1
|
Vassilopoulou E, Agostoni C, Feketea G, Alberti I, Gianni ML, Milani GP. The Role of Breastfeeding in Acute Respiratory Infections in Infancy. Pediatr Infect Dis J 2024:00006454-990000000-00942. [PMID: 38986006 DOI: 10.1097/inf.0000000000004454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Acute respiratory infections (ARIs) affect the respiratory tract, are often caused by viruses such as respiratory syncytial virus and rhinovirus, and present symptoms such as coughing, fever, respiratory distress and breathing difficulty. The global adherence to exclusive breastfeeding (BF) for the first 6 months of life has reached 44%, supported by World Health Organization and United Nations International Children's Emergency Fund efforts. BF provides vital nutrients and contributes to infant immune system development, protecting against infections. The role of BF in preventing and reducing complications of ARIs in infants is gaining attention, prompting a review of current data and future research needs. This review aims to summarize the evidence on the role of BF in reducing the risk and severity of ARIs in infants, elucidate the adaptations in breast milk composition during infections and identify relevant research needs. METHODS AND RESULTS Human milk (HM) is rich in immunoglobulins, antimicrobial peptides, and immunomodulatory factors that protect against various pathogens, including respiratory viruses. Several studies have demonstrated that BF is associated with a significant reduction in hospitalization, oxygen requirements, and mortality in infants with ARIs. The effectiveness of BF varies according to the specific respiratory virus, and a longer duration of exclusive BF appears to enhance its protective effect. It is documented that the composition of HM adjusts dynamically in response to infections, fortifying the infant's immune defenses. Specific immunological components of HM, including leukocytes and immunoglobulins, increase in response to infection in the infant, contributing to the enhancement of the immune defense in infants. Immune-boosting microRNAs enhance immune transfer to the infants and promote early gut maturation, and the HM microbiome along with other factors modifies the the infant's gut microbiome and immune system. CONCLUSIONS BF defends infants from respiratory infections, and the investigation of the microRNAs in HM offers new insights into its antiviral properties. The promotion of BF, especially in vulnerable communities, is of paramount importance in alleviating the global burden of ARIs in infancy.
Collapse
Affiliation(s)
- Emilia Vassilopoulou
- From the Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Carlo Agostoni
- From the Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gavriela Feketea
- Department of Pharmacology, Toxicology and Clinical Pharmacology, University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Pediatric Allergy Outpatient Clinic, Department of Pediatrics, "Karamandaneio" Children's Hospital of Patra, Patras, Greece
| | - Ilaria Alberti
- From the Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Lorella Gianni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gregorio Paolo Milani
- From the Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
2
|
Meneses MM, Freitas C, Machado Morais J, Dias MS, Ferraz C, Peixoto S. Effects of the COVID-19 Pandemic on Breastfeeding Initiation and Duration: A Retrospective Cohort Study. Cureus 2024; 16:e54231. [PMID: 38496125 PMCID: PMC10944011 DOI: 10.7759/cureus.54231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Several studies support the health benefits of breastfeeding for both the mother and the newborn. However, a significant number of mothers discontinue breastfeeding within the first six months of childbirth, with several factors influencing breastfeeding adherence. The purpose of this study is to assess the impact of the COVID-19 pandemic on the prevention of mother-to-newborn infection transmission, breastfeeding patterns and duration, and the incidence of other infections during the first year of life. METHODS Data from a sample of 39 mothers who gave birth at the Hospital Pedro Hispano in Porto, Portugual, between March 2020 and November 2021 were collected and a telephone questionnaire was administered. Statistical analysis was conducted using R software, v. 4.2.1 (R Foundation for Statistical Computing, Vienna, Austria). RESULTS AND DISCUSSION In terms of the impact of the COVID-19 norm 18/2020, which went into effect on March 30th, our research found that the type of feeding during hospitalization was significantly influenced by this norm (X2=10.30, p=0.006). We also confirmed that mothers who received home assistance breastfed for an extra 4.5 months (95% CI: 1-7.5) compared with mothers who did not receive such assistance. Regarding the effect of COVID-19 and breastfeeding on newborn health, our study found that if the total duration of breastfeeding is less than six months, an infection is approximately five times more likely (95% CI = 1.06- 29.56). CONCLUSION Overall, the findings of this study indicate that the efforts implemented at Hospital Pedro Hispano to limit the effects of the COVID-19 pandemic had some effect on immediate breastfeeding patterns, but not on the total duration of breastfeeding or newborn health. Nonetheless, more continuous assistance at home would have been beneficial.
Collapse
Affiliation(s)
| | | | | | - Maria S Dias
- Serviço de Pediatria, Hospital Pedro Hispano, Porto, PRT
| | - Cláudia Ferraz
- Serviço de Pediatria, Hospital Pedro Hispano, Porto, PRT
| | - Sara Peixoto
- Serviço de Pediatria, Hospital Pedro Hispano, Porto, PRT
| |
Collapse
|
3
|
Sharif Sheikh S, Sharif H, Sharif N. A Retrospective Public Health Assessment and Management in Terms of the Social and Clinical Risk Factors of Respiratory Syncytial Virus Infection in Northern Canada. Cureus 2024; 16:e53378. [PMID: 38435208 PMCID: PMC10907965 DOI: 10.7759/cureus.53378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The predominant source of respiratory infections in Northern Canada stems from RSV, leading to potentially life-threatening lower respiratory tract infections in children below the age of 2. Typically, RSV begins to appear in November or December and persists until April or May. Synagis® (Palivizumab), a monoclonal antibody, is employed to mitigate or reduce the effects of RSV. Past research indicated a reduction in hospitalizations with the use of Synagis®. Aim The aim is to estimate the cost-benefit analysis by comparing the health services cost with Synagis® program cost. Also evaluate the association of identified risk factors with the severity of RSV infection. Material and methods The dependent variable is categorized as: "Mild-Medium" cases that didn't undergo intubation or require medical evacuation; "Severe" cases that underwent intubation, required medical evacuation, and intensive care unit facilities. We also calculate the cost of health services and Synagis® of each year. Results It has been found that babies who exclusively breastfed and regularly took vitamin D did not develop severe forms of infection. Prenatal smoking and shared and crowded accommodations contribute to the spreading of RSV. The average cost of health services per participant was higher than that of the Synagis program. Conclusion They are promoting the Synagis® program during the season. Standardize the regulations prohibiting smoking around small children since they are more vulnerable to infection. Practice breastfeeding up to 24-month-old babies.
Collapse
Affiliation(s)
- Sana Sharif Sheikh
- Epidemiology and Public Health, University of Saskatchewan School of Public Health, Saskatoon, CAN
| | - Hina Sharif
- Health Sciences, Agha Khan University Hospital, Karachi, PAK
| | | |
Collapse
|
4
|
Guidi C, Ragusa N, Mussinatto I, Parola F, Luotti D, Calosso G, Rotondo E, Deut V, Timeus F, Brach del Prever A, Berger M. Management of Acute Bronchiolitis in Spoke Hospitals in Northern Italy: Analysis and Outcome. Diseases 2024; 12:25. [PMID: 38248376 PMCID: PMC10814737 DOI: 10.3390/diseases12010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Bronchiolitis is an acute viral infection of the lower respiratory tract that affects infants and young children. Respiratory syncytial virus (RSV) is the most common causative agent; however, other viruses can be involved in this disease. We retrospectively reviewed the clinical features of infants aged less than 12 months hospitalized for acute bronchiolitis in our Pediatric Units of Chivasso, Cirié, and Ivrea in Piedmont, Northern Italy, over two consecutive bronchiolitis seasons (September 2021-March 2022 and September 2022-March 2023). Patient-, disease-, and treatment-related variables were analyzed. The probability of therapeutic success (discharge home) was 96% for all patients (93% for RSV vs. 98% for non-RSV patients, p > 0.05). Among 192 patients, 42 infants (22%) underwent high-flow oxygen support (HFNC), and only 8 (4%) needed to be transferred to our hub referral hospital. Factors associated with hub hospital transfer were the age under 1 month and the failure of HFNC. The wide and increasing use of HFNC in pediatric inpatients improved the management of bronchiolitis in Spoke hospitals, reducing transfer to a hub hospital provided with Intensive Care Units.
Collapse
Affiliation(s)
- Carla Guidi
- Pediatrics Department, Ciriè Hospital, 10073 Ciriè, TO, Italy; (C.G.); (F.P.); (A.B.d.P.)
| | - Neftj Ragusa
- Pediatrics Department, Ivrea Hospital, 10015 Ivrea, TO, Italy; (N.R.)
| | - Ilaria Mussinatto
- Pediatrics Department, Chivasso Hospital, 10034 Chivasso, TO, Italy; (I.M.); (F.T.)
| | - Francesca Parola
- Pediatrics Department, Ciriè Hospital, 10073 Ciriè, TO, Italy; (C.G.); (F.P.); (A.B.d.P.)
| | - Diego Luotti
- Pediatrics Department, Ivrea Hospital, 10015 Ivrea, TO, Italy; (N.R.)
| | - Giulia Calosso
- Pediatrics Department, Chivasso Hospital, 10034 Chivasso, TO, Italy; (I.M.); (F.T.)
| | - Eleonora Rotondo
- Pediatrics Department, Ciriè Hospital, 10073 Ciriè, TO, Italy; (C.G.); (F.P.); (A.B.d.P.)
| | - Virginia Deut
- Pediatrics Department, Ivrea Hospital, 10015 Ivrea, TO, Italy; (N.R.)
| | - Fabio Timeus
- Pediatrics Department, Chivasso Hospital, 10034 Chivasso, TO, Italy; (I.M.); (F.T.)
| | | | - Massimo Berger
- Pediatrics Department, Ivrea Hospital, 10015 Ivrea, TO, Italy; (N.R.)
| |
Collapse
|
5
|
Kobiałka M, Jackowska T, Wrotek A. Risk Factors for Severe Respiratory Syncytial Virus Infection in Hospitalized Children. Viruses 2023; 15:1713. [PMID: 37632055 PMCID: PMC10458146 DOI: 10.3390/v15081713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND RSV often leads to hospitalization, and accurate knowledge of risk factors is crucial. METHODS We retrospectively analyzed laboratory-confirmed RSV hospitalizations regarding pregnancy factors, birth status, cigarette smoke exposure, nutrition, social conditions, clinical presentation, and severe disease defined as a need for passive oxygen therapy (pO2Tx), the presence of pneumonia, respiratory failure, intensive care unit (ICU) transfer, and prolonged hospitalization. RESULTS A univariate analysis included 594 children (median age 4 months) and revealed a pO2Tx relationship with age ≤ 3 months (OR = 1.56), prematurity (OR = 1.71), being born during RSV season (OR = 1.72), smoke exposure during pregnancy (both parents (OR = 2.41, father (OR = 1.8)), dyspnea (OR = 5.09), and presence of apnea (OR = 5.81). Pneumonia was associated with maternal smoke exposure (OR = 5.01), fever (OR = 3.92), dyspnea (OR = 1.62), history of aspiration (OR = 4.63), and inversely with age ≤ 3 months (OR = 0.45). Respiratory failure was associated with prematurity (OR = 3.13) and apnea (OR = 18.78), while the lower odds were associated with older age (OR = 0.57 per month) and presence of fever (OR = 0.11). ICU transfer was associated with apnea (OR = 17.18), but an inverse association was observed with age (OR = 0.54) and fever (OR = 0.11). A prolonged hospital stay was associated with prematurity (OR = 1.76), low birth weight (OR = 2.89), aspiration (OR = 4.93), and presence of fever (OR = 1.51). CONCLUSIONS Age (up to 3 months), prematurity, and presence of apnea are risk factors for a severe RSV course.
