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Year : 2012  |  Volume : 4  |  Issue : 4  |  Page : 187
State of the globe: Studying intestinal colonization of neonates in developing India

1 Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
2 Department of Internal Medicine, Seven Hills Hospital, Mumbai, India

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Date of Web Publication26-Nov-2012

How to cite this article:
Galwankar S, Vanjeri S. State of the globe: Studying intestinal colonization of neonates in developing India. J Global Infect Dis 2012;4:187

How to cite this URL:
Galwankar S, Vanjeri S. State of the globe: Studying intestinal colonization of neonates in developing India. J Global Infect Dis [serial online] 2012 [cited 2022 Nov 27];4:187. Available from:

It is a well-accepted fact that normal gut microflora play a crucial role in developing gut immunity.

In full-term neonates, just less than 2 weeks is required to sufficiently colonize the colon with adverse group of microflora. This is different when a neonate is preterm where there is no opportunity for protective colonization, thus putting the neonate at risk of sepsis and increased mortality. [1],[2] In addition to the delayed colonization and onset of infection, the treatment with antibiotics further hampers the development of protective immunity in neonates. [3]

This study done in India by the team at All India Institute of Medical Sciences focuses on studying the differences in microflora in two groups, namely preterm infants and term neonates. They ensured that they have studied not only the species but also the transitional development of different colonies as they followed the different samples collected on different days right up to the 21 st day post birth.

The results show that the samples grew both gram-positive and gram-negative organisms ranging from Klebsiella pneumoniae,  Escherichia More Details coli, Proteus sp., Enterococcus faecium, Staphylococcus epidermidis, and Micrococcus sp. In addition, the anaerobic flora detected was Bifidobacterium sp. and Clostridium bifermentans. It was also found that gram-positive bacteria were in lesser number in preterm neonates.

In addition, it was also found that the infants who were suffering from nectrotizing enterocolitis were colonized with  Salmonella More Details senftenberg, E. coli, Salmonella typhi, Salmonella gallinarum, and Klebsiella oxytoca. This yet again proves that pathogenic gut flora play a role in the development of neonatal nosocomial sepsis and Necrotizing Enterocolitis (NEC). [4],[5]

Lactobacillus sp. was isolated in only one term baby, while Bifidobacterium sp. was isolated in four samples. Thus, it was noticeable that there was a lack of the usually known protective flora in preterm neonates. [6]

It is known that in premature birth, as the neonate passes through the birth canal or is delivered via surgery, it has very little time to adequately ingest maternal colonic and vaginal flora. This leaves the neonates with a deficit of protective colonies of organisms in the gut, which puts them at risk of getting colonized with virulent environmental pathogens. In addition, premature neonates have a naïve colonic immune system which results in excessive inflammation in response to infective or ischemic insults. Apart from this study, many researchers have emphasized the administration of probiotics along with expressed maternal breast milk to fasten protective colonization to prevent infection and sepsis. [7]

This study highlights the need for studying the role of administering probiotics in neonatal period to bestow protection against developing sepsis and NEC. There is also a window of opportunity to study the role of maternal nutrition, maternal hemoglobin, and birth weight as independent factors in development of gut flora and subsequent development of life-threatening infections, especially in nations with transitional economies such as India.

   References Top

1.Long SS, Swenson RM. Development of an anaerobic fecal flora in healthy new born infants. J Pediatr 1977;91;289-301.  Back to cited text no. 1
2.Huurre A, Kalliomäki M, Rautava S, Rinne M, Salminen S, Isolauri E. Mode of Delivery-effects on gut microbiota and humoral immunity. Neonatology 2008;93:236-40.  Back to cited text no. 2
3.Penders J, Thijis C, Vink C, Stelma FF, Snijders B, Kummeling I, et al. Factors infl uencing the com position of the intestinal microbiota in early infencey. Pediatrics 2006;118:511-21.  Back to cited text no. 3
4.Kosloske AM. A unifying hypothesis for the pathogenesis and prevention of necrotizing enterocolitis. J Pediatr 1990;117:S568-74.  Back to cited text no. 4
5.Westra-Meijer CM, Degener JE, Dzoljic-Danilovic G, Michel MF, Mettau JW. Quantitative study of the aerobic and anaerobic faecal flora in neonatal necrotizing enterocolitis. Arch Dis Child 1983;58:523-8.  Back to cited text no. 5
6.Hall MA, Cole CB, Smith SL, Fuller R, Rolles CJ. Factor infl uencing the presence of faecal lactobacilli in early infancy. Arch Dis Child 1990;65:185-8.  Back to cited text no. 6
7.Ganguli K, Walker WA. Probiotics in the prevention of necrotizing enterocolitis. J Clin Gastroenterol 2011;45 Suppl:S133-8.  Back to cited text no. 7

Correspondence Address:
Sagar Galwankar
Department of Internal Medicine, University of South Florida, Tampa, Florida
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-777X.103894

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