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Bacteria: Both good and bad
We now know that bacteria cannot just be understood in terms of infectious implications but also positive beneficial interactions that have a significant impact of bodily function especially immune system. There is increasing evidence that early environmental and bacterial influences in early life have impact far beyond just the gastrointestinal and local as well as systemic immune system.
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Maternal bacterial and fetal contact
Microbial transfer and contact of the mother with the growing baby in uterus as well as during delivery and breastfeeding cannot be ignored. In fact early exposures have affect the long term bacterial finger-print of the individual also termed as microbiological programming.
Rebooting the body's hard drive
Analogous to many computer problems, the ability to reboot /reset a dysfunctional prenatal and early postnatal interactions affecting body metabolism and immune system using well-targeted specific probiotic strains of bacteria has potential to affect long term health of the individual.
Not all common intestinal bacteria are abundant in environment
It should be noted that not all normal inhabitants of the gut are ubiquitous in the environment. An example is the beneficial Bifidobacterium species seen in infant’s gastrointestinal system suggesting that these are acquired from the early environment primarily the mother and the evolutionary conserved pattern suggests a beneficial role for the human host.
Is fetus really sterile?
Traditionally, fetus has been considered to be sterile and the microbial colonization occurs after birth. Current data suggests that microbial contact actually begins during fetal life.
How do bacteria reach the fetus in utero
Transfer may occur via maternal birth canal, fallopian tubes or via blood stream. The modulation of the immune system after the delivery is species specific with increased or decreased inflammatory response based on type of placental bacterial exposure.
Evolution from initial to final intestinal bacterial imprint
The maturation to the final imprint develops in a logical step-wise fashion. The first impact is the motherload of bacterial from the birth canal, followed by breast feeding, weaning processes and rapidly and stepwise snowballing contact with the environment.
Effect of delivery type and infant feeding
Babies born of vaginal delivery and subsequently breast fed have predominantly Bifidibacterium bacteria whereas formula fed babies have more diverse microflora that includes potentially pathogenic strains. One study indicated that while diverse forms of Bifidobacteria species contributed much of the intestinal flora in exclusively breast milk fed infants, it was half of that in the formula fed babies.
The difference in Bifidobacterium tends to persevere after weaning over to formula feeding.
By the age of 1 year, the infants microflora starts to evolve to adult form with the final establishment of adult intestinal bacterial fingerprint by 2-3 years of age.
Not much is known about gut colonization and the composition of bacteria and its evolution in preterm infants. One thing that is well known is that the factors that may be involved in disruption of normal intestinal flora including Caesarian section, frequent use of antibiotics, parenteral nutrition instead of breast milk feeding, and minimal skin to skin contact for bacterial transfer.
Intestinal bacteria in very preterm infants exhibits belated appearance of Bifidobacteria along with diminished biodiversity. Many species in microflora of such babies have not been characterized.
Role of controlled bacterial exposure and its sources
Fetal growth and development during pregnancy provides fetus with a controlled exposure to environment with low level carefully discriminating selective contact with bacteria helping in organogenesis as well as priming the fetal body for eventual motherload of bacteria awaiting immediately upon birth. These concepts are supported by the fact that maternal exposure to farm animals reduces risk of atopic dermatitis or eczema in infants.
Fetal bacterial exposure may be beneficial and does not always mean sickness
The presence of these bacterial contacts with fetus is not necessarily always associated with any ill-health in the babies. At the same time, potential is there in select cases. Certain bacteria isolated from the amniotic fluid may originate from the oral cavity highlighting the importance of oro-dental health.