Journal of Pediatric Gastroenterology & Nutrition:
Fecal Microflora in Healthy Infants Born by Different Methods of Delivery: Permanent Changes in Intestinal Flora After Cesarean Delivery
Grölund, Minna-Maija*†; Lehtonen, Olli-Pekka†; Eerola, Erkki‡; Kero, Pentti*
*Department of Pediatrics, Turku University Central Hospital, Turku, Finland; †Clinical Microbiology, Turku University Central Hospital ‡Department of Medical Microbiology, University of Turku, Finland
Address correspondence and reprint requests to Minna-Maija Grölund, MD, Department of Paediatrics, Turku University Central Hospital, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland.
Received December 18, 1997; Revised April 7 and June 26, 1998; accepted July 1, 1998.
Background: Newborn infants in modern maternity hospitals are subject to numerous factors that affect normal intestinal colonization-for example, cesarean delivery and antimicrobial agents. To study the duration of the effect of external factors on intestinal colonization, two groups of infants with different delivery methods were investigated.
Methods: The fecal flora of 64 healthy infants was studied prospectively. Thirty-four infants were delivered vaginally, and 30 by cesarean birth with antibiotic prophylaxis administered to their mothers before the delivery. The fecal flora was cultured on nonselective and selective media in infants 3 to 5, 10, 30, 60, and 180 days of age. Gastrointestinal signs were recorded daily by the mothers for 2 months.
Results: The fecal colonization of infants born by cesarean delivery was delayed. Bifidobacterium-like bacteria and Lactobacillus-like bacteria colonization rates reached the rates of vaginally delivered infants at 1 month and 10 days, respectively. Infants born by cesarean delivery were significantly less often colonized with bacteria of the Bacteroides fragilis group than were vaginally delivered infants: At 6 months the rates were 36% and 76%, respectively (p = 0.009). The occurrence of gastrointestinal signs did not differ between the study groups.
Conclusions: This study shows for the first time that the primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after the birth. The clinical relevance of these changes in unknown, and even longer follow-up is needed to establish how long-lasting these alterations of the primary gut flora can be.
The neonatal period is crucial for intestinal colonization. Born sterile and undergoing colonization within a few days, infants are an open field for colonization by different types of bacteria. Gestational age, type of delivery, and feeding affect the stool flora of young infants (1), but there is little information on which long-term factors influence the bacterial selection process in the gut of young infants 2.
Infants born vaginally apparently acquire their gut flora from maternal vaginal and fecal flora (3), but the environment also contributes. Within maternity wards, nosocomial spread is shown to exist among healthy newborn infants (4,5). For the colonization of infants born by cesarean delivery (CD), the environment is extremely important (6,7). Likewise, if infants are separated from their mothers for long periods after birth, the environment becomes an important source of colonizing bacteria (5).
Gut colonization is delayed in infants born by CD, and intestinal colonization is consequently abnormal for several weeks (1,8). Most of the studies on gut colonization of infants born by CD have extended only to the first month of life (1,8-10). Overall, however, the long-term stability of the gut flora of newborn infants has been studied systematically in only a few studies 2,11. Such information would clearly be valuable, because changes in the primary gut flora have been associated with gastrointestinal disorders and infantile colic 12-15. We studied the stability of the changes in the fecal flora of newborn infants and the association between certain bacteria and gastrointestinal signs. To study two distinctly different groups of neonates with different gut flora, two study groups were formed: vaginally delivered (VD) infants (n = 34) and infants born by CD to mothers who had received antimicrobial prophylaxis (n = 30). The fecal flora was recorded for 6 months, and gastrointestinal signs were registered daily for 2 months.
MATERIALS AND METHODS
The study included 64 healthy newborn infants of healthy mothers who delivered at the Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland. Thirty-four VD infants and 30 infants delivered by elective CD were enrolled between February 1995 and June 1996 after written informed consent had been obtained from their parents. The enrollment rate was two to four children per week, because sampling necessitated that the birth took place on Monday through Thursday. The mothers who delivered by cesarean birth received prophylactically 2 g intravenous ampicillin 2 hours before the operation. None of the mothers had received any antimicrobial agents within the month that preceded the delivery. After delivery, the newborns were admitted randomly to one of the two maternity wards for healthy newborn infants.
Fecal Samples and Bacterial Cultures
Fecal samples were taken when the infants were 3 to 5 days old (taken at the hospital) and 10, 30, 60, and 180 days old (taken at home). The specimens were collected in plastic containers. If not cultured immediately, the samples were stored at 4°C. The specimens obtained at home were taken to the laboratory by the parents. The mean storage time of the specimens was 10.7 hours (range, 0.5-34.5 hours).
An approximate 300-mg portion of the specimen was weighed, diluted, and homogenized in fastidious anaerobe broth (Lab M, Bury, UK). Serial 100-fold dilutions were made in the same broth. Duplicate samples of 10 µl of each dilution were cultured on a variety of nonselective and selective media (Table 1).
The MacConkey plates were incubated at 35°C in ambient air for 24 hours. All other cultures were incubated in anaerobic jars with gas-generating kits (Anero Gen, AN35; Oxoid, Basingstoke, UK) at 35°C for 48 hours (fastidious anaerobe agar [FAA], Bacteroides bile esculin agar [BBE] and Clostridium perfringers selective agar), or for 72 hours (Rogosa and modified Petuely's agars). The number of colonies from two parallel plates was counted from a dilution yielding 30 to 300 colony-forming units (CFU)/plate, and average was recorded.
