Establishment and development of intestinal microbiota in preterm neonates

Microbial colonization of the infant gut is essential for the development of the intestine and the immune system. The profile of intestinal microbiota in the full-term, vaginally delivered, breast-fed infant is considered as ideally healthy. However, in preterm infants this process is challenging, mainly because of organ immaturity, antibiotics use, and hospital stay. To assist in a proper microbiota development in these infants, a detailed knowledge of the colonization process, and the differences from that of full-term breast-fed infants, is needed. We assessed the establishment of the gut microbiota and its metabolic activity in preterm neonates (n?=?21) during the first 3?months of life and compared it with that of vaginally delivered, exclusively breast-fed full-term infants (n?=?20) using qualitative and quantitative culture-independent methods. Differences in the gut microbiota composition between both groups were observed. Preterm infants showed higher levels of facultative anaerobic microorganisms and reduced levels of strict anaerobes such as Bifidobacterium, Bacteroides, and Atopobium. Short-chain fatty acids concentrations were lower in preterm infants during the first days of life. Alterations occur in the process of microbiota establishment in preterm infants, indicating the need for intervention strategies to counteract them.     

Analysis of the role of adrenergic receptors in the regulation of small intestine motor activity in sheep

In sheep with chronic fistulae of the small intestine and rumen the participation of alpha- and beta-adrenergic receptors in the regulation of the motor activity of the small intestine was studied by the method of pharmacological analysis. The movements of the fistulated parts of the alimentary tract were recorded by the balloon method. Slow intravenous infusion of isoprenaline inhibited the contractions of the small intestine. This inhibitory effect of isoprenaline was abolished by propranolol. Intravenous phenylephrine inhibited the motor activity of this intestinal part as well. The effect of phenylephrine was abolished by pretreatment with dihydroergotamine. In the small intestine of sheep stimulation of the alpha and beta adrenergic receptors decrease the motor activity of intestine.     

Transcriptional Modulation of Intestinal Innate Defense/Inflammation Genes by Preterm Infant Microbiota in a Humanized Gnotobiotic Mouse Model

Background and Aims

It is known that postnatal functional maturation of the small intestine is facilitated by microbial colonization of the gut. Preterm infants exhibit defects in gut maturation, weak innate immunity against intestinal infection and increased susceptibility to inflammatory disorders, all of which may be related to the inappropriate microbial colonization of their immature intestines. The earliest microbes to colonize the preterm infant gut encounter a naïve, immature intestine. Thus this earliest microbiota potentially has the greatest opportunity to fundamentally influence intestinal development and immune function. The aim of this study was to characterize the effect of early microbial colonization on global gene expression in the distal small intestine during postnatal gut development.

Methods

Gnotobiotic mouse models with experimental colonization by early (prior to two weeks of life) intestinal microbiota from preterm human infants were utilized. Microarray analysis was used to assess global gene expression in the intestinal epithelium.

Results and Conclusion

Multiple intestinal genes involved in metabolism, cell cycle regulation, cell-cell or cell-extracellular matrix communication, and immune function are developmental- and intestinal microbiota- regulated. Using a humanized gnotobiotic mouse model, we demonstrate that certain early preterm infant microbiota from prior to 2 weeks of life specifically induce increased NF-κB activation and a phenotype of increased inflammation whereas other preterm microbiota specifically induce decreased NF-κB activation. These fundamental differences correlate with altered clinical outcomes and suggest the existence of optimal early microbial communities to improve health outcomes.     

Participation of the beta-adrenergic receptor in the enteroruminal reflex and enteroenteric reflex

In sheep with chronic fistulae of the small intestine and rumen the participation of the beta-adrenergic receptor was investigated in the enteroruminal reflex and enteroenteric reflex using the method of pharmacological analysis. The movements of the segments of the digestive tract with fistulae were recorded by the balloon method. A solution of hydrochloric acid administered into the ileum caused a reflex stimulation of its motor activity and inhibited the movements of the rumen. Intravenous administration of propranolol before instillation of the acid into the intestine abolished or reduced greatly the reflex inhibition of the movements of the rumen and in the small intestine it enhanced significantly the studied reflex reaction. Thus stimulation of the beta-adrenergic receptor plays an important role in the reflex stimulation of the motor activity of the rumen, and stimulation of the motor activity of the small intestine in the enteroenteric reflex is limited by the effects derived from this receptor.     

