The 34:3 issue of The Journal of Perinatal & Neonatal Nursing explores the perinatal microbiome. The perinatal microbiome encompasses the maternal and newborn microbiomes prenatally and postnatally. As a newer science, knowledge about the human microbiome may not have been fully integrated into clinical practice. In this issue, authors provide scientific content of the maternal and infant oral microbiomes, the newborn gastrointestinal microbiome, and the perinatal microbiome including laboratory testing within the context of probiotics intervention research. Microbiome content is applicable for both the healthcare provider and for the researcher.
Dr Irene Yang and colleagues describe an exploratory study, titled "Exploring the Maternal and Infant Oral Microbiomes: A Pilot Study." The results from this study contribute to foundational knowledge about the function and diversity of the oral microbiota. This work can be used to identify early practices that may be used to impact oral health of mothers and infants. A Continuing Education unit is featured for this article.
In this policy paper, "Is the Newborn Microbiome Disrupted by Routine Newborn Suctioning? An Exploratory Approach for Policy Development," Drs Pamela O'Neal and Ellise Adams consider how the practice of routine newborn suctioning may be removing healthy bacteria and therefore disrupting the newborn gastrointestinal microbiome. Suggestions are provided for development of newborn suctioning policies to protect the newborn gastrointestinal microbiome.
"Breastfeeding seeds and feeds the newborn gastrointestinal microbiome" is the basic premise of the clinical paper, "Promoting and Protecting the Gastrointestinal Newborn Microbiome Through Breastfeeding Practices" by Jessica Johnson and Drs Ellise Adams and Pamela O'Neal. Through a review of breast milk composition, the newborn gastrointestinal microbiome, and practices that breastfeeding, the authors offer strategies to promote the healthy development of the newborn gastrointestinal microbiome.
The article by Malloy et al, titled, "Laboratory Analysis Techniques for the Perinatal Microbiome: Implications for Studies of Probiotic Interventions," takes a complex topic and makes it understandable for perinatal nurses and midwives. The authors are working collaboratively on a National Institute of Health funded study of probiotics to reduce antenatal group B Streptococcus infection.
The perinatal commentaries take 2 different approaches. Hanson and colleagues challenge the reader to explore the roles of perinatal nurses and midwives in fostering the integrity of the perinatal microbiome. Man et al provide a review of the positive impact of probiotic and symbiotic supplementation on the prevention and treatment of gestational diabetes. In summary, the articles in this issue provide information and insights to signal the importance of the perinatal microbiome in maintaining homeostasis and health for mothers and newborns.
Since completion of the Human Genome Project in 2003, research has evolved to further explore the human microbiome, focused on microbes contained in and on our body. The microbiome is a genetically diverse environment that consists of commensal and pathogenic bacteria within several body systems. Its interaction with the environment influences health, immunity, and disease development. In this special issue of The Journal of Perinatal & Neonatal Nursing (JPNN), we present recent research focused on the neonatal microbiome, including the impact of maternal health before and during pregnancy, and how postnatal environments may contribute to neonatal disease risk.
The human microbiome consists of more than 100 trillion microbes that have an enormous impact on health maintenance and disease onset. Factors such as environment, diet, and genetics influence the degree to which the microbiome may become altered, leading to metabolic imbalance and risk for illness. The microbiome consists of the biological community interplay between commensal (healthy), symbiotic, and pathogenic microorganisms that occupy all body spaces such as the intestine, brain, kidney, and skin. Different microbiomes interact with one another, and disruption in one microbiome (eg, intestine) may affect proper function of another (eg, kidney) through immunological factor "cross talk." However, most research has focused on the intestinal microbiome of the neonate, as it is the largest immune organ in the body and its health directly affects overall health. The preterm infant gut microbiome is especially unique and faces extraordinary challenges to maintain homeostasis. In addition to gastrointestinal immaturity and impaired barrier function, the microbiome is immature and numerous factors prebirth through postbirth may significantly affect its ability to regulate microbial balance and metabolism. Perinatal exposure to maternal microbes influences gut microbial colonies, cesarean delivery may reduce natural acquisition of vaginal commensal bacteria, and postnatal factors such as nutrition, pharmacotherapy, and environmental impact may further impede appropriate microbiome development.
Considerable advances to achieve intestinal microbiome homeostasis have emerged through significant research over the past decade. In this issue, we present scientific reviews with direct clinical relevance and offer practice strategies to promote optimal neonatal health. The systematic review, titled "Determinants of the Very Low-Birth-Weight Infant Intestinal Microbiome: A Systematic Review," presents evidence showing that infant weight, gestational age, mode of delivery, antibiotic use, enteral feeding practice, and perinatal factors shape the preterm infant intestinal microbiome. The authors discuss clinical management approaches that may mitigate intestinal dysbiosis and reduce the risk for adverse intestinal disease. Dunton and colleagues discuss short- and long-term implications of maternal health influence on the developing infant microbiome in their review, titled "Influences of Maternal Prepregnancy Obesity and Gestational Diabetes Mellitus on the Infant Gut Microbiome in Full-Term Infants." Evidence suggests that these maternal conditions reduce the newborn's microbiota diversity and increase the risk for cardiometabolic disease later in life. Our third literature review, titled "Neonatal Microbiome and Its Relationship to Necrotizing Enterocolitis: A Review of the Science," specifically focuses on necrotizing enterocolitis (NEC) and closely examines the pathophysiology surrounding intestinal dysbiosis, associated risk factors, and NEC development.
It is crucial that neonatal intensive care unit (NICU) nurses recognize factors that may disrupt intestinal homeostasis and promptly intervene to reduce risks. Antibiotic stewardship is an essential component to reducing microbiome dysbiosis. Promotion of human milk feeding-both mother's own milk and donor milk-is a clear indicated practice that supports optimal intestinal function and reduces the risk of NEC. Maintaining clean NICU environment with strict oversight of universal precaution practices to reduce cross contamination is paramount. Recognition and awareness of risk factors that may alter the neonatal microbiome-including maternal and infant health factors-will ultimately enhance the short- and long-term quality of life for our tiniest, most vulnerable patients.
-Ellise D. Adams, PhD, CNM
-Lisa Hanson, PhD, CNM, FACNM, FAAN
Perinatal Guest Editors
-Terri Marin, PhD, NNP-BC, FAANP
Neonatal Guest Editor