The total number of colonies was counted and recorded from MacConkey and FAA agars. The number of all different types of colonies was counted from BBE, Rogosa, and modified Petuely's agars and the number of distinctive black colonies from Clostridium perfringens agar. All different types of colonies from BBE, Rogosa, and modified Petuely's agars and distinctive black colonies from Clostridium perfringers agar were subcultured for aerotolerance testing and were Gram stained.
Anaerobic gram-negative, esculin hydrolysing rods growing on BBE agar were recorded as bacteria of the Bacteroides fragilis group. Anaerobic and aerotolerant nonbranching, grampositive rods with parallel sides from Rogosa agar were recorded as Lactobacillus-like bacteria (LLB). It has been shown that all colonies growing well on Rogosa agar may be considered lactic acid bacteria; some enterococci and pediococci may show reduced growth (16). Anaerobic and aerotolerant gram-positive rods from modified Petuely's agars were recorded as Bifidobacterium-like bacteria (BLB). Modified Petuely's agar is highly selective and efficient for detection of Bifidobacterium from fecal samples. In a previous work by Tanaka and Mutai (17) 175 fecal strains were detected from the modified Petuely's medium; from these 94% were bifidobacteria, 3% eubacteria, and 3% peptostreptococci.
Clostridium perfringens was identified by its distinct colony and Gram-stain morphology, by its anaerobic nature in aerotolerance testing, and by positive results in the reversed CAMP test (18). The bacterial counts were expressed as the log10 of colony-forming units per gram of wet weight of feces.
The mothers kept a diary for 2 months of their infants' daily bowel habits, abdominal distension, flatulence, normal and colickly crying, use of antimicrobial agents, and feedings. Crying was defined as colicky if it was a distinctive pain cry, and the infant was difficult to console (19). Abdominal distension and flatulence were given a daily score by the following scale: no signs, a few signs, moderate signs, or heavy signs.
The results were analysed statistically by Fisher's exact test (to compare the number of infants colonized at each time point), Mann-Whitney's rank sum test (to compare bacteria counts of colonized infants at 3 days and 6 months of age), and analysis of variance of repeated measurements (to compare the gastrointestinal signs). A commercial software program (Statistica, version 5.0; Stat Soft, Tulsa, OK, U.S.A.) was used for these calculations. P < 0.05 was considered statistically significant.
The study was approved by the joint Committee of Ethics of the Turku University and Turku University Central Hospital.
The study groups differed slightly by gestational age (VD group, 40 weeks; CD group, 39 weeks; p = 0.04) but the birth weights did not differ statistically (VD group, 3577 g; CD group, 3572 g; p = 0.96). Special attention was paid to the method of feeding the infants. The use of formula was recorded carefully by the mothers. The proportion of infants exclusively breast-fed at 2 months of age or partly breast-fed at 6 months of age did not differ between the study groups (p = 0.2 and 0.8, respectively). Eleven infants received antimicrobial agents during follow-up. All of these therapies were administered when the infants were older than 2 months, and in these infants the subsequent 6-mont fecal samples were excluded from the analysis. (Table 2)
With the exception of one infant (in the CD group) who was culture-negative at 3 days of age, all infants were colonized with aerobic enteric bacteria in every culture. The colonization rates of BLB and LLB were lower in the CD group 'han in the VD group after birth. The colonization rate of BLB coincided in these groups by 1 month and of LLB by 10 days of age (Figs. 1 and 2). The colonization rate of LLB in the CD group even exceeded that of the VD group in infants 2 and 6 months of age (Fig. 2). The Clostridium perfringens colonization rate was statistically higher in the CD group than in the VD group at 1 month of age (57% vs. 17% p = 0.003; Fig. 3).
The colonization rates of bacteria within the Bacteroides fragilis group differed most markedly of all between the study groups. The Bacteroides colonization rate ranged from 52% to 79% in the VD group (Fig. 4). Only one of the infants in the CD group was Bacteroides positive at 3 days of age. After that, Bacteroides was not recovered in any of the samples from the infants in the CD group before the age of 2 months. In infants 6 months of age, the colonization rate was still statistically lower in the CD group than in the VD group (36% vs. 76%; p = 0.009; Fig. 4).
The colonization levels of the different bacteria of the colonized infants are shown in Table 3. The total bacterial counts were significantly lower in the CD group in infants 3 days of age (p = 0.005) and in those 6 months of age (p = 0.03). The aerobic enteric bacterial counts did not differ between the groups. Infants in the CD group had a significantly lower level of BLB when they were 3 days old (p = 0.005) but not when they were 6 months old (p = 0.5). There were no differences in the LLB counts or in the Clostridium perfringens counts between the groups. The amounts of Bacteroides fragilis bacteria did not differ between the groups of infants with colonization at 6 months (p = 0.3).
Two mothers in both groups did not complete the follow-up sheets. No statistically significant differences were found between the study groups in the scores of abdominal distension, flatulence, or in the amount of colicky crying, Infantile colic, according to the definition of Wessel et al. (20), was detected in three of the VD infants and in none of the CD infants (p = 0.2; Fisher's exact test).