Collapse
Affiliation(s)
| | - Teresa Jackowska
- Department of Pediatrics, Bielanski Hospital, 01-809 Warsaw, Poland
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - August Wrotek
- Department of Pediatrics, Bielanski Hospital, 01-809 Warsaw, Poland
- Department of Pediatrics, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
| |
Collapse
|
6
|
Geller RJ, Inhofe NR, Crifase CC, Espinola JA, Gallegos C, Herrera N, Mitri E, Qi Y(S, Sullivan AF, Camargo CA. Case-control study of exclusive breast feeding and severe bronchiolitis in the United States. Paediatr Perinat Epidemiol 2023; 37:425-435. [PMID: 36882670 PMCID: PMC10483022 DOI: 10.1111/ppe.12966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Bronchiolitis is a major cause of infant illness, with few known modifiable risk factors. Breast feeding may reduce risk of severe bronchiolitis, but the association of exclusive vs. partial breast feeding with severe bronchiolitis is unclear. OBJECTIVE To estimate the association of exclusive vs. partial breast feeding during ages 0-2.9 months with bronchiolitis hospitalisation during infancy. METHODS We conducted a case-control study as a secondary analysis of two prospective US cohorts in the Multicenter Airway Research Collaboration. Cases were enrolled in a 17-centre study of infants hospitalised for bronchiolitis during 2011-2014 (n = 921). Controls were enrolled in a five-centre study of healthy infants during 2013-2014 and 2017 (n = 719). Breast feeding history during ages 0-2.9 months was collected by parent interview. Among breastfed infants, the association of exclusive vs. partial breast feeding with odds of bronchiolitis hospitalisation was estimated using a multivariable logistic regression model adjusted for demographic variables, parental asthma history, and early-life exposures. As a secondary analysis, we estimated the associations of exclusive, predominant, and occasional breast feeding vs. no breast feeding with the odds of bronchiolitis hospitalisation. RESULTS Among 1640 infants, the prevalence of exclusive breast feeding was 187/921 (20.3%) among cases and 275/719 (38.3%) among controls. Exclusive vs. partial breast feeding was associated with 48% reduced odds of bronchiolitis hospitalisation (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39, 0.69). In the secondary analysis, exclusive vs. no breast feeding was associated with 58% reduced odds of bronchiolitis hospitalisation (OR 0.42, 95% CI 0.23, 0.77), whereas predominant breast feeding (OR 0.77, 95% CI 0.37, 1.57) and occasional breast feeding (OR 0.98, 95% CI 0.57, 1.69) were not associated with meaningfully reduced odds of bronchiolitis hospitalisation. CONCLUSION Exclusive breast feeding had a strong protective association against bronchiolitis hospitalisation.
Collapse
Affiliation(s)
- Ruth J. Geller
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Nancy R. Inhofe
- Department of Pediatrics, The University of Oklahoma School of Community Medicine – Tulsa, OK
| | | | - Janice A. Espinola
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Catalina Gallegos
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Nicole Herrera
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Elie Mitri
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Ying (Shelly) Qi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Ashley F. Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
7
|
Wu XB, Wang J, Tang Y, Jiang J, Li XM. Altered intestinal microbiota in children with bronchiolitis. Front Microbiol 2023; 14:1197092. [PMID: 37389334 PMCID: PMC10306280 DOI: 10.3389/fmicb.2023.1197092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
Objective To investigate the correlation between the alteration of intestinal microbiota and disease in children with bronchiolitis. Methods Fifty seven children diagnosed with bronchiolitis from January 2020 to January 2022 in our pediatric department were included as the case group, and another 36 normal children were included as the control group. Stool and blood were collected from both groups for high-throughput sequencing, untargeted metabolite detection and ELISA. A mouse model of RSV infection was established to validate the results of clinical case detection. Results Body weight, passive smoking, and a host of other factors were possible as acute bronchiolitis influencing factors in the onset of acute bronchiolitis. The alpha diversity Shannon, Simpson and Pielou's evenness indices were significantly lower in children with acute bronchiolitis than in healthy children with gated levels of Firmicutes, Bacteroidetes and genus levels of Clostridium and other short chain fatty acid-producing bacteria. The relative abundance of short-chain fatty acid (SCFAs)-producing bacteria decreased and the abundance of genus-level sphingolipid-producing bacteria Sphingomonas increased; the progression of acute bronchiolitis is likely to be associated with the abundance of Clostridium and Sphingomonas and higher fecal amino acid concentrations, including FF-MAS, L-aspartic acid, thioinosinic acid, picolinic acid; supplementation with Clostridium butyricum significantly alleviated RSV infection-induced lung inflammation. Conclusion The progression of bronchiolitis may be associated with altered intestinal microbiota, decreased SCFAs and elevated sphingolipids metabolism in children. Some fecal bacteria and metabolites may predict the onset of bronchiolitis, and oral administration of Clostridium butyricum may alleviate RSV infection-induced pulmonary inflammation.
Collapse
Affiliation(s)
- Xiao-bin Wu
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Wang
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Tang
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Jiang
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xue-mei Li
- Chongqing Health Center for Women and Children, Chongqing, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
8
|
Yan J, Zhao L, Zhang T, Wei Y, Guo D, Guo W, Zheng J, Xu Y. Development and validation of a nomogram for predicting severe respiratory syncytial virus-associated bronchiolitis. BMC Infect Dis 2023; 23:249. [PMID: 37072700 PMCID: PMC10114343 DOI: 10.1186/s12879-023-08179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and is related to the severity of the disease. This study aimed to develop and validate a nomogram for predicting severe bronchiolitis in infants and young children with RSV infection. METHODS A total of 325 children with RSV-associated bronchiolitis were enrolled, including 125 severe cases and 200 mild cases. A prediction model was built on 227 cases and validated on 98 cases, which were divided by random sampling in R software. Relevant clinical, laboratory and imaging data were collected. Multivariate logistic regression models were used to determine optimal predictors and to construct nomograms. The performance of the nomogram was evaluated by the area under the characteristic curve (AUC), calibration ability and decision curve analysis (DCA). RESULTS There were 137 (60.4%) mild and 90 (39.6%) severe RSV-associated bronchiolitis cases in the training group (n = 227) and 63 (64.3%) mild and 35 (35.7%) severe cases in the validation group (n = 98). Multivariate logistic regression analysis identified 5 variables as significant predictive factors to construct the nomogram for predicting severe RSV-associated bronchiolitis, including preterm birth (OR = 3.80; 95% CI, 1.39-10.39; P = 0.009), weight at admission (OR = 0.76; 95% CI, 0.63-0.91; P = 0.003), breathing rate (OR = 1.11; 95% CI, 1.05-1.18; P = 0.001), lymphocyte percentage (OR = 0.97; 95% CI, 0.95-0.99; P = 0.001) and outpatient use of glucocorticoids (OR = 2.27; 95% CI, 1.05-4.9; P = 0.038). The AUC value of the nomogram was 0.784 (95% CI, 0.722-0.846) in the training set and 0.832 (95% CI, 0.741-0.923) in the validation set, which showed a good fit. The calibration plot and Hosmer‒Lemeshow test indicated that the predicted probability had good consistency with the actual probability both in the training group (P = 0.817) and validation group (P = 0.290). The DCA curve shows that the nomogram has good clinical value. CONCLUSION A nomogram for predicting severe RSV-associated bronchiolitis in the early clinical stage was established and validated, which can help physicians identify severe RSV-associated bronchiolitis and then choose reasonable treatment.
Collapse
Affiliation(s)
- Jisi Yan
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China
- Clinical School of Pediatrics, Tianjin Medical University, Tianjin, China
- Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, 156 Nankai SAN Lu, Nankai District, Tianjin, 300100, China
| | - LiHua Zhao
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China
| | - Tongqiang Zhang
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China
- Clinical School of Pediatrics, Tianjin Medical University, Tianjin, China
| | - Yupeng Wei
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China
- Clinical School of Pediatrics, Tianjin Medical University, Tianjin, China
- Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, 156 Nankai SAN Lu, Nankai District, Tianjin, 300100, China
| | - Detong Guo
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China
- Clinical School of Pediatrics, Tianjin Medical University, Tianjin, China
| | - Wei Guo
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China.
| | - Jun Zheng
- Department of Neonatology, Tianjin Central Hospital of Gynecology Obstetrics, 156 Nankai SAN Lu, Nankai District, Tianjin, 300100, China.
| | - Yongsheng Xu
- Department of Respiratory Medicine, Tianjin University Children's Hospital (Tianjin Children's Hospital), 238 Longyan Road, Beichen District, Tianjin, 300000, China.
| |
Collapse
|
9
|
Sajadi MM, Shokatpour N, Purcell M, Tehrani ZR, Lankford A, Bathula A, Campbell JD, Hammershaimb EA, Deatrick KB, Bor C, Parsell DM, Dugan C, Levine AR, Ramelli SC, Chertow DS, Herr DL, Saharia KK, Lewis GK, Grazioli A. Maternal transfer of IgA and IgG SARS-CoV-2 specific antibodies transplacentally and via breast milk feeding. PLoS One 2023; 18:e0284020. [PMID: 37023025 PMCID: PMC10079052 DOI: 10.1371/journal.pone.0284020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Although there have been many studies on antibody responses to SARS-CoV-2 in breast milk, very few have looked at the fate of these in the infant, and whether they are delivered to immunologically relevant sites in infants. METHODS Mother/infant pairs (mothers who breast milk fed and who were SARS-CoV-2 vaccinated before or after delivery) were recruited for this cross-sectional study. Mother blood, mother breast milk, infant blood, infant nasal specimen, and infant stool was tested for IgA and IgG antibodies against SARS-CoV-2 spike trimer. RESULTS Thirty-one mother/infant pairs were recruited. Breast milk fed infants acquired systemic anti-spike IgG antibodies only if their mothers were vaccinated antepartum (100% Antepartum; 0% Postpartum; P<0.0001). Breast milk fed infants acquired mucosal anti-spike IgG antibodies (in the nose) only if their mothers were vaccinated antepartum (89% Antepartum; 0% Postpartum; P<0.0001). None of the infants in either group had anti-spike IgA in the blood. Surprisingly, 33% of the infants whose mothers were vaccinated antepartum had high titer anti-spike IgA in the nose (33% Antepartum; 0% Postpartum; P = 0.03). Half-life of maternally transferred plasma IgG antibodies in the Antepartum infant cohort was ~70 days. CONCLUSION Vaccination antepartum followed by breast milk feeding appears to be the best way to provide systemic and local anti-SARS-CoV-2 antibodies for infants. The presence of high titer SARS-CoV-2-specific IgA in the nose of infants points to the potential importance of breast milk feeding early in life for maternal transfer of mucosal IgA antibodies. Expectant mothers should consider becoming vaccinated antepartum and consider breast milk feeding for optimal transfer of systemic and mucosal antibodies to their infants.
Collapse
Affiliation(s)
- Mohammad M. Sajadi
- VA Maryland Healthcare Center, Baltimore, MD, United States of America
- Institute of Human Virology, Baltimore, MD, United States of America
| | - Narjes Shokatpour
- Institute of Human Virology, Baltimore, MD, United States of America
| | - Madeleine Purcell
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | - Allison Lankford
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Allison Bathula
- University of Maryland Medical Center, Baltimore, MD, United States of America
| | - James D. Campbell
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | | | - Casey Bor
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Dawn M. Parsell
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Colleen Dugan
- University of Maryland Medical Center, Baltimore, MD, United States of America
| | - Andrea R. Levine
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | | | - Daniel S. Chertow
- National Institutes of Health, Bethesda, MD, United States of America
| | - Daniel L. Herr
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Kapil K. Saharia
- Institute of Human Virology, Baltimore, MD, United States of America
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - George K. Lewis
- Institute of Human Virology, Baltimore, MD, United States of America
| | - Alison Grazioli
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| |
Collapse
|
10
|
Mineva GM, Purtill H, Dunne CP, Philip RK. Impact of breastfeeding on the incidence and severity of respiratory syncytial virus (RSV)-associated acute lower respiratory infections in infants: a systematic review highlighting the global relevance of primary prevention. BMJ Glob Health 2023; 8:bmjgh-2022-009693. [PMID: 36746518 PMCID: PMC9906265 DOI: 10.1136/bmjgh-2022-009693] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/07/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the principal cause of acute lower respiratory infections (ALRI) among infants worldwide, and an important cause of morbidity, hospitalisation and mortality. While infants are universally exposed to RSV, most mortality occurs among normal term infants from low-income and middle-income countries. Breastfeeding has been suggested to have a protective effect against RSV infection. This study aims to determine the association of breastfeeding on the frequency and severity of RSV-associated ALRI among infants. METHODS A systematic review was conducted using keywords and Medical Subject Headings on MEDLINE, PubMed, Google Scholar, EMBASE, MedRxiv and Cochrane Central Register of Controlled Trials. Full-text articles published in English from 2000 to 2021 that studied exclusively or partially breastfed infants who developed RSV-associated ALRI <12 months of age were included. Covidence software-based evidence extraction and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines were followed. Quality of evidence was analysed using UK National Service Framework grading and the risk-of-bias assessment using Robvis. RESULTS Among 1368 studies screened, 217 qualified full-text review and 198 were excluded based on pre-agreed criteria. Nineteen articles published from 12 countries that included 16 787 infants from 31 countries (of which 8 middle-income) were retained for analysis. Results indicate that non-breastfeeding practices pose a significant risk for severe RSV-associated ALRI and hospitalisation. Exclusive breastfeeding for >4-6 months significantly lowered hospitalisation, length of stay, supplemental oxygen demand and admission to intensive care units. CONCLUSION In the context of no effective or standardised treatment for established RSV-associated ALRI, available evidence suggest that breastfeeding is associated with lower frequency and severity of RSV-associated ALRI, based on observational studies of variable grades of evidence and risk-of-bias. With both exclusive and partial breastfeeding benefiting infants who develop RSV-associated ALRI, breastfeeding should be promoted globally as an adjunct primary prevention; in addition to emerging immunoprophylaxis and maternal immunisation strategies.
