Clostridium perfringens in stool, intraparturn antibiotics and gastrointestinal signs in a neonatal intensive care unit

Abstract

In 1989, we observed in our neonatal intensive care unit (NICU), an increased number of infants with gastrointestinal signs, including five cases of necrotizing enterocolitis. Clostridium perfringens was found in 26% of newborns (n = 168) and was associated significantly with the occurrence of flatulence, distended abdomen, foul-smelling stools, diarrhea and blood in stool (all p < 0.001). C. difficile was found in 17% of the newborns (n = 72). Cesarean section, low gestational age and low birth weight were significantly associated with C. perfringens in stools (all p < 0.001). Treatment with antibiotics was not associated with occurrence of C. perfringens. However, in infants with C. perfringens, intrapartum antibiotics were associated with increased appearance of abdominal distension (p < 0.05). Thus the antibiotics, which disturb primary colonization, may also favor the pathogenic role of opportunistic gut bacteria, such as C. perfringens.

Effects of Prebiotic‐Containing Infant Formula on Gastrointestinal Tolerance and Fecal Microbiota in a Randomized Controlled Trial

“…These shifts may be related to the largely indigestible carbohydrate portion of the oligosaccharides acting as a receptor analog to preclude pathogen colonization by preventing epithelial adherence. [36][37][38][39] Overall, although statistically significant, the differences in fecal microbiota studied herein were relatively small when considering the magnitude of the resident microbiota of the human infant. Increases in bifidobacteria were observed, but the changes that occurred were no greater than 1 log of colony-forming units (CFU).…”

“…These shifts may be related to the largely indigestible carbohydrate portion of the oligosaccharides acting as a receptor analog to preclude pathogen colonization by preventing epithelial adherence 36 . ‐ 39 …”

Caesarean section and gastrointestinal symptoms, atopic dermatitis, and sensitisation during the first year of life

“…A study in 168 infants from the neonatal intensive care unit in Turku, Finland, reported caesarean section and prematurity to be significant risk factors for C perfringens in stool, which was associated with the occurrence of gastrointestinal symptoms like flatulence, distended abdomen, diarrhoea, and blood in stool. 15 In contrast, in 64 healthy term infants born at the same hospital no differences were found between infants born by caesarean section (n = 30) and vaginally (n = 34) with respect to flatulence, abdominal distension, bowel habits, and colicky crying within the first two months of life in spite of differences found for the gut flora. 3 These studies were both confined to a selected group of children from one hospital.…”

Necrotizing enterocolitis of the neonate with Clostridium perfringens: diagnosis, clinical course, and role of alpha toxin

“…Bacterial colonisation of the neonatal gut begins by contact with the vaginal flora and is stimulated by oral feedings and exposure to the postpartum environment [5]. One report from Finland [1] describes how the intestinal flora is colonised with Cp in the presence of gastrointestinal disorders like flatulence, distended abdomen, diarrhea, etc., but without NEC in neonates. Still, early Cp colonisation seems to be correlated with NEC in premature infants [6], where intrapartum antibiotics and gut flora imbalance favour the growth of Cp.…”