This study shows that the fecal flora of infants born by CD with prophylactic antibiotics administered to the mother is very different from that of infants delivered vaginally. The greatest differences were seen in the bacteria of the Bacteroides fragilis group, which is in agreement with studies in infants born by CD; in earlier studies the duration of follow-up, however, was only 10 to 60 days (1,8,10). In the present study, no permanent colonization with Bacteroides fragilis group bacteria was found in the CD group before the infants were 2 months of age. Still, in infants 6 months of age in the CD group, the colonization rate of the Bacteroides fragilis group was only half that of infants in the VD group (36% and 76%, respectively; p = 0.009). Similarly, Bennet and Nord (8) were unable to detect Bacteroides bacteria 3 to 8 weeks after birth in term and preterm infants born by CD.
We used selective culture media to describe intestinal flora in this study. The counts detected from these selective culture media represent mainly the bacterial genera level but cannot detect the absolute counts of different bacterial genera or species, except those of Clostridium perfringens, which were further identified. Nevertheless, this method can identify differences between the delivery groups and the changes taking place in intestinal flora after birth, which was the main purpose of the current study. Furthermore, the main differences in the fecal flora between the delivery groups were found in Bacteroides fragilis group bacteria that were detected from the BBE media, which is highly selective for the Bacteroides fragilis group (21).
The long-lasting changes seen in the primary gut flora of infants born by CD could be the result of one or both of the two abnormal components of their birth: CD itself or the prophylactic ampicillin and administered to the mother 2 hours before the elective CD. Ampicillin is very poorly protein-bound and crosses the placenta readily: maternal and fetal serum ampicillin levels equilibrate within 1 hour after intravenous administration (22). The decline in BLB could be explained by the intravenous ampicillin that the infants were exposed to before delivery, but fecal LBL should not decline with ampicillin therapy, at least this is not the case in older children (10 months to 12 years). Also, only a minor decline is detected in fecal Bacteroides sp. counts in these older children and the Bacteroides sp. counts return to normal stage within only 3 to 6 days after cessation of the ampicillin therapy (23). Thus, it seems unlikely that the long-term changes recorded in the fecal flora of the infants in the CD group in our study could be explained by the administration of ampicillin before delivery. Rather, previous reports imply that this phenomenon is caused by CD itself (1,8). Still, ampicillin could have more profound effects when administered immediately after the birth because the gut is empty, and the drug can select the primary colonizing bacteria.
The changes that took place in the fecal bacterial flora could not be associated with gastrointestinal signs. Any signs were meticulously recorded daily by the mothers for 2 months. In a previous study, Clostridium perfringens has been associated with an increased incidence of gastrointestinal signs, such as flatulence, distended abdomen, foul-smelling stools, diarrhea, and blood in stools (12). In the present study, the infants born by CD had a higher colonization rate of Clostridium perfringens than the VD group of infants at 1 month (57% and 17%, respectively). Even at this time point, the scores of gastrointestinal signs did not differ between the study groups. The inconsistency of the results between these two studies might be explained by the differences between the study populations. In the previous study most of the infants were treated in the intensive care unit and were preterm infants, whereas in the present study all infants were healthy full-term neonates.
There is great variation among the reports of the predominant bacteria in the fecal flora of breast-fed newborns. Some researchers have found bifidobacteria to predominate and Bacteroides to be scarce (2,24,25), whereas others have found the opposite (26,27). However, the predominant bacterium has been classified differently among the studies. Some investigators define the predominant bacterium as the most frequently occurring bacteria (26) and some as the bacterium with the highest counts in fecal samples (28). In the present study, 19 of the 34 VD infants were exclusively breast-fed for 2 months. Among all the VD children, the most frequent bacteria during the first 2 months of life were BLB (85-97%), although Bacteroides fragilis group bacteria were also common (52-79%). The highest colony counts were encountered for BLB (10.2-10.9 log10 CFU/g wet weight of feces). The Bacteroides colony counts were lower (8.7-9.5 log10 CFU/g). These results agree with those in a recent study from Germany (28).
The present study is the first one to show that the changes in the primary intestinal flora of infants born by CD to mothers who have received antimicrobial prophylaxis last for no less than 6 months after birth, maybe longer. We do not know how long these abnormalities in the fecal flora last on the whole, but the primary quality and quantity of colonization of the gut seems to be critical in the selection process between different genera of bacteria. Some bacteria such as Bacteroides are not as easily accessible to the gut of infants delivered the under sterile conditions of CD. Other, perhaps more aerotolerant, bacteria may take over in the intestine and inhibit the subsequent colonization of the gut by Bacteroides. This phenomenon is the generally known as interbacterial inhibition (29). Apparently, the bacterial predominances are not readily subject to change under normal domestic conditions after the first months of the colonization process.
Normal intestinal flora has immunostimulatory functions, as has been demonstrated in numerous animal studies (30-32). Mucosal IgA plasma cells are especially scarce in germ-free animals (33). Additionally, when probiotic bacteria belonging to the normal intestinal flora have been administered orally to children in association with diarrhea or mucosal vaccination, an increase in antigen-specific and nonspecific IgA and IgM responses has been detected (34,35). Secretory IgA and IgM are the main humoral mediators of mucosal immunity in cooperation with a variety of innate protective mechanisms. Well-functioning mucosal immunity is a prerequisite for health, because the mucosal surfaces are favored as portals of entry by most infectious agents, allergens, and carcinogens (36). Further research is under way to determine whether the delay found in intestinal colonization in these infants born by CD has any effect on the development of the gut-associated immune system.