Collapse
Affiliation(s)
- Gabriela M Mineva
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland
| | - Helen Purtill
- Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick School of Medicine, Limerick, Ireland
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland .,Division of Neonatology, Department of Paediatrics, University of Limerick School of Medicine, Limerick, Ireland
| |
Collapse
|
11
|
Hersh CJ, Sorbo J, Moreno JM, Hartnick E, Fracchia MS, Hartnick CJ. Aspiration does not mean the end of a breast-feeding relationship. Int J Pediatr Otorhinolaryngol 2022; 161:111263. [PMID: 35947926 DOI: 10.1016/j.ijporl.2022.111263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/24/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Breastfeeding is widely recommended as optimal nutrition for infants. However, there are no known publications on the impact of prandial aspiration of breast milk fed infants with dysphagia. The goal of this study was to assess pulmonary outcomes in infants with dysphagia who were given medical clearance for intake of breast milk. METHODS This retrospective cohort study included review of 80 infants examined between August 2016 to March 2021. Patients were evaluated by an interdisciplinary team of providers in a tertiary pediatric aerodigestive center. Patient inclusion criteria included a VFSS with documented aspiration or penetration with thin liquids. Participants met inclusion criteria if given medical clearance for intake of breast milk despite aspiration risk. Pulmonary health was monitored for three months following medical clearance for the consumption of breast milk. Pulmonary illness was defined as development of bronchiolitis, wheezing, unexplained stridor during feeding, croup, pneumonia, or persistent bacterial bronchitis requiring medical intervention. RESULTS Forty-three males (54%) and 37 females (46%) enrolled in the study with an age range of 1 month-6 months corrected age. Mean age at initial VFSS was 3.6 months. Twenty-six out of 80 (32.5%) had a report of a mild cough but did not require intervention. Eight out of 80 (10%) received a diagnosis of a pulmonary illness. Seventy-two out of 80 (90%) did not report pulmonary illness. CONCLUSION This pilot study reveals that the majority (90%) of this single institution, small sample size cohort of breast milk fed infants with documented oropharyngeal dysphagia remained healthy despite continued intake of breast milk. Prospective investigation is warranted to follow pulmonary health outcomes longitudinally and a head to head comparative study would be helpful to identify whether there were indeed significant changes to pulmonary health according to differential feeding regimens offered and followed.
Collapse
Affiliation(s)
- Cheryl J Hersh
- Department of Speech Language and Swallowing Disorders, Massachusetts General Hospital, MGH Professional Office Building, 3rd Floor, 275 Cambridge St., Boston, MA, 02114, USA
| | - Jessica Sorbo
- Department of Speech Language and Swallowing Disorders, Massachusetts General Hospital, MGH Professional Office Building, 3rd Floor, 275 Cambridge St., Boston, MA, 02114, USA
| | - Juan Manuel Moreno
- Universidad de Los Andes, Colombia, School of Medicine, Mass Eye & Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
| | - Elizabeth Hartnick
- Brown University, Providence, RI, 101 Revere St., Boston, MA, 02114, USA
| | - M Shannon Fracchia
- Department of Pediatric Pulmonology, Massachusetts General Hospital, Boston, MA, MGH Professional Office Building, 5th Floor, 75 Cambridge St., Boston, MA, 02114, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, Mass Eye & Ear Infirmary, 243 Charles St., Boston, MA, 02114, USA.
| |
Collapse
|
12
|
LeMoine FV, Witt C, Howard S, Chapple A, Pam L, Sutton EF. Factors Attributed to Breastfeeding Success in a Tertiary Obstetric Hospital. WOMEN'S HEALTH REPORTS 2022; 3:624-632. [PMID: 36185071 PMCID: PMC9518802 DOI: 10.1089/whr.2022.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/15/2022]
Abstract
Introduction: Increasing breastfeeding rates is a national health objective, however substantial barriers and disparities continue to exist in breastfeeding initiation and continuation. Our study aim is to identify factors associated with birthing persons' breastfeeding “success” (patients admitted to Labor & Delivery desiring to breastfeed and discharged breastfeeding) and breastfeeding “failure” (patients admitted to Labor & Delivery desiring to breastfeed and discharged exclusively formula feeding). Materials and Methods: We conducted a retrospective cohort study between July 2015 and June 2016. Patients were asked infant feeding plan intentions (breast, formula, combination) upon admission for delivery. Feeding plan was reassessed at discharge from delivery stay and validated to serve as proxy for feeding status at discharge. Logistic regression was used to identify the population(s) most likely to voice intent to breastfeed and to identify predictors of altered breastfeeding intent at discharge. Results: Between July 2015 and June 2016, 6690 patients met criteria for analysis. Patients reporting intent to breastfeed before delivery were more likely Caucasian (p < 0.0001), married (p < 0.001), nulliparous (p < 0.01), privately insured (p < 0.0001), educated (p < 0.0001), and older (p < 0.01) compared with patients not intending to breastfeed. These characteristics were similar in those who were “successful breastfeeders,” that is, breastfeeding at discharge. The strongest predictor of breastfeeding at discharge was intent to breastfeed before delivery (p < 0.0001). African American race was the strongest predictor of nonbreastfeeding intent at admission (p < 0.0001) and conversion to formula feeding by hospital discharge (p < 0.001). Conclusion: Intent to breastfeed before delivery was the strongest predictor of breastfeeding at discharge; thus, prenatal breastfeeding education within the at-risk population is crucial to increasing breastfeeding rates.
Collapse
Affiliation(s)
- Felicia V. LeMoine
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
| | - Caitlin Witt
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
| | - Shelby Howard
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
| | - Andrew Chapple
- Department of Biostatistics, School of Public Health, Louisiana State University Health and Sciences Center, New Orleans, Louisiana, USA
| | - LaKedra Pam
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, USA
| | - Elizabeth F. Sutton
- Research Department, Woman's Hospital Research Center, Woman's Hospital, Baton Rouge, Louisiana, USA
| |
Collapse
|
13
|
Rosa F, Sharma AK, Gurung M, Casero D, Matazel K, Bode L, Simecka C, Elolimy AA, Tripp P, Randolph C, Hand TW, Williams KD, LeRoith T, Yeruva L. Human Milk Oligosaccharides Impact Cellular and Inflammatory Gene Expression and Immune Response. Front Immunol 2022; 13:907529. [PMID: 35844612 PMCID: PMC9278088 DOI: 10.3389/fimmu.2022.907529] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
Human milk harbors complex carbohydrates, including human milk oligosaccharides (HMOs), the third most abundant component after lactose and lipids. HMOs have been shown to impact intestinal microbiota, modulate the intestinal immune response, and prevent pathogenic bacterial binding by serving as decoy receptors. However, the direct effect of HMOs on intestinal function and immunity remains to be elucidated. To address this knowledge gap, 21-day-old germ-free mice (C57BI/6) were orally gavaged with 15 mg/day of pooled HMOs for 7 or 14 days and euthanized at day 28 or 35. A set of mice was maintained until day 50 to determine the persistent effects of HMOs. Control groups were maintained in the isolators for 28, 35, or 50 days of age. At the respective endpoints, intestinal tissues were subjected to histomorphometric and transcriptomic analyses, while the spleen and mesenteric lymph nodes (MLNs) were subjected to flow cytometric analysis. The small intestine (SI) crypt was reduced after HMO treatment relative to control at days 28 and 35, while the SI villus height and large intestine (LI) gland depth were decreased in the HMO-treated mice relative to the control at day 35. We report significant HMO-induced and location-specific gene expression changes in host intestinal tissues. HMO treatment significantly upregulated genes involved in extracellular matrix, protein ubiquitination, nuclear transport, and mononuclear cell differentiation. CD4+ T cells were increased in both MLNs and the spleen, while CD8+ T cells were increased in the spleen at day 50 in the HMO group in comparison to controls. In MLNs, plasma cells were increased in HMO group at days 28 and 35, while in the spleen, only at day 28 relative to controls. Macrophages/monocytes and neutrophils were lower in the spleen of the HMO group at days 28, 35, and 50, while in MLNs, only neutrophils were lower at day 50 in the 14-day HMO group. In addition, diphtheria toxoid and tetanus toxoid antibody-secreting cells were higher in HMO-supplemented group compared to controls. Our data suggest that HMOs have a direct effect on gastrointestinal tract metabolism and the immune system even in the absence of host microbiota.
Collapse
Affiliation(s)
- Fernanda Rosa
- Arkansas Children’s Nutrition Center, United States Department of Agriculture-Agricultural Research Service (USDA-ARS), Little Rock, AR, United States
- School of Veterinary Medicine, Texas Tech University, Amarillo, TX, United States
| | - Ashok K. Sharma
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai, Los Angeles, CA, United States
| | - Manoj Gurung
- Arkansas Children’s Nutrition Center, United States Department of Agriculture-Agricultural Research Service (USDA-ARS), Little Rock, AR, United States
| | - David Casero
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai, Los Angeles, CA, United States
| | - Katelin Matazel
- Arkansas Children’s Nutrition Center, United States Department of Agriculture-Agricultural Research Service (USDA-ARS), Little Rock, AR, United States
| | - Lars Bode
- Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, University of California San Diego, La Jolla, CA, United States
- Department of Pediatrics, University of California San Diego, La Jolla, CA, United States
| | - Christy Simecka
- Division of Laboratory Animal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Ahmed A. Elolimy
- Arkansas Children’s Nutrition Center, United States Department of Agriculture-Agricultural Research Service (USDA-ARS), Little Rock, AR, United States
- Animal Production Department, National Research Centre, Giza, Egypt
| | - Patricia Tripp
- Arkansas Children’s Nutrition Center, United States Department of Agriculture-Agricultural Research Service (USDA-ARS), Little Rock, AR, United States
| | - Christopher Randolph
- Center for Translational Pediatric Research, Arkansas Children’s Research Institute, Little Rock, AR, United States
| | - Timothy W. Hand
- University of Pittsburgh School of Medicine, R.K. Mellon Foundation Institute for Pediatric Research, University of Pittsburgh Medical Center (UPMC) Children’s Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Keith D. Williams
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Tanya LeRoith
- Department of Biomedical Sciences & Pathobiology, Virginia Tech, Blacksburg, VA, United States
| | - Laxmi Yeruva
- Arkansas Children’s Nutrition Center, United States Department of Agriculture-Agricultural Research Service (USDA-ARS), Little Rock, AR, United States
| |
Collapse
|
14
|
Yagi K, Asai N, Huffnagle GB, Lukacs NW, Fonseca W. Early-Life Lung and Gut Microbiota Development and Respiratory Syncytial Virus Infection. Front Immunol 2022; 13:877771. [PMID: 35444639 PMCID: PMC9013880 DOI: 10.3389/fimmu.2022.877771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/11/2022] [Indexed: 12/24/2022] Open
Abstract
Several environmental factors can influence the development and establishment of the early-life microbiota. For example, exposure to different environmental factors from birth to childhood will shape the lung and gut microbiota and the development of the immune system, which will impact respiratory tract infection and widespread disease occurrence during infancy and later in life. Respiratory syncytial virus (RSV) infects most infants by the age of two and is the primary cause of bronchiolitis in children worldwide. Approximately a third of infants hospitalized with bronchiolitis develop asthma later in life. However, it is unclear what factors increase susceptibility to severe RSV-bronchiolitis and the subsequent asthma development. In recent years, the role of the gut and lung microbiota in airway diseases has received increased interest, and more studies have focused on this field. Different epidemiological studies and experimental animal models have associated early-life gut microbiota dysbiosis with an increased risk of lung disease later in life. This work will review published evidence that correlated environmental factors that affect the early-life microbiota composition and their role in developing severe RSV infection.
