriptome and reduces antioxidant capacity in a murine model. High-fat diet consumption also increases the colonization of the gut by 5 immunogenic bacteria and decreases colonization by Lachnospiraceae_NK4A136_group. Uteri from high-fat diet mice had increased expression of genes that stimulate the inflammatory-oxidative stress axis, autophagy/apoptosis, and smooth muscle contraction. Repetitive endotoxin priming protects high-fat diet dams from spontaneous preterm birth, increases colonization of the gut by Lachnospiraceae_NK4A136_group, decreases levels of immunogenic bacteria in the gut microbiome, and reduces the number of dysregulated genes after high-fat diet consumption from 994 to 74. CONCLUSION: High-fat diet-potentiated spontaneous preterm birth is mediated by increased inflammation, oxidative stress, and gut dysbiosis. The induction of immune tolerance via endotoxin priming reverses these effects and protects high-fat diet dams from spontaneous preterm birth. Based on this work, the role of immunomodulation as a novel therapeutic approach to prevent preterm birth among women who consume high-fat diets should be explored.

Effect of perinatal glucocorticoids on vascular health and disease.

The benefits of antenatal glucocorticoids are now firmly established in the perinatal management of threatened preterm birth. Postnatal glucocorticoid therapy, however, remains controversial in neonatal medicine, with the need to balance short-term physiological benefits against the potential for long-term adverse consequences. This review focuses on the vascular effects of prenatal and postnatal glucocorticoids, synthesizing data from both experimental animal models and human infants with the goal of better appreciation of the short and long-term effects of these commonly used drugs. Due to their widespread and varied use, improved understanding of the cellular and molecular impact of glucocorticoids is important in guiding current practice and future research.