Acknowledgement: The authors thank Mr. Hans Helenius, M.Sc., Department of Biostatistics, University of Turku, for his help with the statistical analysis; and the nurses of the Department of Obstetrics and Gynecology, and Mrs. Satu Ekblad, Department of Pediatrics, for their invaluable help in performing this study.
Supported in part by The South-West Finnish Fund of Neonatal Research.
1. Long SS, Swenson RM. Development of anaerobic fecal flora in healthy newborn infants. J Pediatr 1977;91:298-301.
2. Stark PL, Lee A. The microbial ecology of the large bowel of breast-fed and formula-fed infants during the first year of life. J Med Microbiol 1982;15:189-203.
3. Tannock GW, Fuller R, Smith SL, Hall MA. Plasmid profiling of members of the family Enterobacteriaceae, lactobacilli, and bifidobacteria to study the transmission of bacteria from mother to infant. J Clin Microbiol 1990;28:1225-8.
4. Delmeé M, Verellen G, Avesani V, Francois G. Clostridium difficile in neonates: Serogrouping and epidemiology. Eur J Pediatr 1988;147:36-40.
5. Murono K, Fujita K, Yoshikawa M, et al. Acquisition of nonmaternal Enterobacteriaceae by infants delivered in hospitals. J Pediatr 1993;122:120-5.
6. Fryklund B, Tullus K, Berglund B, Burman LG. Importance of the environment and the faecal flora of infants, nursing staff and parents as sources of gram-negative bacteria colonizing newborns in three neonatal wards. Infection 1992;20:253-7.
7. Lennox-King SM, O'Farrell SM, Bettelheim KA, Shooter RA. Escherichia coli isolated from babies delivered by caesarean section and their environment. Infection 1976;4:139-45.
8. Bennet R, Nord CE. Development of the faecal anaerobic microflora after caesarean section and treatment with antibiotics in newborn infants. Infection 1987;15:332-6.
9. Hall MA, Cole CB, Smith SL, Fuller R, Rolles CJ. Factors influencing the presence of faecal lactobacilli in early infancy. Arch Dis Child 1990;65:185-8.
10. Neut C, Bezirtzoglou E, Romond C, Beerens H, Delcroix M, Noel AM. Bacterial colonization of the large intestine in newborns delivered by cesarean section. Zentralbl Bakteriol Mikrobiol Hyg A 1987;266:330-7.
11. Ellis-Pegler RB, Crabtree C, Lambert HP. The faecal flora of children in the United Kingdom. J Hyg Lond 1975;75:135-42.
12. Ahtonen P, Lehtonen OP, Kero P, Eerola E, Hartiala K. Clostridium perfringens in stool, intrapartum antibiotics and gastrointestinal signs in a neonatal intensive care unit. Acta Paediatr 1994;83:389-90.
13. Lehtonen L, Korvenranta H, Eerola E. Intestinal microflora in colicky and noncolicky infants: Bacterial cultures and gas-liquid chromatography. J Pediatr Gastroenterol Nutr 1994;19:310-4.
14. Miller JJ, McVeagh P, Fleet GH, Petocz P, Brand JC. Breath hydrogen excretion in infants with colic. Arch Dis Child 1989;64:725-9.
15. Moore DJ, Robb TA, Davidson GP. Breath hydrogen response to milk containing lactose in colicky and noncolicky infants. J Pediatr 1988;113:979-84.
16. The Oxoid Manual. 7th ed. Basingstoke, UK: Unipath Ltd., 1995: 2-186.
17. Tanaka R, Mutai M. Improved medium for selective isolation and enumeration of Bifidobacterium. Appl Environ Microbiol 1980;40:866-9.
18. Buchanan AG. Clinical laboratory evaluation of a reverse CAMP test for presumptive identification of Clostridium perfringens. J Clin Microbiol 1982;16:761-2.
19. Lester BM, Boukydis CFZ, Garcia-Coll CT, Hole WT. Colic for developmentalists. Infant Mental Hlth J 1990;321-33.
20. Wessel MA, Cobb JC, Jackson EB, Harris GSJ, Detweiler AC. Paroxymal fussing in infancy, sometimes called "colic." J Pediatr 1954;14:421-34.
21. Livingston SJ, Kominos SD, Yee RB. New medium for selection and presumptive identification of the Bacteroides fragilis group. J Clin Microbiol 1978;7:448-53.
22. Bray RE, Boe RW, Johnson WL. Transfer of ampicillin into fetus and amniotic fluid from maternal plasma in late pregnancy. Am J Obstet Gynecol 1966;96:938-42.
23. Sakata H, Fujita K, Yoshioka H. The effect of antimicrobial agents on fecal flora of children. Antimicrob Agents Chemother 1986;29:225-9.
24. Roberts AK, Chierici R, Sawatzki G, Hill MJ, Volpato S, Vigi V. Supplementation of an adapted formula with bovine lactoferrin: 1. Effect on the infant faecal flora. Acta Paediatr 1992;81:119-24.
25. Yoshioka H, Iseki K, Fujita K. Development and differences of intestinal flora in the neonatal period in breast-fed and bottle-fed infants. Pediatrics 1983;72:317-21.