Collapse
Affiliation(s)
- Kazuma Yagi
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Nobuhiro Asai
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Gary B Huffnagle
- Department of Molecular, Cellular and Developmental Biology, University of Michigan, Ann Arbor, MI, United States.,Mary H. Weiser Food Allergy Center, University of Michigan , Ann Arbor, MI, United States
| | - Nicholas W Lukacs
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States.,Mary H. Weiser Food Allergy Center, University of Michigan , Ann Arbor, MI, United States
| | - Wendy Fonseca
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
15
|
Short-chain fatty acid acetate triggers antiviral response mediated by RIG-I in cells from infants with respiratory syncytial virus bronchiolitis. EBioMedicine 2022; 77:103891. [PMID: 35220042 PMCID: PMC8871125 DOI: 10.1016/j.ebiom.2022.103891] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 12/31/2022] Open
Abstract
Background Gut microbiota-derived short-chain fatty-acid (SFCA) acetate protects mice against RSV A2 strain infection by increasing interferon-β production and expression of interferon-stimulated genes (ISGs). However, the role of SFCA in RSV infection using strains isolated from patients is unknown. Methods We first used RSV clinical strains isolated from infants hospitalized with RSV bronchiolitis to investigate the effects of in vitro SCFA-acetate treatment of human pulmonary epithelial cells. We next examined whether SCFA-acetate treatment is beneficial in a mouse model of RSV infection using clinical isolates. We sought to investigate the relationship of gut microbiota and fecal acetate with disease severity among infants hospitalized with RSV bronchiolitis, and whether treating their respiratory epithelial cells with SCFA-acetate ex-vivo impacts viral load and ISG expression. We further treated epithelial cells from SARS-CoV-2 infected patients with SCFA-acetate. Findings In vitro pre-treatment of A549 cells with SCFA-acetate reduced RSV infection with clinical isolates and increased the expression of RIG-I and ISG15. Animals treated with SCFA-acetate intranasally recovered significantly faster, with reduction in the RSV clinical isolates viral load, and increased lung expression of IFNB1 and the RIG-I. Experiments in RIG-I knockout A549 cells demonstrated that the protection relies on RIG-I presence. Gut microbial profile was associated with bronchiolitis severity and with acetate in stool. Increased SCFA-acetate levels were associated with increasing oxygen saturation at admission, and shorter duration of fever. Ex-vivo treatment of patients’ respiratory cells with SCFA-acetate reduced RSV load and increased expression of ISGs OAS1 and ISG15, and virus recognition receptors MAVS and RIG-I, but not IFNB1. These SCFA-acetate effects were not found on cells from SARS-CoV-2 infected patients. Interpretation SCFA-acetate reduces the severity of RSV infection and RSV viral load through modulation of RIG-I expression. Funding FAPERGS (FAPERGS/MS/CNPq/SESRS no. 03/2017 - PPSUS 17/2551-0001380-8 and COVID-19 20/2551-0000258-6); CNPq 312504/2017-9; CAPES) - Finance Code 001.
Collapse
|
16
|
Kobayashi Y, Togo K, Agosti Y, McLaughlin JM. Epidemiology of respiratory syncytial virus in Japan: A nationwide claims database analysis. Pediatr Int 2022; 64:e14957. [PMID: 34388302 PMCID: PMC9300113 DOI: 10.1111/ped.14957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of hospitalization for bronchiolitis and pneumonia in infancy. In Japan, limited data are publicly available on RSV epidemiology and clinical characteristics among infants. METHODS This retrospective study described RSV incidence, seasonality, patient characteristics, resource use, and clinical outcomes among Japanese children <2 years from January 2017 through December 2018. The RSV cases were identified using the Japanese Medical Data Center database. RESULTS In the database, 9,711 and 8,509 RSV patients <2 years were identified in 2017 and 2018, respectively. Of these, 25% required hospitalization. Ninety percent of hospitalized patients did not have a known RSV risk factor. Nineteen percent of hospitalized patients experienced dehydration, and 12% had acute respiratory failure. Hospitalization lasted 1 week on average and 7% required some type of mechanical ventilation. The peak of hospitalizations occurred at 2 months. The incidence of RSV hospitalization in children <2 years was 23.2 per 1,000 person-years, which increased to 35.4 per 1,000 for infants <6 months. This age group accounted for 40% of all RSV-associated hospitalizations among children <2 years. CONCLUSIONS Roughly one-fourth of all RSV patients <2 years were hospitalized. Ninety percent of these did not have an underlying risk condition. This underscores that RSV can cause serious disease among all young children. Three to four out of every 100 Japanese children <6 months were hospitalized for RSV, and this age group accounted for ~40% of all RSV-associated hospitalizations. Novel and broad-based RSV prevention strategies, especially those targeting young infants, are needed.
Collapse
Affiliation(s)
| | - Kanae Togo
- Health & Value, Pfizer Japan Inc, Tokyo, Japan
| | | | | |
Collapse
|
17
|
Willers M, Viemann D. Role of the gut microbiota in airway immunity and host defense against respiratory infections. Biol Chem 2021; 402:1481-1491. [PMID: 34599869 DOI: 10.1515/hsz-2021-0281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022]
Abstract
Colonization of the intestine with commensal bacteria is known to play a major role in the maintenance of human health. An altered gut microbiome is associated with various ensuing diseases including respiratory diseases. Here, we summarize current knowledge on the impact of the gut microbiota on airway immunity with a focus on consequences for the host defense against respiratory infections. Specific gut commensal microbiota compositions and functions are depicted that mediate protection against respiratory infections with bacterial and viral pathogens. Lastly, we highlight factors that have imprinting effects on the establishment of the gut microbiota early in life and are potentially relevant in the context of respiratory infections. Deepening our understanding of these relationships will allow to exploit the knowledge on how gut microbiome maturation needs to be modulated to ensure lifelong enhanced resistance towards respiratory infections.
Collapse
Affiliation(s)
- Maike Willers
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, D-30625 Hannover, Germany
| | - Dorothee Viemann
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, D-30625 Hannover, Germany
- Cluster of Excellence RESIST (EXC 2155), Hannover Medical School, D-30625 Hannover, Germany
- Department of Pediatrics, Translational Pediatrics, University Hospital Würzburg, Zinklesweg 10, D-97078 Würzburg, Germany
| |
Collapse
|
18
|
Caliskan MN, Tekin M, Konca C. Determination of predictive risk factors for severe bronchiolitis. Int J Clin Pract 2021; 75:e14760. [PMID: 34455690 DOI: 10.1111/ijcp.14760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/21/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the predictive risk factors for development of severe bronchiolitis in patients with acute bronchiolitis with no previous chronic disease. METHODS Four hundred forty children aged 1-24 months hospitalised with acute bronchiolitis, were examined between February 2018 and February 2019 in this prospective study. RESULTS Eighty-five cases were regarded as severe bronchiolitis and 355 as mild-moderate bronchiolitis. Statistically significant differences were observed between the severe and mild-moderate bronchiolitis groups in terms of weight-for-age z-scores, history of bronchiolitis, haemoglobin levels, and time elapsed between the onset of symptoms and admission. Weight-for-age z-scores, the mean time interval between the onset of symptoms and admission, and mean haemoglobin values were lower in the severe bronchiolitis group while the mean number of bronchiolitis attacks was higher than in the mild-moderate bronchiolitis group. Logistic regression analysis determined that a low weight-for-age z-score increased the risk of severe bronchiolitis development 0.56-fold (CI: 0.409-0.760), a short duration between the onset of symptoms and admission increased the risk 0.62-fold (CI: 0.519-0.735), a frequent history of bronchiolitis increased the risk 1.81-fold (CI: 1.135-2.968) and low haemoglobin levels increased the risk 0.72-fold (CI: 0.537-0.969). CONCLUSION Low weight-for-age z-scores, a short duration between the onset of symptoms and admission, a high number of previous attacks and low haemoglobin levels were identified as independent parameters of severe bronchiolitis development.
Collapse
Affiliation(s)
| | - Mehmet Tekin
- Department of Pediatrics, School of Medicine, Adıyaman University, Adiyaman, Turkey
| | - Capan Konca
- Department of Pediatrics, School of Medicine, Adıyaman University, Adiyaman, Turkey
| |
Collapse
|
19
|
Hill DR, Chow JM, Buck RH. Multifunctional Benefits of Prevalent HMOs: Implications for Infant Health. Nutrients 2021; 13:3364. [PMID: 34684364 PMCID: PMC8539508 DOI: 10.3390/nu13103364] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022] Open
Abstract
Breastfeeding is the best source of nutrition during infancy and is associated with a broad range of health benefits. However, there remains a significant and persistent need for innovations in infant formula that will allow infants to access a wider spectrum of benefits available to breastfed infants. The addition of human milk oligosaccharides (HMOs) to infant formulas represents the most significant innovation in infant nutrition in recent years. Although not a direct source of calories in milk, HMOs serve as potent prebiotics, versatile anti-infective agents, and key support for neurocognitive development. Continuing improvements in food science will facilitate production of a wide range of HMO structures in the years to come. In this review, we evaluate the relationship between HMO structure and functional benefits. We propose that infant formula fortification strategies should aim to recapitulate a broad range of benefits to support digestive health, immunity, and cognitive development associated with HMOs in breastmilk. We conclude that acetylated, fucosylated, and sialylated HMOs likely confer important health benefits through multiple complementary mechanisms of action.
Collapse
Affiliation(s)
| | | | - Rachael H. Buck
- Abbott Nutrition, 3300 Stelzer Road, Columbus, OH 43219, USA; (D.R.H.); (J.M.C.)
| |
Collapse
|
20
|
Quitadamo PA, Comegna L, Cristalli P. Anti-Infective, Anti-Inflammatory, and Immunomodulatory Properties of Breast Milk Factors for the Protection of Infants in the Pandemic From COVID-19. Front Public Health 2021; 8:589736. [PMID: 33738273 PMCID: PMC7960784 DOI: 10.3389/fpubh.2020.589736] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
COVID-19 pandemic since the end of 2019 spreads worldwide, counting millions of victims. The viral invasion, systemic inflammation, and consequent organ failure are the gravest features of coronavirus disease 2019 (COVID-19), and they are associated with a high mortality rate. The aim of this study is to evaluate the role of breast milk in the COVID-19 pandemic, analyzing its antiviral, anti-inflammatory, and immunoregulatory effects due to its bioactive components, so numerous and important for the protection of infants. The study tried to demonstrate that all the components of human milk are capable of performing functions on all the pathogenic events recognized and described in COVID-19 disease. Those human milk factors are well-tolerated and practically free of side effects, so breast milk should become a research topic to discover therapies even in this epidemic. In the first part, the mechanisms of protection and defense of the breast milk elements will be delineated; in the second section, it will describe the human milk effects in viral infections and it will be hypothesized how the known mechanisms could act in COVID infection.
Collapse
Affiliation(s)
- Pasqua Anna Quitadamo
- NICU “Casa Sollievo della Sofferenza” Foundation, Scientific Research and Care Institute, San Giovanni Rotondo, Italy
| | | | | |
Collapse
|
21
|
Shi T, Vennard S, Mahdy S, Nair H. Risk factors for RSV associated acute lower respiratory infection poor outcome and mortality in young children: A systematic review and meta-analysis. J Infect Dis 2021; 226:S10-S16. [PMID: 33576788 DOI: 10.1093/infdis/jiaa751] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Respiratory syncytial virus associated acute lower respiratory infection (RSV-ALRI) constitutes a substantial disease burden in young children. We aimed to identify all studies investigating the risk factors of RSV-ALRI poor outcome or mortality in young children.We carried out a systematic literature review across 7 databases with data from studies published from January 1995 to December 2019. We defined poor outcome as need for prolonged hospital stay, oxygen supplementation, mechanical ventilation or intensive care unit (ICU) admission. Quality of all eligible studies was assessed according to modified GRADE criteria. We conducted meta-analyses to estimate odds ratio (OR) with 95% confidence intervals (CI) for individual risk factors. We identified 27 eligible studies, which investigated 20 risk factors for RSV-ALRI poor outcome and/or mortality in children younger than 5 years old, in comparison to those with RSV-ALRI who did not have poor outcome or mortality. Among those risk factors, 6 had statistically significant associations with RSV-ALRI poor outcome: any comorbidity (OR 2.69 (95% CI 1.89-3.83)), congenital heart disease (3.40 (95% CI 2.14-5.40)), prematurity with gestational age (GA) <37 weeks (1.75 (95% CI 1.31-2.36)), prematurity with GA ≤32 weeks (2.68 (95% CI 1.43-5.04)), age <3 months (4.91 (95% CI 1.64-14.71)), age <6 months (2.02 (95% CI 1.73-2.35)). Apart from age <3 months, the meta-estimate ORs for all other risk factors were based on studies using multivariable analysis. For mortality, only prematurity with GA <37 weeks had a significant meta-estimate of OR 3.81 (95% CI 1.68-8.63) based on univariable analysis.This study represents a comprehensive report of the association between various risk factors and RSV-ALRI poor outcome and mortality in young children. More research should be carried out to elucidate risk factors associated with poor outcome and mortality using multivariable analysis.
