Arboleya S, Binetti A, Salazar N, Fernández N, Solís G, Hernández-Barranco A, Margolles A, de los Reyes-Gavilán CG, Gueimonde M: Establishment and development of intestinal microbiota in preterm neonates. FEMS Microbiology Ecology 2012, 79(3):763-772.
These Spanish investigators surveyed the intestinal microbiome of 10 full term breast fed, vaginally delivered newborns sequentially over 3 months of life, and compared this to 21 preterm infants many of whom had antibiotics, and who were born between 30 and 34 weeks. The patterns were different, particularly there were fewer bifidobacteria in the preterms, this work is more quantitative and over a more prolonged period than previous similar studies.

Collado MC, Delgado S, Maldonado A, Rodríguez JM: Assessment of the bacterial diversity of breast milk of healthy women by quantitative real-time pcr. Letters in Applied Microbiology 2009, 48(5):523-528. This is a slightly older study that I just saw. The breast milk of healthy women was studied, they found a lot of stuff by PCR, including in 100% of the samples, bifidobacteria and lactobacilli!

Keski-Nisula L, Kyynäräinen H-R, Kärkkäinen U, Karhukorpi J, Heinonen S, Pekkanen J: Maternal intrapartum antibiotics and decreased vertical transmission of lactobacillus to neonates during birth. Acta Paediatrica 2013. When mothers get antibiotics, it kills their lactobacilli. So the babies don’t get them. Lactobacilli are good bugs, we should try not to kill them.

All of which makes me think of the Oracle II trial; a large multicenter trial of antibiotics for preventing premature delivery in mothers presenting with preterm labor without PROM and without signs of infection. Most of the mothers eventually delivered after 37 weeks, so there wasn’t a big group of preterm infants at risk for NEC. William Tarnow-Mordi reminded me recently that there were twice as many cases of NEC per 100 babies when the mother received antibiotics as when she received placebo. This wasn’t statistically significant, but is suggestive, giving antibiotics to the mother messes up her flora, changes what she can pass on to the baby and so increases the chance of developing NEC.

Christmann V, Visser R, Engelkes M, de Grauw AM, van Goudoever JB, van Heijst AFJ: The enigma to achieve normal postnatal growth in preterm infants – using parenteral or enteral nutrition? Acta Paediatrica 2013. This I don’t understand. The group in Nijmegen in the Netherlands, including Jan van Goudoever and others have shown repeatedly that preterm babies can tolerate intravenous amino acids at 2.4 or even 3.5 g/kg/d right from birth, and are in an anabolic state if they receive that. They now present a comparison of 2 cohorts from their own NICU where they changed the nutritional protocols. In the new enhanced protocol, the babies start on ….0.75 g/kg/d of amino acids, and increase over the next 3 days to a maximum of 3. Cohort 1 (from 2004) started at 0.5 and reached a maximum intake of 2.5 g/kg/d, and they took a week to get to nearly adequate calories of 92 kcal/kg/d. Not surprisingly the infants overall grew poorly, progressively falling off their growth curves. As I said I don’t understand, why the nutrition protocol is this limited in a center who have been world leaders in research in this area.It is possible to do better than this.

Sanders RC, Jr., Giuliano JS, Jr., Sullivan JE, Brown CA, 3rd, Walls RM, Nadkarni V, Nishisaki A, for the National Emergency Airway Registry for Children I, Pediatric Acute Lung I, Sepsis Investigators N: Level of trainee and tracheal intubation outcomes. Pediatrics 2013. intubation success in the PICU is no better than in the NICU for junior trainess. Critically ill patients are not the place for trainees to learn techniques, not now that we have alternatives.