26. Lundequist B, Nord CE, Winberg J. The composition of the faecal microflora in breastfed and bottle fed infants from birth to eight weeks. Acta Paediatr Scand 1985;74:45-51.
27. Simhon A, Douglas JR, Drasar BS, Soothill JF. Effect of feeding on infants' faecal flora. Arch Dis Child 1982;57:54-8.
28. Kleessen B, Bunke H, Tovar K, Noack J, Sawatzki G. Influence of two infant formulas and human milk on the development of the faecal flora in newborn infants. Acta Paediatr 1995;84:1347-56.
29. Sprunt K, Redman W. Evidence suggesting importance of role of interbacterial inhibition in maintaining balance of normal flora. Ann Intern Med 1968;68:579-90.
30. Crabbé PA, Bazin H, Eyssen H, Heremans JF. The normal microbial flora as a major stimulus for proliferation of plasma cells synthesizing IgA in the gut. The germ-free intestinal tract. Int Arch Allergy Appl Immunol 1968;34:362-75.
31. Moreau MC, Ducluzeau R, Guy-Grand D, Muller MC. Increase in the population of duodenal immunoglobulin A plasmocytes in axenic mice associated with different living or dead bacterial strains of intestinal origin. Infect Immun 1978;21:532-9.
32. Shroff KE, Meslin K, Cebra JJ. Commensal enteric bacteria engender a self-limiting humoral mucosal immune response while permanently colonizing the gut. Infect Immun 1995;63:3904-13.
33. Crabbé PA, Nash DR, Bazin H, Eyssen H, Heremans JF. Immunohistochemical observations on lymphoid tissues from conventional and germ-free mice. Lab Invest 1970;22:448-57.
34. Kaila M, Isolauri E, Soppi E, Virtanen E, Laine S, Arvilommi H. Enhancement of the circulating antibody secreting cell response in human diarrhea by a human Lactobacillus strain. Pediatr Res 1992;32:141-4.
35. Isolauri E, Joensuu J, Suomalainen H, Luomala M, Vesikari T. Improved immunogenicity of oral D × RRV reassortant rotavirus vaccine by Lactobacillus casei GG. Vaccine 1995;13:310-2.
36. Brandtzaeg P. Molecular and cellular aspects of the secretory immunoglobulin system. APMIS 1995;103:1-19.
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Carol Sakala's letter from North America: An uncontrolled experiment: Elective delivery predominates in the United States
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Fems Microbiology EcologyGenomic diversity of cultivable Lactobacillus populations residing in the neonatal and adult gastrointestinal tractFems Microbiology Ecology
Agro Food Industry Hi-Tech
Bacterial colonisation of the infant gut, the influence of diet and its role in health
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American Journal of Respiratory and Critical Care MedicineMaternal complications and procedures in pregnancy and at birth and wheezing phenotypes in childrenAmerican Journal of Respiratory and Critical Care Medicine
Journal of Hospital InfectionHealthcare-associated infections in neonatal units: lessons from contrasting worldsJournal of Hospital Infection
Development of intestinal bacterial enzymes in infants - Relationship to mode of delivery and type of feeding
Toll of allergy reduced by probiotics
Monatsschrift KinderheilkundeProbiotics and allergyMonatsschrift Kinderheilkunde
International Journal of Food MicrobiologyGut bacteria and health foods - the European perspectiveInternational Journal of Food Microbiology
Nutrition ResearchGalactooligosaccharide in combination with Bifidobacterium and Bacteroides affects the population of Clostridium perfringens in the intestine of gnotobiotic miceNutrition Research
Journal of Clinical MicrobiologyHigh rate of transfer of Staphylococcus aureus from parental skin to infant gut floraJournal of Clinical Microbiology
Journal of General and Applied Microbiology
Development of the intestinal microbiota in the piglet
Journal of General and Applied Microbiology, 51(4):
PediatricsFactors influencing the composition of the intestinal microbiota in early infancyPediatrics
World Journal of Gastroenterology
Do probiotics have a therapeutic role in gastroenterology?
World Journal of Gastroenterology, 12():
Gastroenterologie Clinique Et Biologique
Establishment of the intestinal microflora in neonates
Gastroenterologie Clinique Et Biologique, 31(5):
Issues in Complementary Feeding
The microbiological risk
Issues in Complementary Feeding, 60():
Twin Research and Human Genetics
Asthma and mode of birth delivery: A study in 5-year-old Dutch twins
Twin Research and Human Genetics, 11(2):
Journal of Allergy and Clinical ImmunologyBirth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopyJournal of Allergy and Clinical Immunology
International Dairy JournalSpecific metabolite production by gut microbiota as a basis for probiotic functionInternational Dairy Journal
Drugs Under Experimental and Clinical Research
Bifidobacteria and lactobacilli in human health
Drugs Under Experimental and Clinical Research, 26(3):
British Journal of NutritionIntestinal microflora of human infants and current trends for its nutritional modulationBritish Journal of Nutrition
Bjog-An International Journal of Obstetrics and GynaecologyII. The unfacts of 'request' caesarean section - CommentaryBjog-An International Journal of Obstetrics and Gynaecology
Fems Microbiology EcologyVertical and horizontal transmission of intestinal commensal bacteria in the rat modelFems Microbiology Ecology
Indian Journal of Medical MicrobiologyProbioticsIndian Journal of Medical Microbiology
Journal of Allergy and Clinical ImmunologyIs delivery by cesarean section a risk factor for food allergy?Journal of Allergy and Clinical Immunology
Intestinal microflora in early infancy: composition and development
Acta Paediatrica, 92():
Agro Food Industry Hi-Tech
Usefulness of infant formulae supplemented with probiotics or prebiotics?