Collapse
Affiliation(s)
- Ting Shi
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Sophie Vennard
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Sara Mahdy
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| |
Collapse
|
22
|
Tomori C, Gribble K, Palmquist AE, Ververs M, Gross MS. When separation is not the answer: Breastfeeding mothers and infants affected by COVID-19. MATERNAL & CHILD NUTRITION 2020; 16:e13033. [PMID: 32458558 PMCID: PMC7267086 DOI: 10.1111/mcn.13033] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 12/16/2022]
Abstract
The World Health Organization (WHO) has provided detailed guidance on the care of infants of women who are persons under investigation (PUI) or confirmed to have COVID-19. The guidance supports immediate post-partum mother-infant contact and breastfeeding with appropriate respiratory precautions. Although many countries have followed WHO guidance, others have implemented infection prevention and control (IPC) policies that impose varying levels of post-partum separation and discourage or prohibit breastfeeding or provision of expressed breast milk. These policies aim to protect infants from the potential harm of infection from their mothers, yet they may fail to fully account for the impact of separation. Global COVID-19 data are suggestive of potentially lower susceptibility and a typically milder course of disease among children, although the potential for severe disease in infancy remains. Separation causes cumulative harms, including disrupting breastfeeding and limiting its protection against infectious disease, which has disproportionate impacts on vulnerable infants. Separation also presumes the replaceability of breastfeeding-a risk that is magnified in emergencies. Moreover, separation does not ensure lower viral exposure during hospitalizations and post-discharge, and contributes to the burden on overwhelmed health systems. Finally, separation magnifies maternal health consequences of insufficient breastfeeding and compounds trauma in communities who have experienced long-standing inequities and violence, including family separation. Taken together, separating PUI/confirmed SARS-CoV-2-positive mothers and their infants may lead to excess preventable illnesses and deaths among infants and women around the world. Health services must consider the short-andlong-term impacts of separating mothers and infants in their policies.
Collapse
Affiliation(s)
- Cecília Tomori
- Johns Hopkins School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Karleen Gribble
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Aunchalee E.L. Palmquist
- Gillings School of Global Public Health, Carolina Global Breastfeeding InstituteUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Mija‐Tesse Ververs
- Johns Hopkins Bloomberg School of Public Health, Center for Humanitarian HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Marielle S. Gross
- Johns Hopkins Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreMarylandUSA
| |
Collapse
|
23
|
Verstegen RHJ, Anderson PO, Ito S. Infant drug exposure via breast milk. Br J Clin Pharmacol 2020; 88:4311-4327. [PMID: 32860456 DOI: 10.1111/bcp.14538] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/08/2020] [Accepted: 08/26/2020] [Indexed: 12/31/2022] Open
Abstract
More than half of women take medications during breastfeeding, predisposing their infants to medication exposure via breast milk. As a result, adverse drug reactions may emerge in the infant, although they are rarely reported. Disposition of maternal drugs in breast milk is described with several key parameters, which include relative infant dose (RID): infant drug intake via milk (weight- and time-adjusted) expressed as a percentage of the similarly adjusted mother's dose. Most drugs show RID values of <10%, indicating that drug concentrations in infant serum do not reach a level known to be therapeutic in adults unless drug clearance is markedly lower than the adult level on a weight basis. RID is a function of milk-to-(maternal) plasma drug concentration ratio (MP ratio) and maternal drug clearance. Therefore, MP ratio between drugs must be interpreted not by itself but with maternal drug clearance of each drug. This is why some drugs such as phenobarbital show an MP ratio of <1 but an RID as high as 50-70%, while morphine shows an MP ratio of 2 but an RID in the range of 5%. Using RID, we interpreted case reports of infant adverse outcomes, and we observed cases with relatively low infant serum concentrations of drug, consistent with low RID, as well as those with near- or above-adult therapeutic serum concentrations, with or without increased drug intake (i.e. high RID). It is important to consider both pharmacokinetic and pharmacodynamic factors in interpreting adverse outcomes in infants breastfed by a mother taking medications.
Collapse
Affiliation(s)
- Ruud H J Verstegen
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philip O Anderson
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, California, USA
| | - Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Jang MJ, Kim YJ, Hong S, Na J, Hwang JH, Shin SM, Ahn YM. Positive association of breastfeeding on respiratory syncytial virus infection in hospitalized infants: a multicenter retrospective study. Clin Exp Pediatr 2020; 63:135-140. [PMID: 32024328 PMCID: PMC7170789 DOI: 10.3345/kjp.2019.00402] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Breastfeeding reportedly reduces the overall frequency of infections. Respiratory syncytial virus (RSV), the most common respiratory pathogen in infants, involves recurrent wheezing and has a pathogenic mechanism related to airway structural damage. PURPOSE This study aimed to investigate whether breastfeeding has a beneficial effect against RSV-induced respiratory infection compared to formula feeding among infants in Korea. METHODS We retrospectively reviewed the medical records of infants under 1 year of age who were admitted with RSV infection between January 2016 and February 2018 at the department of pediatrics of 4 hospitals. We investigated the differences in clinical parameters such as cyanosis, chest retraction, combined infection, fever duration, oxygen use, oxygen therapy duration, intensive care unit (ICU) admission, and corticosteroid treatment of exclusive breast milk feeding (BMF), artificial milk formula fed (AMF), and mixed feeding (MF) groups. RESULTS Among the 411 infants included in our study, 94, 161, and 156 were included in the BMF, MF, and AMF groups, respectively. The rates of oxygen therapy were significantly different among the BMF (4.3%), MF (8.1%), and AMF (13.5 %) groups (P=0.042). The odds ratios (ORs) for oxygen therapy was significantly higher in the AMF group than in the BMF group (adjusted OR, 3.807; 95% confidence interval, 1.22-11.90; P=0.021). The ICU admission rate of the BMF group (1.1%) was lower than that of the MF (3.5%) and AMF (4.5%) groups; however, the dissimilarity was not statistically significant (P=0.338). CONCLUSION The severity of RSV infection requiring oxygen therapy was lower in the BMF than the AMF group. This protective role of human milk on RSV infection might decrease the need for oxygen therapy suggesting less airway damage.
Collapse
Affiliation(s)
- Min Jeong Jang
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul, Korea
| | - Shinhye Hong
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul, Korea
| | - Jaeyoon Na
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul, Korea
| | - Jong Hee Hwang
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Son Moon Shin
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
| | - Young Min Ahn
- Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| |
Collapse
|
25
|
Wang S, Xiang D, Fang C, Yao B. Association between breastfeeding and Kawasaki disease: a case-control study. Eur J Pediatr 2020; 179:447-453. [PMID: 31797082 DOI: 10.1007/s00431-019-03529-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 02/08/2023]
Abstract
The association between breastfeeding and Kawasaki disease is not fully understood. We performed a case-control study to examine the association between breastfeeding and Kawasaki disease. In this study, 389 children diagnosed with Kawasaki disease and 426 gender- and age-matched controls were identified at Renmin Hospital of Wuhan University between November 2013 and March 2019. Demographic and clinical data were collected from a structured telephone interview and medical record database. Odds ratio and 95% confidence interval for risk of Kawasaki disease were estimated. Children who were breastfed exclusively had a decrease in developing Kawasaki disease (adjusted odds ratios and 95% confidence intervals 0.53 (0.38-0.74). Although the risk reduction was not statistically different, partial breastfeeding also provided a protective effect (adjusted odds ratios and 95% confidence intervals 0.70 (0.48-1.01). In the stratified analysis, we still observed that exclusive breastfeeding was inversely associated with the development of complete Kawasaki disease (adjusted odds ratios and 95% confidence intervals 0.52 (0.31-0.88) and incomplete Kawasaki disease (adjusted odds ratios and 95% confidence intervals 0.54 (0.38-0.77). However, there was no significant association between exclusive breastfeeding and the intravenous immunoglobulin treatment response (adjusted odds ratios and 95% confidence intervals 0.69 (0.27-1.69) and the risk of coronary artery lesions (adjusted odds ratios and 95% confidence intervals 0.79 (0.49-1.31) in Kawasaki disease.Conclusion: Our analysis suggests that exclusive breastfeeding was inversely associated with the development of Kawasaki disease and that breastfeeding might be a potential protective factor against Kawasaki diseaseWhat is known• Previous studies have demonstrated that breastfeeding has been shown to potentially confer protection against several autoimmune disorders of childhood.• The association between breastfeeding and Kawasaki disease is not fully understood.What is newThe first study to evaluate the association between breastfeeding and the development of Kawasaki disease in China with a large sample size.• Exclusive breastfeeding was inversely associated with the development of Kawasaki disease and breastfeeding might be a potential protective factor against Kawasaki disease.
Collapse
Affiliation(s)
- Shun Wang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dan Xiang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Congcong Fang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Baozhen Yao
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
| |
Collapse
|
26
|
Sorce LR, Curley MAQ, Kleinpell R, Swanson B, Meier PP. Mother's Own Milk Feeding and Severity of Respiratory Illness in Acutely Ill Children: An Integrative Review. J Pediatr Nurs 2020; 50:5-13. [PMID: 31670137 DOI: 10.1016/j.pedn.2019.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 03/25/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
PROBLEM Breastfed infants experience less severe infections while actively breastfeeding. However, little is known about whether a history of prior breastfeeding affects severity of illness. Therefore, the purpose of this integrative review was to examine the relationship between previous exposure to mother's own milk (MOM) feeding and severity of respiratory infectious illness in infants and children. ELIGIBILITY CRITERIA Studies meeting the following criteria were included: human subjects, term birth, ages 0-35 months at time of study, diagnosis of pneumonia, bronchiolitis or croup, MOM feeding, and statistical analyses reporting separate respiratory infectious illness outcomes when combined with other infections. SAMPLE Twelve articles met eligibility criteria. RESULTS Major findings were inconsistent definitions of both dose and exposure period of breastfeeding and the severity of illness. In particular, the severity of illness measure was limited by the use of proxy variables such as emergency room visits or hospitalizations that lacked reliability and validity. However, given this limitation, the data suggested that exclusive breastfeeding for four to six months was associated with reduced severity of illness as measured by frequency of visits to the primary care provider office, emergency department or hospitalization. CONCLUSIONS Future research in this area should incorporate reliable and valid measures of MOM dose and exposure period and severity of illness outcomes in the critically ill child. IMPLICATIONS Among many positive outcomes associated with breastfeeding, an additional talking point for encouragement of exclusive breastfeeding for four to six months may be protective against severe respiratory infectious illness after cessation of breastfeeding.
Collapse
Affiliation(s)
- Lauren R Sorce
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL USA.
| | - Martha A Q Curley
- Ruth M. Colket Endowed Chair in Pediatric Nursing, Children's Hospital of Philadelphia, University of Pennsylvania School of Nursing, Anesthesia and Critical Care Medicine - Perelman School of Medicine, Philadelphia, PA USA.
| | - Ruth Kleinpell
- Rush University College of Nursing, Nashville, TN USA; Vanderbilt University School of Nursing, Nashville, TN USA.
| | - Barbara Swanson
- Adult Health & Gerontological Nursing, Nursing Science Studies, Journal of the Association of Nurses in AIDS Care, Rush University College of Nursing, Chicago, IL USA.
| | - Paula P Meier
- Neonatal Intensive Care, Pediatrics, Women, Children and Family Nursing, Rush University Medical Chicago, IL USA.
| |
Collapse
|
27
|
Mazur NI, Horsley NM, Englund JA, Nederend M, Magaret A, Kumar A, Jacobino SR, de Haan CAM, Khatry SK, LeClerq SC, Steinhoff MC, Tielsch JM, Katz J, Graham BS, Bont LJ, Leusen JHW, Chu HY. Breast Milk Prefusion F Immunoglobulin G as a Correlate of Protection Against Respiratory Syncytial Virus Acute Respiratory Illness. J Infect Dis 2019; 219:59-67. [PMID: 30107412 PMCID: PMC6284547 DOI: 10.1093/infdis/jiy477] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/01/2018] [Indexed: 01/03/2023] Open
Abstract
Background Transplacental respiratory syncytial virus (RSV) antibody transfer has been characterized, but little is known about the protective effect of breast milk RSV-specific antibodies. Serum antibodies against the prefusion RSV fusion protein (pre-F) exhibit high neutralizing activity. We investigate protection of breast milk pre-F antibodies against RSV acute respiratory infection (ARI). Methods Breast milk at 1, 3, and 6 months postpartum and midnasal swabs during infant illness episodes were collected in mother-infant pairs in Nepal. One hundred seventy-four infants with and without RSV ARI were matched 1:1 by risk factors for RSV ARI. Pre-F immunoglobulin A (IgA) and immunoglobulin G (IgG) antibody levels were measured in breast milk. Results The median breast milk pre-F IgG antibody concentration before illness was lower in mothers of infants with RSV ARI (1.4 [interquartile range {IQR}, 1.1-1.6] log10 ng/mL) than without RSV ARI (1.5 [IQR, 1.3-1.8] log10 ng/mL) (P = .001). There was no difference in median maternal pre-F IgA antibody concentrations in cases vs controls (1.7 [IQR, 0.0-2.2] log10 ng/mL vs 1.7 [IQR, 1.2-2.2] log10 ng/mL, respectively; P = .58). Conclusions Low breast milk pre-F IgG antibodies before RSV ARI support a potential role for pre-F IgG as a correlate of protection against RSV ARI. Induction of breast milk pre-F IgG may be a mechanism of protection for maternal RSV vaccines.