猪小肠移植术供肠的灌洗和保存

目的探讨围手术期移植小肠灌注和保存的方法。方法切取猪供肠后,采用100 cm左右高度、略加压法,经移植肠血管以15 mL/min左右灌洗速度持续灌注4℃ 3%羟乙基淀粉注射液、4℃生理盐水保存移植肠。移植前对保存的移植小肠进行组织学检查。结果供肠总灌注时间为50.5±10.6 min;冷缺血时间为80.24±24.62min。组织学检查显示移植肠组织学没有明显改变。移植肠存活良好。结论采取上述方法在短时间内可以提供质量良好的供肠。     

Parameters of Surface Electromyograms in Full-Term and Preterm Infants in the Neonatal Period: The Possible Contribution of Gravity

The purpose of this study was to compare the postnatal evolution of spectral–amplitude and nonlinear parameters of surface electromyogram (sEMG) in the full-term and preterm infants with regard to their biological and calendar age. In full-term infants, all sEMG parameters (dimension, entropy, mean frequency, and amplitude) are increased by 10–30% two weeks after birth. On the contrary, sEMG parameters in preterm infants were constant for six weeks after birth. This finding indicates that both postnatal and antenatal periods are important for the development of the motor system of infants. Therefore, the adaptation of the motor system to extrauterine conditions consists of two stages. The authors suppose that gravity can be a driving factor of these sEMG metamorphoses.     

Neonatal small bowel epithelia: enhancing anti-bacterial defense with lactoferrin and Lactobacillus GG

BACKGROUND AND AIMS: Extremely preterm human infants have increased susceptibility to small bowel infection. We hypothesized that early colonization of the immature small intestine with Lactobacillus GG (LGG), and use of a recombinant lactoferrin (rhLF) to promote growth of LGG, would enhance gut defenses against enteroinvasive Escherichia coli. METHODS: Newborn rat pups were treated with nothing, intra-gastric LGG, or rhLF + LGG on days 3 and 4 of life. Gut colonization by LGG was quantified in lavaged jejunal and ileal fluid and gut wall homogenates on day 5 of life. Separate studies used similarly treated litters of newborn rats that were infected late on day 4 of life with E. coli [10(12) CFU/kg]. Sixteen hours later, the numbers of E. coli were measured in small bowel fluid and gut wall homogenates. RESULTS: Control pups initially had lactic acid bacteria colonize the bowel, but these bacteria were not LGG. Pups treated with LGG or rhLF + LGG had significantly higher numbers of LGG in the ileum versus jejunum. Contrary to our hypothesis, rhLF did not augment LGG colonization. After E. coli-related gut infection, planktonic [lavage fluid] and epithelia-adherent growth [gut wall homogenates] of E. coli in the small bowel were most effectively reduced by pre-treatment with rhLF and LGG (P < .05). CONCLUSION: Prophylactic therapy with recombinant human lactoferrin and the probiotic, Lactobacillus GG, act to enhance defenses against invasive E. coli in the nascent small intestine. We suggest that rhLF and LGG are therapeutic agents that may reduce necrotizing enterocolitis and gut-related sepsis in preterm human infants.     

Nonspecific killer cells in premature and mature neonates and infants

K (killer) and natural killer (NK) cells were investigated in peripheral blood of 76 children, preterm small for date babies (n = 8), preterm babies (n = 15), fullterm small for date babies (n = 6) fullterm babies (n = 7) and infants up to 12 months age (n = 40). The K and NK cell activity of human leukocytes was analysed as compared with those cells of the K 562 cell line and murine cells covered by xenologous antibodies in Graffi erythroblast leukemia by means of the 51Cr release test. K cell activities were significantly lower in preterm small for date babies to infants with 1-12 months of age. In our results it is shown that NK capacity of preterm or term newborns and infants up to 6 months age does not differ significantly from each other. Children who are 6-12 months old will have significantly higher NK cell activities. It can be concluded that K cell activities are fully developed during pregnancy and NK cell activities later when the children are between 6 and 12 months of age.     