Agro Food Industry Hi-Tech, 17(2):
Embo ReportsThe gut flora as a forgotten organEmbo Reports
Digestive Diseases and SciencesColonization and impact of disease and other factors on intestinal microbiotaDigestive Diseases and Sciences
Journal of AsthmaBirth-related exposures and asthma and allergy in adulthood: A population-based cross-sectional study of young adults in North StaffordshireJournal of Asthma
Inflammatory Bowel DiseasesAssociation Between Early-life Factors and Risk of Child-onset Crohn's Disease Among Victorian Children Born 1983-1998: A Birth Cohort StudyInflammatory Bowel Diseases
American Journal of EpidemiologyMaternal and Perinatal Characteristics and the Risk of Cow's Milk Allergy in Infants up to 2 Years of Age: A Case-Control Study Nested in the Finnish PopulationAmerican Journal of Epidemiology
Immunologic tolerance and dietary antigens - A review of: Newberry RD, Stenson WF, Lorenz RG 1999 cyclooxygenase-2-dependent arachidonic acid metabolites are essential modulators of the immune response to dietary antigen. Nature Med 5 : 900-906
Pediatric Research, 47(4):
American Journal of Physiology-Regulatory Integrative and Comparative PhysiologyElective cesarean delivery affects gut maturation and delays microbial colonization but does not increase necrotizing enterocolitis in preterm pigsAmerican Journal of Physiology-Regulatory Integrative and Comparative Physiology
Influence of Maternal Bifidobacteria on the Establishment of Bifidobacteria Colonizing the Gut in Infants
Pediatric Research, 65(6):
Clinical NutritionDevelopment of intestinal bifidobacteria and lactobacilli in breast-fed neonatesClinical Nutrition
International Dairy JournalGut microbiota: Changes throughout the lifespan from infancy to elderlyInternational Dairy Journal
American Journal of PrimatologyFecal Bacterial Diversity of Human-Habituated Wild Chimpanzees (Pan troglodytes schweinfurthii) at Mahale Mountains National Park, Western TanzaniaAmerican Journal of Primatology
To the editor: Comment on Mallol et al
Pediatric Pulmonology, 32(3):
Revue Francaise D Allergologie Et D Immunologie Clinique
Medicines for asthma, rhinitis and allergies - Precautions for pregnancy and breastfeeding
Revue Francaise D Allergologie Et D Immunologie Clinique, 43():
Medical Science Monitor
Model of the epidemic of childhood atopy
Medical Science Monitor, 10(2):
Journal of Infectious DiseasesCesarean Delivery and Risk of Intestinal Bacterial InfectionJournal of Infectious Diseases
Perinatology 2001, Vols 1 and 2
Pro- and pre-biotics administration in preterm infants: Colonization and influence on the fecal flora
Perinatology 2001, Vols 1 and 2, ():
Gut flora in health and disease
Pediatric Allergy and Immunology
Mode of delivery and development of atopic disease during the first 2 years of life
Pediatric Allergy and Immunology, 15(1):
European Journal of Clinical Microbiology & Infectious DiseasesEffects of mode of delivery and necrotising enterocolitis on the intestinal microflora in preterm infantsEuropean Journal of Clinical Microbiology & Infectious Diseases
Journal of Biological ChemistryFunctional genomic and metabolic studies of the adaptations of a prominent adult human gut symbiont, Bacteroides thetaiotaomicron, to the suckling periodJournal of Biological Chemistry
Dynamics of gut colonization and source of intestinal flora in healthy newborn infants
Acta PaediatricaComparative analysis of neonatal morbidity for vaginal and caesarean section deliveries using hospital chargeActa Paediatrica
Clinical NutritionThe effect of glutamine-enriched enteral nutrition on intestinal microflora in very low birth weight infants: A randomized controlled trialClinical Nutrition
Pediatric Clinics of North AmericaProbiotics in childrenPediatric Clinics of North America
Journal of Allergy and Clinical ImmunologyProbiotics prevent IgE-associated allergy until age 5 years in cesarean-delivered children but not in the total cohortJournal of Allergy and Clinical Immunology
Arquivos Brasileiros De Endocrinologia E Metabologia
Translational research into gut microbiota: new horizons in obesity treatment
Arquivos Brasileiros De Endocrinologia E Metabologia, 53(2):
Inflammatory Bowel DiseasesPreterm birth but not mode of delivery is associated with an increased risk of developing inflammatory bowel disease later in lifeInflammatory Bowel Diseases
World Journal of Gastroenterology
Breath test for differential diagnosis between small intestinal bacterial overgrowth and irritable bowel disease: An observation on non-absorbable antibiotics
World Journal of Gastroenterology, 13():
Journal of Nutrition
Postnatal development of intestinal microflora as influenced by infant nutrition
Journal of Nutrition, 138(9):
Journal of Tropical PediatricsProphylactic Probiotics for Prevention of Necrotizing Enterocolitis in Very Low Birth Weight NewbornsJournal of Tropical Pediatrics
Clinical and Experimental Allergy
Caesarean section increases the risk of hospital care in childhood for asthma and gastroenteritis
Clinical and Experimental Allergy, 33(6):
Best Practice & Research in Clinical GastroenterologyProbioticsBest Practice & Research in Clinical Gastroenterology
Journal of Complementary Medicine
The hygiene hypothesis and probiotics in children