Collapse
Affiliation(s)
- Natalie I Mazur
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Department of Medicine, University of Washington, Seattle.,Immunotherapy Laboratory, Laboratory for Translational Immunology, University Medical Center Utrecht, The Netherlands
| | | | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute
| | - Maaike Nederend
- Immunotherapy Laboratory, Laboratory for Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Amalia Magaret
- Department of Laboratory Medicine, University of Washington, Seattle.,Department of Biostatistics, University of Washington, Seattle
| | - Azad Kumar
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Shamir R Jacobino
- Immunotherapy Laboratory, Laboratory for Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Cornelis A M de Haan
- Virology Division, Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - James M Tielsch
- Department of Global Health, George Washington University, Washington, District of Columbia
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barney S Graham
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Louis J Bont
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Laboratory of Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Jeanette H W Leusen
- Immunotherapy Laboratory, Laboratory for Translational Immunology, University Medical Center Utrecht, The Netherlands
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle
| |
Collapse
|
28
|
Ito S. Opioids in Breast Milk: Pharmacokinetic Principles and Clinical Implications. J Clin Pharmacol 2019; 58 Suppl 10:S151-S163. [PMID: 30248201 DOI: 10.1002/jcph.1113] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/01/2018] [Indexed: 12/14/2022]
Abstract
Safety of maternal drug therapy during breastfeeding may be assessed from estimated levels of drug exposure of the infant through milk. Pharmacokinetic (PK) principles predict that the lower the clearance is, the higher the infant dose via milk will be. Drugs with low clearance (<1 mL/[kg·min]) are likely to cause an infant exposure level greater than 10% of the weight-adjusted maternal dose even if the milk-to-plasma concentration ratio is 1. Most drugs cause relatively low-level exposure below 10% of the weight-adjusted maternal dose, but opioids require caution because of their potential for severe adverse effects. Furthermore, substantial individual variations of drug clearance exist in both mother and infant, potentially causing drug accumulation over time in some infants even if an estimated dose of the drug through milk is small. Such PK differences among individuals are known not only for codeine and tramadol through pharmacogenetic variants of CYP2D6 but also for non-CYP2D6 substrate opioids including oxycodone, indicating difficulties of eliminating PK uncertainty by simply replacing an opioid with another. Overall, opioid use for pain management during labor and delivery and subsequent short-term use for 2-3 days are compatible with breastfeeding. In contrast, newly initiated and prolonged maternal opioid therapy must follow a close monitoring program of the opioid-naive infants. Until more safety data become available, treatment duration of newly initiated opioids in the postpartum period should be limited to 2-3 days in unsupervised outpatient settings. Opioid addiction treatment with methadone and buprenorphine during pregnancy may continue into breastfeeding, but infant conditions must be monitored.
Collapse
Affiliation(s)
- Shinya Ito
- Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Rossey I, Saelens X. Vaccines against human respiratory syncytial virus in clinical trials, where are we now? Expert Rev Vaccines 2019; 18:1053-1067. [DOI: 10.1080/14760584.2019.1675520] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Iebe Rossey
- VIB-UGent Center for Medical Biotechnology, VIB, Ghent, Belgium
- Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| | - Xavier Saelens
- VIB-UGent Center for Medical Biotechnology, VIB, Ghent, Belgium
- Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium
| |
Collapse
|
30
|
Awad S, Khader Y, Mansi M, Yusef D, Alawadin S, Qudah W, Khasawneh R. Viral Surveillance of Children with Acute Respiratory Infection in Two Main Hospitals in Northern Jordan, Irbid, during Winter of 2016. J PEDIAT INF DIS-GER 2019; 15:1-10. [PMID: 32300275 PMCID: PMC7117070 DOI: 10.1055/s-0039-1692972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/20/2019] [Indexed: 11/22/2022]
Abstract
Acute lower respiratory infection (ALRI) is a major cause of morbidity and mortality worldwide. Data regarding the etiology of acute respiratory infection (ARI) is scarce in developing countries. The aim of this study was to identify the viral etiology of ARI/ALRI in hospitalized children and factors associated with increased length of stay (LoS) and severe disease presentation in Northern Jordan. This was a prospective viral surveillance study using real-time reverse transcriptase-polymerase chain reaction in children younger than 5 years admitted with ARI to two main hospitals in Northern Jordan during the winter of 2016. Nasopharyngeal swabs were obtained and tested for respiratory syncytial virus (RSV) and other viruses. Demographic and clinical characteristics of RSV-positive patients were compared with those of RSV-negative patients. There were 479 patients hospitalized with ARI. Their mean age (standard deviation) was 10.4 (11.6) months. 53.9% tested positive for at least one virus, with RSV being the most commonly detected virus (34%). Compared with RSV-negative patients, RSV-positive patients were younger, more likely to have chronic lung disease, and more likely to present with cough, rhinorrhea, difficulty in breathing, retraction, flaring, grunting, wheezing, and a higher respiratory rate. Prematurity, presence of a chronic illness, oxygen saturation < 90%, and atelectasis and consolidation on chest X-rays were significantly associated with an increased mean LoS. Patients with a history of prematurity had higher risk of severe disease (odds ratio = 2.6; 95% confidence interval: 1.5, 4.7;
p
= 0.001). Compared with patients 6 months old and younger, patients aged 6.1 to 12 months were less likely to have severe disease. Human metapneumovirus (HMPV)-positive ALRI was associated with increased odds of severe disease. Viruses are recognized as etiological agent of ARI/ALRI-associated morbidity in developing countries that need more attention and implementation of targeted strategies for prevention and detection. HMPV can be a cause of severe ALRI.
Collapse
Affiliation(s)
- Samah Awad
- Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef Khader
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Moa'th Mansi
- Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Dawood Yusef
- Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Salah Alawadin
- Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Walaa Qudah
- Department of Pediatrics and Neonatology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Ruba Khasawneh
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
31
|
Sales-Campos H, Soares SC, Oliveira CJF. An introduction of the role of probiotics in human infections and autoimmune diseases. Crit Rev Microbiol 2019; 45:413-432. [PMID: 31157574 DOI: 10.1080/1040841x.2019.1621261] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
During the last decades, studies exploring the role of microorganisms inhabiting human body in different scenarios have demonstrated the great potential of modulating them to treat and prevent diseases. Among the most outstanding applications, probiotics have been used for over a century to treat infections and inflammation. Despite the beneficial role of other probiotics, Lactobacillus and Bifidobacterium species are the most frequently used, and have been effective as a therapeutic option in the treatment/prevention of dental caries, periodontal diseases, urogenital infections, and gastrointestinal infections. Additionally, as gastrointestinal tract harbors a great diversity of microbial species that directly or indirectly modulate host metabolism and immune response, the influence of intestinal microbiota, one of the targets of therapies using probiotics, on the biology of immune cells can be explored to treat inflammatory disorders or immune-mediated diseases. Thus, it is not surprising that probiotics have presented promising results in modulating human inflammatory diseases such as type 1 diabetes, multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease, among others. Hence, the purpose of this review is to discuss the potential of therapeutic approaches using probiotics to constrain infection and development of inflammation on human subjects.
Collapse
Affiliation(s)
- Helioswilton Sales-Campos
- Laboratory of Immunology and Bioinformatics, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro , Uberaba , Minas Gerais , Brazil.,Department of Biosciences and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás , Goiás , Goiânia , Brazil
| | - Siomar Castro Soares
- Laboratory of Immunology and Bioinformatics, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro , Uberaba , Minas Gerais , Brazil
| | - Carlo José Freire Oliveira
- Laboratory of Immunology and Bioinformatics, Institute of Natural and Biological Sciences, Federal University of Triângulo Mineiro , Uberaba , Minas Gerais , Brazil
| |
Collapse
|
32
|
Meyer K, Volkmann A, Hufnagel M, Schachinger E, Klau S, Horstmann J, Berner R, Fischer M, Lehner A, Haas N, Ulrich S, Jakob A. Breastfeeding and vitamin D supplementation reduce the risk of Kawasaki disease in a German population-based case-control study. BMC Pediatr 2019; 19:66. [PMID: 30808315 PMCID: PMC6390341 DOI: 10.1186/s12887-019-1438-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/18/2019] [Indexed: 01/16/2023] Open
Abstract
Background In Kawasaki disease (KD), a vasculitis of unknown etiology, the most serious complication is the development of coronary artery aneurysm (CAA). To date, the exact pathomechanism of KD is unknown. Both environmental and genetic factors seem to be associated with the development of the disease. Methods Data on KD patients recruited from the population-based German Pediatric Surveillance Study during 2012–2014 were used to evaluate the impact of various factors from the perinatal and infancy period on the development of KD. The study design was a matched case-control study with respect to age, sex and place of residence (n = 308 KD cases, n = 326 controls). All KD patients were individually re-evaluated; all fulfilled the international diagnostic KD criteria. A standardized questionnaire was used to review breastfeeding practices, vitamin D supplementation and birth characteristics. Logistic regression analyses were performed to obtain odds ratios (OR) for various risk factors among the case-control pairs. Simple measures of association were used to assess the impact of these factors on the clinical course. Results There was no difference in lengths of gestation, birth weight or parturition between KD patients and controls, but independently from each other vitamin D supplementation and breastfeeding were negatively associated with KD, even when adjusted for age, place of residence and sex. The duration of vitamin D was significantly shorter among children with KD than among children without KD (p = 0.039, OR = 0.964, 95% CI: 0.931–0.998), as was the duration of breastfeeding (p = 0.013, OR = 0.471, 95% CI: 0.260–0.853). Comparing KD patients with and without breastfeeding and/or vitamin D supplementation, there were no differences regarding developing CAA, being refractory to intravenous immunoglobulin treatment, age at onset of the disease and levels of inflammatory laboratory values. Conclusion Our findings indicate breastfeeding and vitamin D supplementation to have protective effects in association with KD in our study population; however, these seem not to influence the natural course of the disease. Although the overall effects were relatively small, they nevertheless underline the overall benefit of both interventions. Trial registration Clinical Trial Registration: German clinical trial registration, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010071. Date of registration was 26. February 2016. The trial was registered retrospectively. Electronic supplementary material The online version of this article (10.1186/s12887-019-1438-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- K Meyer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Mathildenstraße 1, D-79106, Freiburg, Germany.
| | - A Volkmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - M Hufnagel
- Division of Pediatric Infectious Disease and Rheumatology, Center for Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - E Schachinger
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Mathildenstraße 1, D-79106, Freiburg, Germany
| | - S Klau
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - J Horstmann
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg, Mathildenstraße 1, D-79106, Freiburg, Germany
| | - R Berner
- Department for Pediatrics, University Hospital Carl Gustav Carus of the Technische Universität Dresden, Dresden, Germany
| | - M Fischer
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - A Lehner
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - N Haas
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - S Ulrich
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - A Jakob
- Department of Pediatric Cardiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| |
Collapse
|
33
|
Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis. J Pediatr 2018; 203:190-196.e21. [PMID: 30293638 DOI: 10.1016/j.jpeds.2018.08.008] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 07/12/2018] [Accepted: 08/08/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To use a quantitative approach to evaluate the literature for quantity, quality, and consistency of studies of maternal and infant characteristics in association with breastfeeding initiation and continuation, and to conduct a meta-analysis to produce summary relative risks (RRs) for selected factors. STUDY DESIGN A systematic review using PubMed and CINAHL through March 2016 was conducted to identify relevant observational studies in developed nations, reporting a measure of risk for 1 or more of 6 quantitatively derived, high impact factors in relation to either breastfeeding initiation or continuation. One author abstracted data using a predesigned database, which was reviewed by a second independent author; data evaluation and interpretation included all co-authors. These factors were summarized using standard meta-analysis techniques. RESULTS Six high impact factors were identified (smoking [39 papers], mode of delivery [47 papers], parity [31 papers], dyad separation [17 papers], maternal education [62 papers], and maternal breastfeeding education [32 papers]). Summary RR from random-effects models for breastfeeding initiation were highest for high vs low maternal education (RR 2.28 [95% CI 1.92-2.70]), dyad connection vs not (RR 2.01 [95% CI 1.38-2.92]), and maternal nonsmoking vs smoking (RR = 1.76 [95% CI 1.59-1.95]); results were similar for breastfeeding continuation. CONCLUSIONS Despite methodological heterogeneity across studies, relatively consistent results were observed for these perinatally identifiable factors associated with breastfeeding initiation and continuation, which may be informative in developing targeted interventions to provide education and support for successful breastfeeding in more families.
