1. Erin Smith

2. Research Question  Does an infant gain the same amount of bacteria necessary for that initial micro-flora development when born vaginally vs. being born by caesarean section?  Does the type of feeding have an impact?

3.  Background Information  Case study overviews  Conclusion  Room for improvement

4.  ‘live micro-organisms which confer a health benefit on the host when administered in adequate amounts’  Prebiotics  Synbiotics  Natural sources: yogurts and Kefir

6.  Bifidobacterium - added in probioitic supplementation B. Infantis  E. coli - diarrhea, nausea, and stomach cramping  C. difficile- leading cause of diarrhea and colitis

7.  denaturing gradient gel electrophoresis (DGGE)  temperature gradient gel electrophoresis (TGGE) “molecular fingerprinting techniques”

8. VAGINAL DELIVERY CESAREAN DELIVERY  Infant comes in contact with the vaginal and intestinal flora of the mother which starts the colonization  Infant is relying exclusively on the environmental bacteria to aid in colonization

9.  46 full term infants  Fecal sample on day 3  TGGE and DGGE Conclusion- Delivery mode influenced within 3 days of life with little to no influence of the type of feeding

10.  1032 infants  fecal samples at one month of age  Participants with diverse lifestyles Conclusion- There were also same differences except feeding method also had and impact

11. Bifidobact eria E.ColiC. difficileB fragilis- Group Lactobacill i Place and Mode of Deliviery Prevalence % Natural delivery at home 9985 198332 Natural delivery in hospital 9988 268534 Artificial delivery in a hospital 10091 348730 Cesarean section in hospital 9691 426332

12.  Most were breast-fed exclusively for 1 mo.  232 formula-fed exclusively  98 combination Conclusion- Formula fed more colonized with E. coli and C. difficile.

13. Vaginal Delivery Cesarean Delivery Bifidobacterium C difficile E. Coli

14.  606 infants  5 European Countries  Filled out 2 questionaires  Fecal samples at 6wks. Conclusion- Cesarean had counts of Bifidobacterium and counts of C. difficile

16.  Breast-fed babies- bifidobacteria and significantly proportions of bacteroides, C coccoides, and Lactobacillus groups compared with formula-fed babies.

18.  2 healthy baby boys  Both vaginally delivered and breast-fed immediately after birth.

19.  Baby 1- breast-fed 130 days, then infant formula was added and baby was weaned by day 200.  Baby 2- breast-fed until day 17, then infant formula was added and increased over time  Samples daily first 2 wks of life  Then twice a months For 10 to 12 months Conclusion- Breast-fed baby had more Bifidobacterium.

20.  All conclude that mode of delivery has an impact on bacterial development.  One study suggests type of feeding has no impact in first 3 days of life.  Other 3 studies suggest that by 1 month of age nutrition type does have an impact on development.

21.  Feces samples taken at a clinic or location of the studies.  Ensure same infant formula is used with all infants. These would decrease inconsistency.