Journal of Complementary Medicine, 6(4):
Pediatric Allergy and ImmunologyIs caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: A systematic reviewPediatric Allergy and Immunology
Isme Journal16S rRNA gene-based analysis of fecal microbiota from preterm infants with and without necrotizing enterocolitisIsme Journal
PediatricsCesarean Delivery Is Associated With Celiac Disease but Not Inflammatory Bowel Disease in ChildrenPediatrics
Archives of Disease in Childhood
Importance of intestinal colonisation in the maturation of humoral immunity in early infancy: a prospective follow up study of healthy infants aged 0-6 months
Archives of Disease in Childhood, 83(3):
Effects of bifidobacterium breve supplementation on intestinal flora of low birth weight infants
Pediatrics International, 46(5):
Journal of Clinical Gastroenterology
Bacterial colonization, probiotics, and necrotizing enterocolitis
Journal of Clinical Gastroenterology, 42(6):
Pediatric Allergy and Immunology
An anthroposophic lifestyle and intestinal microflora in infancy
Pediatric Allergy and Immunology, 13(6):
Proceedings of the Nutrition SocietyDietary fibre in infancy and childhoodProceedings of the Nutrition Society
Journal of Allergy and Clinical ImmunologyMode of delivery at birth and development of asthma: A population-based cohort studyJournal of Allergy and Clinical Immunology
Clinical and Experimental AllergyMaternal breast-milk and intestinal bifidobacteria guide the compositional development of the Bifidobacterium microbiota in infants at risk of allergic diseaseClinical and Experimental Allergy
Journal of Allergy and Clinical ImmunologyAsthma and obesity: Common early-life influences in the inception of diseaseJournal of Allergy and Clinical Immunology
Fems Microbiology EcologyDevelopment of the intestinal microbiota in rats and its possible interactions with the evolution of the luminal IgA in the intestineFems Microbiology Ecology
CellEcological and evolutionary forces shaping microbial diversity in the human intestineCell
Clinical NutritionThe intestinal bacterial colonisation in preterm infants: A review of the literatureClinical Nutrition
Mutation Research-Fundamental and Molecular Mechanisms of MutagenesisImportance of microbial colonization of the gut in early life to the development of immunityMutation Research-Fundamental and Molecular Mechanisms of Mutagenesis
Clinical and Experimental AllergyBirth by caesarean section and asthmaClinical and Experimental Allergy
American Journal of EpidemiologyPerinatal factors and the risk of asthma in childhood - A population-based register study in FinlandAmerican Journal of Epidemiology
AllergyBirth-related increase in intracolonic hydrogen gas and nitric oxide as indicator of host-microbial interactionsAllergy
Archives De PediatrieEarly bacterial colonisation of the intestine: why it matters?Archives De Pediatrie
Current Opinion in BiotechnologyProgramming infant gut microbiota: influence of dietary and environmental factorsCurrent Opinion in Biotechnology
Journal of Allergy and Clinical Immunology
Caesarean section and risk of asthma and allergy in adulthood
Journal of Allergy and Clinical Immunology, 107(4):
Probiotics: a role in the treatment of intestinal infection and inflammation?
Journal of Allergy and Clinical ImmunologyMode of delivery and risk of developing allergic diseaseJournal of Allergy and Clinical Immunology
Explore-the Journal of Science and Healing
Probiotics in Pediatric Care
Explore-the Journal of Science and Healing, 5(4):
Inflammatory Bowel DiseasesRelationships Between Inflammatory Bowel Disease and Perinatal Factors: Both Maternal and Paternal Disease Are Related to Preterm Birth of OffspringInflammatory Bowel Diseases
Infection and Immunity
Influence of major histocompatibility complex on bacterial composition of fecal flora
Infection and Immunity, 69(4):
Hypothesis: inappropriate colonization of the premature intestine can cause neonatal necrotizing enterocolitis
Faseb Journal, 15(8):
Journal of Allergy and Clinical ImmunologyMode of delivery and risk of allergic rhinitis and asthmaJournal of Allergy and Clinical Immunology
Pediatric ResearchNo association between preeclampsia or cesarean section and incidence of type 1 diabetes among children: A large, population-based cohort studyPediatric Research
Clinical and Experimental AllergyMode of delivery is not associated with asthma or atopy in childhoodClinical and Experimental Allergy
Journal of Allergy and Clinical ImmunologyGut microbiota and development of atopic eczema in 3 European birth cohortsJournal of Allergy and Clinical Immunology
Clinical and Experimental AllergyCaesarean delivery and risk of atopy and allergic disesase: meta-analysesClinical and Experimental Allergy
AnaerobeFecal microflora of Greek healthy neonatesAnaerobe
Personalized Nutrition for the Diverse Needs of Infants and Children
Factors Influencing the Establishment of the Intestinal Microbiota in Infancy
Personalized Nutrition for the Diverse Needs of Infants and Children, 62():
GastroenterologyPatterns and Scales in Gastrointestinal Microbial EcologyGastroenterology
European Journal of PediatricsCesarean section and the risk of overweight in grade 6 childrenEuropean Journal of Pediatrics