Collapse
|
34
|
Kyler KE, McCulloh RJ. Current Concepts in the Evaluation and Management of Bronchiolitis. Infect Dis Clin North Am 2018; 32:35-45. [DOI: 10.1016/j.idc.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Fonseca W, Lukacs NW, Ptaschinski C. Factors Affecting the Immunity to Respiratory Syncytial Virus: From Epigenetics to Microbiome. Front Immunol 2018. [PMID: 29515570 PMCID: PMC5825926 DOI: 10.3389/fimmu.2018.00226] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a common pathogen that infects virtually all children by 2 years of age and is the leading cause of hospitalization of infants worldwide. While most children experience mild symptoms, some children progress to severe lower respiratory tract infection. Those children with severe disease have a much higher risk of developing childhood wheezing later in life. Many risk factors are known to result in exacerbated disease, including premature birth and early age of RSV infection, when the immune system is relatively immature. The development of the immune system before and after birth may be altered by several extrinsic and intrinsic factors that could lead to severe disease predisposition in children who do not exhibit any currently known risk factors. Recently, the role of the microbiome and the resulting metabolite profile has been an area of intense study in the development of lung disease, including viral infection and asthma. This review explores both known risk factors that can lead to severe RSV-induced disease as well as emerging topics in the development of immunity to RSV and the long-term consequences of severe infection.
Collapse
Affiliation(s)
- Wendy Fonseca
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas W Lukacs
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States.,University of Michigan, Mary H. Weiser Food Allergy Center, Ann Arbor, MI, United States
| | - Catherine Ptaschinski
- Department of Pathology, University of Michigan, Ann Arbor, MI, United States.,University of Michigan, Mary H. Weiser Food Allergy Center, Ann Arbor, MI, United States
| |
Collapse
|
36
|
Abstract
Separation of mothers and infants after birth is standard practice for many hospitals, yet not evidence-based. Nonseparation clearly has numerous benefits. However, newborns lack a voice to make choices to direct their course of care. The evidence supports nonseparation strategies for mothers and infants that promote attachment, physiologic regulation, nutrition, sleep, communication, and management of stress/pain. Moreover, the evidence is compelling that nonseparation is essential. The time has come to act on the evidence and begin seeing the care we provide through the newborn's eyes.
Collapse
|
37
|
Human Milk and Allergic Diseases: An Unsolved Puzzle. Nutrients 2017; 9:nu9080894. [PMID: 28817095 PMCID: PMC5579687 DOI: 10.3390/nu9080894] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023] Open
Abstract
There is conflicting evidence on the protective role of breastfeeding in relation to the development of allergic sensitisation and allergic disease. Studies vary in methodology and definition of outcomes, which lead to considerable heterogeneity. Human milk composition varies both within and between individuals, which may partially explain conflicting data. It is known that human milk composition is very complex and contains variable levels of immune active molecules, oligosaccharides, metabolites, vitamins and other nutrients and microbial content. Existing evidence suggests that modulation of human breast milk composition has potential for preventing allergic diseases in early life. In this review, we discuss associations between breastfeeding/human milk composition and allergy development.
Collapse
|
38
|
Ponce-Garcia C, Hernandez IA, Major P, Flores-Mir C. Association between Breast Feeding and Paediatric Sleep Disordered Breathing: a Systematic Review. Paediatr Perinat Epidemiol 2017; 31:348-362. [PMID: 28590549 DOI: 10.1111/ppe.12372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Breast feeding has been suggested as a potential protective factor against childhood snoring and sleep disordered breathing (SDB). SDB can have major health consequences. The objective of this systematic review is to synthesise the available literature concerning any potential association between infant feeding methods and SDB in young children. METHODS Five electronic databases were searched. All searches were inclusive until August 5, 2016. Two authors independently reviewed potentially relevant articles for eligibility. Any prospective or retrospective study, case-control study, cohort study, clinical trial, and cross-sectional study that evaluated the association between infant feeding methods and SDB were included. Data on study design, aim of study, sample size, study population, assessment tool, infant feeding methods, and outcome measures were extracted. RESULTS Nine studies fulfilled the criteria to be finally included in this review, only cohorts and cross-sectional studies were identified. While seven of the selected studies reported a statistically significant association between breast feeding and reduced risk of SDB, the remaining two studies did not report any association. The main methodological limitation was high heterogeneity in the diagnostic criteria and assessment tools to identify SDB and limited data collection on infant feeding methods. CONCLUSIONS The current evidence may point to a protective association, however, as uncertainty is moderate, any suggestion that breast feeding may or may not decrease the risk of SDB is currently unwarranted. More research on the topic is required to resolve some of the contradictions between included studies.
Collapse
Affiliation(s)
- Cecilia Ponce-Garcia
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Paul Major
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
39
|
Lynch JP, Sikder MAA, Curren BF, Werder RB, Simpson J, Cuív PÓ, Dennis PG, Everard ML, Phipps S. The Influence of the Microbiome on Early-Life Severe Viral Lower Respiratory Infections and Asthma-Food for Thought? Front Immunol 2017; 8:156. [PMID: 28261214 PMCID: PMC5311067 DOI: 10.3389/fimmu.2017.00156] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/30/2017] [Indexed: 12/24/2022] Open
Abstract
Severe viral lower respiratory infections are a major cause of infant morbidity. In developing countries, respiratory syncytial virus (RSV)-bronchiolitis induces significant mortality, whereas in developed nations the disease represents a major risk factor for subsequent asthma. Susceptibility to severe RSV-bronchiolitis is governed by gene-environmental interactions that affect the host response to RSV infection. Emerging evidence suggests that the excessive inflammatory response and ensuing immunopathology, typically as a consequence of insufficient immunoregulation, leads to long-term changes in immune cells and structural cells that render the host susceptible to subsequent environmental incursions. Thus, the initial host response to RSV may represent a tipping point in the balance between long-term respiratory health or chronic disease (e.g., asthma). The composition and diversity of the microbiota, which in humans stabilizes in the first year of life, critically affects the development and function of the immune system. Hence, perturbations to the maternal and/or infant microbiota are likely to have a profound impact on the host response to RSV and susceptibility to childhood asthma. Here, we review recent insights describing the effects of the microbiota on immune system homeostasis and respiratory disease and discuss the environmental factors that promote microbial dysbiosis in infancy. Ultimately, this knowledge will be harnessed for the prevention and treatment of severe viral bronchiolitis as a strategy to prevent the onset and development of asthma.
Collapse
Affiliation(s)
- Jason P. Lynch
- Laboratory of Respiratory Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Md. Al Amin Sikder
- Laboratory of Respiratory Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Bodie F. Curren
- Laboratory of Respiratory Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Rhiannon B. Werder
- Laboratory of Respiratory Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jennifer Simpson
- Laboratory of Respiratory Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Páraic Ó Cuív
- Translational Research Institute, The University of Queensland Diamantina Institute, The University of Queensland, St. Lucia, QLD, Australia
| | - Paul G. Dennis
- The School of Agriculture and Food Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Mark L. Everard
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Simon Phipps
- Laboratory of Respiratory Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St. Lucia, QLD, Australia
- Australian Infectious Diseases Research Centre, The University of Queensland, St. Lucia, QLD, Australia
| |
Collapse
|
40
|
Abstract
Host-microorganism interactions shape local cell functionality, immune responses, and can influence disease development. Evidence indicates that the impact of host-microbe interactions reaches far beyond the local environment, thus influencing responses in peripheral tissues. There is a vital cross-talk between the mucosal tissues of our body, as exemplified by intestinal complications during respiratory disease and vice versa. Although, mechanistically, this phenomenon remains poorly defined, the existence of the gut-lung axis and its implications in both health and disease could be profoundly important for both disease etiology and treatment. In this review, we highlight how changes in the intestinal microenvironment, with a particular focus on the intestinal microbiota, impact upon respiratory disease.
Collapse
|
41
|
Dixon DL. The Role of Human Milk Immunomodulators in Protecting Against Viral Bronchiolitis and Development of Chronic Wheezing Illness. CHILDREN (BASEL, SWITZERLAND) 2015; 2:289-304. [PMID: 27417364 PMCID: PMC4928768 DOI: 10.3390/children2030289] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/21/2015] [Accepted: 06/29/2015] [Indexed: 12/26/2022]
Abstract
Infants who are breastfed are at an immunological advantage when compared with formula fed infants, evidenced by decreased incidence of infections and diminished propensity for long term conditions, including chronic wheeze and/or asthma. Exclusive breastfeeding reduces the duration of hospital admission, risk of respiratory failure and requirement for supplemental oxygen in infants hospitalised with bronchiolitis suggesting a potentially protective mechanism. This review examines the evidence and potential pathways for protection by immunomodulatory factors in human milk against the most common viral cause of bronchiolitis, respiratory syncytial virus (RSV), and subsequent recurrent wheeze in infants. Further investigations into the interplay between respiratory virus infections such as RSV and how they affect, and are affected by, human milk immunomodulators is necessary if we are to gain a true understanding of how breastfeeding protects many infants but not all against infections, and how this relates to long-term protection against conditions such as chronic wheezing illness or asthma.
Collapse
Affiliation(s)
- Dani-Louise Dixon
- Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide 5042, Australia.
- Department of Critical Care Medicine, Flinders University, Adelaide 5001, Australia .
| |
Collapse
|
42
|
den Hartog G, Jacobino S, Bont L, Cox L, Ulfman LH, Leusen JHW, van Neerven RJJ. Specificity and Effector Functions of Human RSV-Specific IgG from Bovine Milk. PLoS One 2014; 9:e112047. [PMID: 25375837 PMCID: PMC4222812 DOI: 10.1371/journal.pone.0112047] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/11/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection is the second most important cause of death in the first year of life, and early RSV infections are associated with the development of asthma. Breastfeeding and serum IgG have been shown to protect against RSV infection. Yet, many infants depend on bovine milk-based nutrition, which at present lacks intact immunoglobulins. OBJECTIVE To investigate whether IgG purified from bovine milk (bIgG) can modulate immune responses against human RSV. METHODS ELISAs were performed to analyse binding of bIgG to human respiratory pathogens. bIgG or hRSV was coated to plates to assess dose-dependent binding of bIgG to human Fcγ receptors (FcγR) or bIgG-mediated binding of myeloid cells to hRSV respectively. S. Epidermidis and RSV were used to test bIgG-mediated binding and internalisation of pathogens by myeloid cells. Finally, the ability of bIgG to neutralise infection of HEp2 cells by hRSV was evaluated. RESULTS bIgG recognised human RSV, influenza haemagglutinin and Haemophilus influenza. bIgG bound to FcγRII on neutrophils, monocytes and macrophages, but not to FcγRI and FcγRIII, and could bind simultaneously to hRSV and human FcγRII on neutrophils. In addition, human neutrophils and dendritic cells internalised pathogens that were opsonised with bIgG. Finally, bIgG could prevent infection of HEp2 cells by hRSV. CONCLUSIONS The data presented here show that bIgG binds to hRSV and other human respiratory pathogens and induces effector functions through binding to human FcγRII on phagocytes. Thus bovine IgG may contribute to immune protection against RSV.
Collapse
Affiliation(s)
- Gerco den Hartog
- Laboratory of Translational Immunology, Immunotherapy group, UMC Utrecht, Utrecht, The Netherlands
- Cell Biology and Immunology, Wageningen University, Wageningen, The Netherlands
| | - Shamir Jacobino
- Laboratory of Translational Immunology, Immunotherapy group, UMC Utrecht, Utrecht, The Netherlands
| | - Louis Bont
- Laboratory of Translational Immunology, Immunotherapy group, UMC Utrecht, Utrecht, The Netherlands
- Department of Pediatrics, UMC Utrecht, Utrecht, The Netherlands
| | | | | | - Jeanette H. W. Leusen
- Laboratory of Translational Immunology, Immunotherapy group, UMC Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - R. J. Joost van Neerven
- Cell Biology and Immunology, Wageningen University, Wageningen, The Netherlands
- FrieslandCampina, Amersfoort, The Netherlands
| |
Collapse
|
43
|
Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, Johnson DW, Light MJ, Maraqa NF, Mendonca EA, Phelan KJ, Zorc JJ, Stanko-Lopp D, Brown MA, Nathanson I, Rosenblum E, Sayles S, Hernandez-Cancio S. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134:e1474-502. [PMID: 25349312 DOI: 10.1542/peds.2014-2742] [Citation(s) in RCA: 1048] [Impact Index Per Article: 104.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
This guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:
Collapse
|
44
|
Constantinescu S, Pai A, Coscia LA, Davison JM, Moritz MJ, Armenti VT. Breast-feeding after transplantation. Best Pract Res Clin Obstet Gynaecol 2014; 28:1163-73. [PMID: 25271063 DOI: 10.1016/j.bpobgyn.2014.09.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 12/17/2022]
Abstract
Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during pregnancy and breast-feeding. This article reviews case and series reports regarding breast-feeding in those taking transplant medications. Avoidance of breast-feeding has been the customary advice because of the potential adverse effects of immunosuppressive exposure on the infant. Subsequent studies have demonstrated that not all medication exposure translates to risk for the infant, that the exposure in utero is greater than via breast milk and that no lingering effects due to breast-feeding have been found to date in infants who were breast-fed while their mothers were taking prednisone, azathioprine, cyclosporine, and/or tacrolimus. Thus, except for those medications where clinical information is inadequate (mycophenolic acid products, sirolimus, everolimus, and belatacept), the recommendation for transplant recipients regarding breast-feeding has evolved into one that is cautiously optimistic.
