RESUMO
Purpose: Exclusive breastfeeding promotes gut microbial compositions associated with lower rates of metabolic and autoimmune diseases. Its cessation is implicated in increased microbiome-metabolome discordance, suggesting a vulnerability to dietary changes. Formula supplementation is common within our low-income, ethnic-minority community. We studied exclusively breastfed (EBF) neonates' early microbiome-metabolome coupling in efforts to build foundational knowledge needed to target this inequality. Methods: Maternal surveys and stool samples from seven EBF neonates at first transitional stool (0-24 hours), discharge (30-48 hours), and at first appointment (days 3-5) were collected. Survey included demographics, feeding method, medications, medical history and tobacco and alcohol use. Stool samples were processed for 16S rRNA gene sequencing and lipid analysis by gas chromatography-mass spectrometry. Alpha and beta diversity analyses and Procrustes randomization for associations were carried out. Results: Firmicutes, Proteobacteria, Bacteroidetes and Actinobacteria were the most abundant taxa. Variation in microbiome composition was greater between individuals than within (p=0.001). Palmitic, oleic, stearic, and linoleic acids were the most abundant lipids. Variation in lipid composition was greater between individuals than within (p=0.040). Multivariate composition of the metabolome, but not microbiome, correlated with time (p=0.030). Total lipids, saturated lipids, and unsaturated lipids concentrations increased over time (p=0.012, p=0.008, p=0.023). Alpha diversity did not correlate with time (p=0.403). Microbiome composition was not associated with each samples' metabolome (p=0.450). Conclusion: Neonate gut microbiomes were unique to each neonate; respective metabolome profiles demonstrated generalizable temporal developments. The overall variability suggests potential interplay between influences including maternal breastmilk composition, amount consumed and living environment.
RESUMO
Our healthcare institution chose to strive for Baby Friendly Hospital Initiative (BFHI) designation to enhance our support of breastfeeding. To complete Baby Friendly Hospital Initiative Step 2, a 5-hour educational program of supervised clinical experience was designed incorporating learning needs identified through gap analysis. Five interdisciplinary simulation stations included (1) a video on practical aspects of skin-to-skin contact immediately after delivery, (2) a dynamic interactive exercise on skin to skin in the labor and delivery setting, (3) couplet care on admission to the maternal infant unit, (4) breast milk expression, and (5) common challenges. Small groups of staff rotated among stations in 45-minute intervals. Two hundred fifty staff completed this educational program and an additional 54 nurses have become certified breastfeeding counselors. Evaluations highly favored this model of active participation and our work toward achieving Baby-Friendly Hospital designation has been greatly enhanced.