Journal of Maternal-Fetal & Neonatal MedicineFactors influencing the development of a personal tailored microbiota in the neonate, with particular emphasis on antibiotic therapyJournal of Maternal-Fetal & Neonatal Medicine
Early Human DevelopmentThe long-term effects of birth by caesarean section: The case for a randomised controlled trialEarly Human Development
Seminars in Pediatric SurgeryNecrotizing enterocolitis: Pathophysiology, platelet-activating factor, and probioticsSeminars in Pediatric Surgery
Indian Journal of PediatricsMolecular Characterization of Bacterial Colonization in the Preterm and Term Infant's IntestineIndian Journal of Pediatrics
NeonatologyAntibiotic Use in Newborns with Transient Tachypnea of the NewbornNeonatology
Canadian Journal of Gastroenterology
Environment and the inflammatory bowel diseases
Canadian Journal of Gastroenterology, 27(3):
Journal of BiosciencesComparative analysis of fecal microflora of healthy full-term Indian infants born with different methods of delivery (vaginal vs cesarean): Acinetobacter sp prevalence in vaginally born infantsJournal of Biosciences
Plos OneTrends in the Distribution of Gestational Age and Contribution of Planned Births in New South Wales, AustraliaPlos One
Journal of Allergy and Clinical ImmunologyEstablishment of the intestinal microbiota and its role for atopic dermatitis in early childhoodJournal of Allergy and Clinical Immunology
Seminars in Fetal & Neonatal MedicineIntroducing enteral feeds in the high-risk preterm infantSeminars in Fetal & Neonatal Medicine
Iranian Journal of Allergy Asthma and Immunology
Raised Interleukin-13 Levels in Cord Blood Increases the Risk of Allergic Sensitization at 5 Years of Age
Iranian Journal of Allergy Asthma and Immunology, 12(2):
American Journal of Clinical NutritionIntestinal microbiology in early life: specific prebiotics can have similar functionalities as human-milk oligosaccharidesAmerican Journal of Clinical Nutrition
American Journal of Clinical NutritionRelevance of pre- and postnatal nutrition to development and interplay between the microbiota and metabolic and immune systemsAmerican Journal of Clinical Nutrition
Acta PaediatricaMaternal intrapartum antibiotics and decreased vertical transmission of Lactobacillus to neonates during birthActa Paediatrica
International Journal of ObesityThe impact of cesarean section on offspring overweight and obesity: a systematic review and meta-analysisInternational Journal of Obesity
Asian Pacific Journal of Allergy and Immunology
Caesarean section and asthma in Malaysian children: a case-control study
Asian Pacific Journal of Allergy and Immunology, 30(3):
Journal of Antimicrobial ChemotherapyLong-term faecal carriage in infants and intra-household transmission of CTX-M-15-producing Klebsiella pneumoniae following a nosocomial outbreakJournal of Antimicrobial Chemotherapy
Current Allergy and Asthma ReportsThe Relationship Between Advances in Understanding the Microbiome and the Maturing Hygiene HypothesisCurrent Allergy and Asthma Reports
American Journal of PerinatologyMaternal Antenatal Treatments Influence Initial Oral Microbial Acquisition in Preterm InfantsAmerican Journal of Perinatology
Nutrition JournalCesarean section and increased body mass index in school children: two cohort studies from distinct socioeconomic background areas in BrazilNutrition Journal
Acta PaediatricaIntestinal microbial profiles in extremely preterm infants with and without necrotizing enterocolitisActa Paediatrica
Current Opinion in GastroenterologyThe immunologic basis for intestinal food allergyCurrent Opinion in Gastroenterology
Journal of Pediatric Gastroenterology and NutritionEffect of Maternal Consumption of Lactobacillus GG on Transfer and Establishment of Fecal Bifidobacterial Microbiota in NeonatesJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionClinical Evidence for Immunomodulatory Effects of Probiotic BacteriaJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionAdministration of Oral Probiotic Bacteria to Pregnant Women Causes Temporary Infantile ColonizationJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionThe Hygiene Hypothesis of Atopic Disease—An Extended VersionJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionFecal Calprotectin in Very Low Birth Weight InfantsJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionChanges of Gut Microbiota and Immune Markers During the Complementary Feeding Period in Healthy Breast-fed InfantsJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionImpact of Diet on the Intestinal Microbiota in 10-month-old InfantsJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionMolecular Characterization of Intestinal Microbiota in Infants Fed With SoymilkJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionProbiotic Intervention in the First Months of Life: Short-Term Effects on Gastrointestinal Symptoms and Long-Term Effects on Gut MicrobiotaJournal of Pediatric Gastroenterology and Nutrition
Journal of Pediatric Gastroenterology and NutritionFecal Microbial Community in Preterm InfantsJournal of Pediatric Gastroenterology and Nutrition
Bacteroides; Cesarean delivery; Colic; Colonization; Gut; Intestine
© 1999 Lippincott Williams & Wilkins, Inc.
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