Collapse
Affiliation(s)
- Serban Constantinescu
- Temple University School of Medicine, Kresge West, 3440 N. Broad St., Suite 100, Philadelphia, PA 19140, USA.
| | - Akshta Pai
- Temple University School of Medicine, Kresge West, 3440 N. Broad St., Suite 100, Philadelphia, PA 19140, USA.
| | - Lisa A Coscia
- National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, 401 N. 3rd Street, Philadelphia, PA 19123, USA.
| | - John M Davison
- Institute of Cellular Medicine, 3rd Floor, Leech Building, Faculty of Medical Sciences, Framlington Place, Newcastle upon Tyne NE2 4HH, UK.
| | - Michael J Moritz
- Lehigh Valley Hospital, 1250 S. Cedar Crest Blvd. Suite 210, Allentown, PA 18103, USA; University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Vincent T Armenti
- National Transplantation Pregnancy Registry (NTPR), Gift of Life Institute, 401 N. 3rd Street, Philadelphia, PA 19123, USA; University of Central Florida, Orlando, FL, USA.
| |
Collapse
|
45
|
Abstract
OBJECTIVES There is a dearth of information on the long-term maternal effects of breastfeeding. The objective of this study was to examine adherence to breastfeeding recommendations of exclusive breastfeeding for ≥4 months and continuation of breastfeeding for ≥1 year and maternal weight retention 6 years after delivery. METHODS Using data from the Infant Feeding Practices Study II (IFPS II), we categorized women by the degree to which they met breastfeeding recommendations. Mothers' self-reported weight 6 years after delivery (IFPS Year 6 Follow-Up) was compared with self-reported prepregnancy weight from IFPS II. Using linear regression models, adjusting for covariates, we examined associations between breastfeeding recommendation adherence and weight retention. RESULTS Of the 726 women in our study, 17.9% never breastfed. Among those who initiated breastfeeding, 29.0% breastfed exclusively for ≥4 months, and 20.3% breastfed exclusively for ≥4 months and continued breastfeeding for ≥12 months. Prepregnancy BMI modified the association between breastfeeding recommendation adherence and weight retention. Adjusting for covariates, we found no association between breastfeeding recommendations adherence and weight retention among normal and overweight mothers. Among obese mothers, there was a significant linear trend (P = .03), suggesting that those who fully adhered to breastfeeding recommendations retained less weight (-8.0 kg) than obese women who never breastfed. CONCLUSIONS This study suggests that improving adherence to breastfeeding recommendations may help reduce long-term maternal weight retention among obese mothers. Larger studies, with diverse populations and similar longitudinal designs, are needed to explore this relationship.
Collapse
Affiliation(s)
- Andrea J Sharma
- US Public Health Service Commissioned Corps, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Deborah L Dee
- US Public Health Service Commissioned Corps, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia
| |
Collapse
|
46
|
Infectious burden of respiratory syncytial virus in relation to time of birth modifies the risk of lower respiratory tract infection in infancy: the Norwegian Mother and Child Cohort. Pediatr Infect Dis J 2013; 32:e235-41. [PMID: 23385949 DOI: 10.1097/inf.0b013e31828ab9ff] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The risk of respiratory syncytial virus (RSV) infection according to calendar month of birth has previously been demonstrated. We hypothesize that the real-time infectious burden (IB) of RSV, in relation to time and county of birth, modifies the risk of lower respiratory tract infection (LRTI) in infants, an association that has not been investigated previously, and may be used as an alternative measure of RSV risk when drafting RSV immunoprophylaxis guidelines. METHODS Thirty thousand eighty-seven pregnancies were included from July 1, 2003, to July 31, 2006. IB was defined by month and county as the number of RSV detections per inhabitant. IB for 5 periods ante- and postnatally was calculated for each child. Outcome variables were maternally reported hospitalization for LRTI before age 6 months and LRTI before age 12 months. Logistic regression was used to estimate associations between IB and LRTI. RESULTS The odds of hospitalization for LRTI rise with increased IB the first 3 months after birth. Low IB: odds ratio (OR) 1.17 (95% confidence interval [CI]: 0.98-1.39); medium IB: OR 1.42 (95% CI: 1.21-1.68); high IB: OR 2.51 (95% CI: 2.15-2.94). High IB 3-0 months before birth confers a lower odds of hospitalization for LRTI the first 6 months of life, OR 0.51 (95% CI: 0.43-0.61). Similar results were seen for maternally reported LRTI the first 12 months of life. CONCLUSIONS We find an association between real-time RSV infectious burden and LRTI in infancy: high burden before birth is protective and high burden after birth increases the risk.
Collapse
|
47
|
Lanari M, Prinelli F, Adorni F, Di Santo S, Faldella G, Silvestri M, Musicco M. Maternal milk protects infants against bronchiolitis during the first year of life. Results from an Italian cohort of newborns. Early Hum Dev 2013; 89 Suppl 1:S51-7. [PMID: 23809352 DOI: 10.1016/s0378-3782(13)70016-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Bronchiolitis is one of the primary causes of hospitalization in infancy. We evaluated the effect of breastfeeding on the occurrence of hospitalization for bronchiolitis in the first year of life. METHODS In a prospective cohort study, 1,814 newborns of =33 weeks of gestational age (wGA) were enrolled in 30 Italian Neonatology Units and followed-up for 1 year to assess hospitalizations for bronchiolitis. Children were grouped as 'never breastfed' and 'ever breastfed'; these latter were further divided into those 'exclusively breastfed' and 'breastfed associated with milk formula'. The risk of hospitalization for bronchiolitis was evaluated with survival analysis, and hazard ratios (HR) with 95% confidence interval [95% CI] were calculated. RESULTS Among enrolled newborns 22.9% were 'never breastfed'; in the breastfed group, 65% were 'exclusively breastfed' and 35% were 'breastfed with associated milk formula'. At 12 months of age, the risk of hospitalization for bronchiolitis was significantly higher in the 'never breastfed' group (HR: 1.57; 95% CI: 1.00-2.48). 'Breastfed associated with formula milk' and 'exclusively breastfed' groups were at similar risk of hospitalization for bronchiolitis. This observed protective effect of maternal milk was not explained by the higher prevalence of conditions able to increase the risk of bronchiolitis among 'never breastfed newborns'. CONCLUSIONS Breastfeeding, even in association with formula milk, reduces the risk of hospitalization for bronchiolitis during the first year of life. Encouraging breastfeeding might be an effective/inexpensive measure of prevention of lower respiratory tract infections in infancy.
Collapse
Affiliation(s)
- Marcello Lanari
- Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Li Y, Dang S, Deng H, Wang W, Jia X, Gao N, Li M, Wang J. Breastfeeding, previous Epstein-Barr virus infection, Enterovirus 71 infection, and rural residence are associated with the severity of hand, foot, and mouth disease. Eur J Pediatr 2013; 172:661-6. [PMID: 23344210 DOI: 10.1007/s00431-013-1939-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/09/2013] [Indexed: 12/12/2022]
Abstract
Severe hand, foot, and mouth disease (HFMD) is likely to develop critical complications such as brainstem encephalitis, acute pulmonary edema, and circulatory failure, which cause child mortality during outbreaks. This study aims to investigate factors that predict the severity of HFMD. One hundred sixteen in-patient children with severe HFMD and 202 with mild HFMD were retrospectively enrolled. Potential factors were collected for each child including sex, age, residence, modes of delivery, birth weight, virus types causing HFMD, and virus exposure history. Univariate and multivariable logistic regression were used to determine which factors were associated with HFMD severity. In the univariate analysis, breastfeeding (OR 0.514, 95 % CI 0.309-0.856), rural residence (OR 1.971, 95 % CI 1.239-3.137), current Enterovirus 71 (EV71) infection (OR 2.539, 95 % CI 1.504-4.287), and previous Epstein-Barr virus (EBV) exposure (OR 3.136, 95 % CI 1.863-5.278) were each associated with the severity of HFMD. In the multivariate model, breastfeeding (OR 0.570, 95 % CI 0.332-0.980), rural residence (OR 1.973, 95 % CI 1.202-3.237), current EV71 infection (OR 2.290, 95 % CI 1.315-3.987), and previous EBV exposure (OR 2.550, 95 % CI 1.470-4.422) remained independently associated with the severity of HFMD. In conclusion, previous EBV exposure, EV71 infection, and rural residence are risk factors for severe HFMD; breastfeeding is a protective factor.
Collapse
Affiliation(s)
- Yaping Li
- Department of Infectious Diseases, Second Affiliated Hospital of Medical School, Xi'an Jiaotong University, No. 157, Xiwu Road, Xi'an, Shaanxi 710004, China
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Jeurink P, van Bergenhenegouwen J, Jiménez E, Knippels L, Fernández L, Garssen J, Knol J, Rodríguez J, Martín R. Human milk: a source of more life than we imagine. Benef Microbes 2013; 4:17-30. [DOI: 10.3920/bm2012.0040] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The presence of bacteria in human milk has been acknowledged since the seventies. For a long time, microbiological analysis of human milk was only performed in case of infections and therefore the presence of non-pathogenic bacteria was yet unknown. During the last decades, the use of more sophisticated culture-dependent and -independent techniques, and the steady development of the -omic approaches are opening up the new concept of the ‘milk microbiome’, a complex ecosystem with a greater diversity than previously anticipated. In this review, possible mechanisms by which bacteria can reach the mammary gland (contamination versus active migration) are discussed. In addition, the potential roles of human milk for both infant and maternal health are summarised. A better understanding of the link between the milk microbiome and health benefit, the potential factors influencing this relationship and whether or not it can be influenced by nutrition is required to open new avenues in the field of pregnancy and lactation.
Collapse
Affiliation(s)
- P.V. Jeurink
- Danone Research, Centre for Specialised Nutrition, P.O. Box 7005, 6700 CA Wageningen, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB Utrecht, the Netherlands
| | - J. van Bergenhenegouwen
- Danone Research, Centre for Specialised Nutrition, P.O. Box 7005, 6700 CA Wageningen, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB Utrecht, the Netherlands
| | - E. Jiménez
- Dpto Nutrición, Bromatología y Tecnología de los Alimentos, UCM, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - L.M.J. Knippels
- Danone Research, Centre for Specialised Nutrition, P.O. Box 7005, 6700 CA Wageningen, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB Utrecht, the Netherlands
| | - L. Fernández
- Dpto Nutrición, Bromatología y Tecnología de los Alimentos, UCM, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - J. Garssen
- Danone Research, Centre for Specialised Nutrition, P.O. Box 7005, 6700 CA Wageningen, the Netherlands
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB Utrecht, the Netherlands
| | - J. Knol
- Danone Research, Centre for Specialised Nutrition, P.O. Box 7005, 6700 CA Wageningen, the Netherlands
- Laboratory of Microbiology, Wageningen University, P.O. Box 8033, 6700 EJ Wageningen, the Netherlands
| | - J.M. Rodríguez
- Dpto Nutrición, Bromatología y Tecnología de los Alimentos, UCM, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain
| | - R. Martín
- Danone Research, Centre for Specialised Nutrition, P.O. Box 7005, 6700 CA Wageningen, the Netherlands
| |
Collapse
|
50
|
Abstract
This article reviews risks of illness or exposures to breastfed infants. Galactosemia in an infant is a contraindication to breastfeeding. There are no medical conditions in the mother that are contraindications, although diagnostic procedures, treatment, or illness can interfere. Restrictive diets or malnutrition are not contraindications but are opportunities to provide nutritional counseling. Environmental toxic exposures within the United States are uncommon; breastfeeding is not usually contraindicated. In any concerning situation, an assessment and discussion of risks and benefits for the mother-infant dyad (breastfed or formula fed) is indicated. Coordinated medical care and lactation assistance can facilitate successful breastfeeding.
Collapse
|