Comparison in Outcomes at Two-Years of Age of Very Preterm Infants Born in 2000, 2005 and 2010

ObjectiveTo investigate alteration in 2-year neurological/behavioral outcomes of very preterm infants born in a French level three neonatal intensive care unit.MethodsWe conducted a prospective, comparative study of very preterm infants born before 33 weeks’ gestation at 5-year intervals in 2000, 2005 and 2010 at Rouen University Hospital. Neonatal mortality/morbidities, ante- and neonatal treatments, and at age 2 years motor, cognitive and behavioral data were collected by standardized questionnaires.ResultsWe included 536 very preterm infants. Follow-up rates at two years old were 78% in 2000, 93% in 2005 and 92% in 2010 respectively. No difference in gestational age, birthweight, neonatal mortality/morbidities was observed except a decrease in low grade subependymal/intraventricular hemorrhages. Care modifications concerned use of antenatal magnesium sulfate, breast-feeding and post-natal corticosteroid therapy. Significant improvement in motor outcome and dramatic decrease in cerebral palsy rates (12% in 2000, 6% in 2005, 1% in 2010, p<0.001) were observed, as were improvements in feeding behavior. Although a non significant difference to better psychosocial behavior was reported, there was no difference in cognitive outcome.ConclusionsImprovement in neuromotor outcome and behavior was reported. This could be due to multiple modifications in care: including administration of magnesium sulfate to women at risk of preterm birth, increase in breast-feeding, decrease in low grade subependymal/intraventricular hemorrhages, and decrease in post-natal corticosteroid therapy, all of which require further investigation in other studies. Extended follow-up until school age is mandatory for better detection of cognitive, learning and behavioral disorders.     

Influence of postconceptual age on the electromyographic characteristics in newborns

The purpose of the study was to investigate the neuromuscular state in the preterm infants using surface electromyography (EMG). Ten preterm (gestational age, 31–32 weeks) and ten term infants (gestational age, 38–39 weeks) participated in the study in the second, fourth and sixth postnatal weeks. Linear and novel nonlinear parameters were used for the treatment of the interference EMG (iEMG) in four muscles (mm. bic. br. dext., trie. br. dext, tib. ant. sin., and gastr. sin.). In the preterm infants aged 33–37 weeks, both linear and nonlinear iEMG parameters were significantly lower in comparison to the term infants. Thus, the iEMG of the preterm infants was characterized by a more primitive time-domain structure and lower amplitude and spectrum frequency. In addition, unlike in term newborns, the lifetime dynamics of the iEMG parameters in the preterm infants was retarded. Thus, the motor system of a preterm infant is likely to be less prepared for postnatal life due to the shorter stay in utero. Nonetheless, the iEMG of the preterm infants may be characterized as more complex in comparison to the term newborns of the same postconceptual age. This may be attributed to the new postnatal sensory stimuli.     

Interrelationship of the cardiovascular and digestive systems in the genesis of experimental atherosclerosis]

In chronic experiments (up to 2 years) on dogs on atherogenic diets the motor activity of the gastrointestinal tract, cholesterol, the phospholipid level in the blood and in the intestinal secretion as well as the morphology of the small intestine and the vascular system were examined. At the early stages of atherosclerosis (up to 4 months) the rise of the blood cholesterol level was followed by an increase in the periods of the activity of the gastrointestinal tract, a rise of cholesterol discharge by the small intestine, and the development of the hypertrophic process in the mucous membrane. At the later stages a change in the mucous membrane of the small intestine was observed with development of a dystrophic-atrophic process, a disturbance of motor activity of the gastrointestinal tract and of the correlations between the cholesterol content in the blood and its discharge by the small intestine. This period was characterized by a high and persistent hypercholesterolemia and pronounced atherosclerotic changes in the vascular system.     

Gastroschisis, low maternal age, and fetal morbidity outcomes

OBJECTIVE: To determine if the risk for fetal growth inhibition among gastroschisis-afflicted fetuses is heightened among younger gravidas (teen mothers). METHOD: This was a retrospective cohort study on live-born infants with isolated gastroschisis delivered in New York State from 1983 through 1999. We compared infants of mature (>20 years) mothers with those of younger (<20 years) mothers with respect to the following indices of fetal morbidity outcomes: low birth weight and very low birth weight, preterm and very pre-term, and small for gestational age. We used adjusted odds ratios to approximate relative risks. RESULTS: A total of 368 infants with isolated gastroschisis were analyzed. The two groups differed in terms of mean gestational age at delivery [Mean + standard deviation(SD) for infants with gastroschisis born to mature mothers = 37.2 weeks +/- 2.8 versus 36.3 weeks + 3.6 for those of teenage mothers(p = 0.01)], as well as mean birth weight [mean birth weight +/- SD for infants with gastroschisis born to mature mothers = 2562.4 grams +548.8 versus 2367.9 grams +/- 645.2 for those of younger mothers (p = 0.004)]. Infants of teen mothers were about twice as likely to be of low birth weight (OR = 1.70; 95% CI = 1.05-2.77) and about three times as likely to be born very preterm when compared to those of mature mothers (OR = 2.80; 95% Cl = 1.02-8.00). No significant differences were observed with respect to very low birth weight, pre-term and small for gestational age. CONCLUSION: Low maternal age appears to be a risk factor for low birth weight and very preterm birth among gastroschisis-affected fetuses. This information is potentially useful for planning by care providers and in counseling affected parents.     

