Trysha Hicks, BSN Honors Student

§ Develop best practice for encouraging optimal microbiome

development in infants
§ Focus on elective postnatal choices
§ Delivery type
§ Food type/exclusivity
§ Delaying newborn care practices
§ Use of skin-to-skin practice
§ Antibiotic/probiotic exposure
§ Vaginal seeding
§ Educating health care professionals, who can then educate parents
§ Routine hospital care:
§ Put under warmer,
§ Dry infant
§ Perform physical assessment
§ Vitamin K shot
§ Infant weighed/measured
§ Recent legislation/bodies that support microbiome development
§ American Academy of Pediatrics
§ Healthy People 2020
§ Center for Disease Control and Prevention
§ WHO/UNICEF
§ Sterile gut at birth
§ CDC: ¼ infants successfully follows exclusive breastfeeding recommendation
§ Specifcially Bifidobacteria (Bifidobacterium and Lactobacillus spp.) helps
colonize the gut and produce immune IGA cells.
§ Establishing a good microbiome reflected in long-term health
§ Lower risk of developing:
§ Allergies
§ Asthma
§ Hospital-acquired infections
§ Decreased infection rates
§ Fewer Clostridia species
§ Type 1 diabetes
§ Obesity
§ Databases:
§ CINAHL, PubMed, Google Scholar, Cochrane Database
§ 16 articles in total
§ Published dates: 2006-2017
§ Search terms:
Articles According to Level of Evidence
§ Neonate/infant & Microbiota
Level II Evidence: 2
§ Sub-searches Level III Evidence: 8
§ Bathing Level IV Evidence: 6
§ vaginal seeding,
§ delivery method
§ Probiotic
§ feeding method
§ Vaginal Delivery preferred over Cesarean Delivery (6 articles)
§ Exclusive breastfeeding vs. combo feeding or formula only feeding (5)
§ Breastmilk profiles change based on delivery type (3)
§ Skin-to-skin contact immediately after birth and delayed post-birth
practices (2)
§ Judicial use of antibiotics (4)
§ More Information Needing:
§ Supplementing with prebiotics (1)
§ Siblings at home (not modifiable) (2)
§ Exposure to vaginal fluids for partial microbiota restoration (1)
§ Delayed Bathing for Microbiome development
§ Educational brochure-targeted at expectant parents during prenatal
visits or at the time of birth
§ Nurses need to be educated as well—two brochures? In-services?
§ Theories
§ Grahm et al. as cited in Melnyk
§ ID problem & change agents, ID practice change effective through
research, potential barriers, use effective strategies to disseminate info,
implement practice change, evaluate, ID activities to sustain change
§ Johns Hopkins
§ Secure resources, implement action plan & pilot test, evaluate outcomes &
processes, disseminate outcomes to stakeholders
§ Evaluation
§ Ideally: long-term research studies on microbiota development in
infants after these practices
§ Realistically: keeping track of parent choices following education from
healthcare workers
§ Measure outcomes:
§ Breastfeeding exclusivity rates
§ Elective cesarean rates after receiving information
§ Patients asking for/providers offering vaginal seeding
§ Hours after birth when bathing is performed
§ Immediate skin-to-skin contact
§ Antibiotic use
§ Strengths & Weaknesses
§ Targets primary prevention through education of parents before a
problem has developed
§ Thorough Lit review
§ Lots of Evidence incorporated
§ Lack of evidence about newer practices such as delayed bathing and
partial vaginal microbial restoration
§ Recommendations for future research
§ Newer practices
§ Probiotic use in formula
§ Long-term health effects following implementation of these practices
References available upon request