Plasma and erythrocyte selenium and glutathione peroxidase activity in preterm infants at risk for bronchopulmonary dysplasia

The purpose of this study was to examine the relationships between selenium status, as measured by plasma and erythrocyte selenium and glutathione peroxidase (GPx) activity, and other postnatal factors, including selenium intake, gestational age, and oxygen dependence in preterm infants at risk for bronchopulmonary dysplsia. Eighteen preterm infants of 30 wk gestational age or less were included. At postnatal wk 1 and 4, selenium concentrations and GPx activity were measured and oxygen dependence and daily selenium intakes were determined from the medical chart. Plasma and erythrocyte selenium concentrations decreased from wk 1 to wk 4, whereas erythrocyte GPx activity increased. Increased selenium intakes during wk 1 were associated with increased erythrocyte GPx activity at both time-points, as well as a decreased need for supplemental oxygen on d 28. Preterm infants display increasing erythrocyte GPx activity despite declines in plasma and erythrocyte selenium. GPx activity might be enhanced by very early selenium supplementation.     

Neonatal White Matter Abnormalities an Important Predictor of Neurocognitive Outcome for Very Preterm Children

Background

Cerebral white matter abnormalities on term MRI are a strong predictor of motor disability in children born very preterm. However, their contribution to cognitive impairment is less certain.

Objective

Examine relationships between the presence and severity of cerebral white matter abnormalities on neonatal MRI and a range of neurocognitive outcomes assessed at ages 4 and 6 years.

Design/Methods

The study sample consisted of a regionally representative cohort of 104 very preterm (≤32 weeks gestation) infants born from 1998–2000 and a comparison group of 107 full-term infants. At term equivalent, all preterm infants underwent a structural MRI scan that was analyzed qualitatively for the presence and severity of cerebral white matter abnormalities, including cysts, signal abnormalities, loss of white matter volume, ventriculomegaly, and corpus callosal thinning/myelination. At corrected ages 4 and 6 years, all children underwent a comprehensive neurodevelopmental assessment that included measures of general intellectual ability, language development, and executive functioning.

Results

At 4 and 6 years, very preterm children without cerebral white matter abnormalities showed no apparent neurocognitive impairments relative to their full-term peers on any of the domain specific measures of intelligence, language, and executive functioning. In contrast, children born very preterm with mild and moderate-to-severe white matter abnormalities were characterized by performance impairments across all measures and time points, with more severe cerebral abnormalities being associated with increased risks of cognitive impairment. These associations persisted after adjustment for gender, neonatal medical risk factors, and family social risk.

Conclusions

Findings highlight the importance of cerebral white matter connectivity for later intact cognitive functioning amongst children born very preterm. Preterm born children without cerebral white matter abnormalities on their term MRI appear to be spared many of the cognitive impairments commonly associated with preterm birth. Further follow-up will be important to assess whether this finding persists into the school years.     

The effect of alcohol on zinc absorption

Two methods of intestinal perfusion are described and used to study the effecs of alcohol on zinc absorption in the rat small intestine. The first method used perfusion of the lumen of the rat small intestinein situ without interruption of the vascular supply. During perfusion with a zinc-containing medium (with and without alcohol), alcohol was found to have no effect on net zinc uptake from the lumen of the intestine. However, there were significantly higher serum zinc concentrations recorded in the rats perfused wih the zinc and alcohol, 28.8 μmol/L, when compared with a group perfused without alcohol, 19.1 μmol/L (P < 0.01). The second method used simultaneous perfusion of the lumen of the rat small intestine, with constant-rate perfusion of the vascular bed with an artificial blood supply. In this experiment with a zinc-containing medium, with and without alcohol, there was no difference noted in zinc absorption from the lumen of the intestine, or release into the artificial blood supply. Therefore, in conclusion, alcohol does not appear to directly influence zinc absorption by the mucosal cells of the small intestine.     

Sensory neurons of metasympathetic (intramural) ganglia in the guinea pig small intestine

The hypothesis that multiaxonal neurons of the myenteric plexus of the small intestine are sensory neurons, was tested. The rising principle of the issue to sensory information in the metasympathetic ganglions of the small intestine was discovered by microapplication of the salt acid solution. Serotonin (5-hydroxytriptamine) and acetylcholine can participate in forming primary sensory signals in the multiaxonal neurons. Pulsed activity in primary sensory neurons by mucous perfusion of the small intestine by physiological solution with pH 3.5-3.8 was revealed. The enterochromaffin cells of the mucosa and multiaxonal neurons of the submucous and myenteric plexuses take part in reception of the salt acid.     

Ultrastructural changes in interneuron connections in intramural ganglia of the small intestine in suckling rabbits with experimental cholera]

Data, received in investigation of the small intestine intramural ganglia of 34 suckling rabbits show, that development of experimental cholera induce in the neurons reactive shifts, changed by dystrophic alterations. Prevaluation of cholinergic influences in autonomic ganglia in small intestine promotes enterocytes hypersecretion and accelerating of motor activity.     

Changes in serotonin levels and 5-HT receptor activity in duodenum of streptozotocin-diabetic rats

Few previous studies have discussed the changes in serotonin receptor activity in the small intestine of diabetic animals. Therefore, we examined serotonin content in duodenal tissue and dose-dependent effects of serotonin agonists and antagonists on the motor activity of ex vivo vascularly perfused duodenum of streptozotocin (STZ)-diabetic rats. Serotonin content was significantly increased in enterochromaffin cells but not altered in serotonin-containing neurons in STZ-diabetic rats. Motor activity assessed by frequency, amplitude, and percent motility index per 10 min of pressure waves was reduced in the duodenum of diabetic rats, and this reduction was reversed by insulin treatment. Serotonin dose dependently increased the motor activity in control rat duodenum but only a higher concentration of serotonin increased the motor activity in diabetic rats. The 5-hydroxytryptamine (5-HT) receptor subtype 4 (5-HT(4)) antagonist SB-204070 dose dependently reduced motor activity in both control and diabetic rats, whereas the 5-HT(3) receptor antagonist azasetron, even at a higher concentration, failed to affect motor activity in diabetic rat duodenum but dose dependently reduced motor activity in control rat duodenum. These results suggest that 5-HT(3) receptor activity was impaired but 5-HT(4) receptor activity was intact in STZ-diabetic rat duodenum. Such an impairment of 5-HT(3) receptor activity may induce the motility disturbance in the small intestine of diabetes mellitus.     

Glucose metabolism in the mucosa of the small intestine. Changes of hexokinase activity during perfusion of the proximal half of rat small intestine

1. The effect of perfusion on the activities of hexokinase and lactate dehydrogenase was studied in the proximal half of the small intestine of fed and starved rats. 2. Perfusion of preparations from starved rats with a medium containing glucose caused a significant increase in hexokinase activity of the particle-free supernatant. The increase in activity was observed as early as 5min after the start of perfusion and persisted for up to 66min of perfusion. No increase in hexokinase activity of the particle-free supernatant was observed when a medium containing mannitol was used. As a further control, preparations from fed rats were perfused under the same conditions. With the medium containing glucose, the hexokinase activity of the particle-free supernatant remained unchanged during the first 15min of perfusion and thereafter fell gradually until, after 66min of perfusion, 73% of the original activity was retained. 3. The activity of lactate dehydrogenase in the particle-free supernatant prepared from the proximal half of the untreated small intestine of starved rats was significantly lower than in corresponding preparations from fed animals. However, it did not change significantly on perfusion with media containing either mannitol or glucose. 4. The distribution of hexokinase activity between total particulate fraction and particle-free supernatant was measured in preparations from starved rats after perfusion for 5–10min. In preparations that had not been perfused the ratio of hexokinase activity in total particulate fraction/particle-free supernatant was significantly higher in starved than in fed animals. After perfusion with a medium containing glucose, the total homogenate activity had not changed significantly, whereas the ratio of hexokinase activity in total particulate fraction/particle-free supernatant decreased significantly and approached the value obtained with fed animals. 5. The results agree with the view that the glucose-dependent increase of hexokinase activity in the soluble cell compartment as observed in vivo and in vitro in the intestinal mucosa of starved rats is brought about by a release of hexokinase activity from a particulate subcellular structure(s).