Lunch Simp.-prof Dr.djauhariah a MAdjid

7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid

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CURRICULUM VITAE

Nama : Prof. dr. Ny. Djauhariah A. Madjid, SpA(K)Tempat/Tanggal lahir : Mamasa, 31 Januari 1944

Jabatan Akademik : Dosen Tetap

Alamat kantor : Bagian Ilmu Kesehatan Anak

RSUP. Dr. Wahidin Sudirohusodo

Jl. Perintis Kemerdekaan Km.12, Makassar, 90245

Alamat rumah : Komp. Chrysant G/10,Panakkukang Mas Makassar

No. Telp./Fax./HP : 0411-430328

Riwayat Pendidikan :

S1 Kedokteran Universitas Hasanuddin 1971

S2 Kedokteran Universitas Airlangga 1975


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Djauhariah Arifuddin Madjid


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Several studies had shown that there are differences of

gut microbiota between breastfed and non breastfed

babies, i.e. greater number of bifidobacteria in

breastfed baby, which is the most important microbiotaof the gut

Several factors in breastmilk can enhance growth of

bifidobacteria , which are glucose, lactoferin, galactoseand fructose

Duggan CG, et al. Am J Clin Nutr 2002


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Breastmilk bacteria should thus be

considered an important source of

bacteria in the establishment of

infantile intestinal microbiota


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Human breast milk cells contain :

A limited number of viable bacteria and bacterialDNA that might have been transported from the

mothers intestine to the mammary gland through

an endogenous cellular route

Pablo F.P., et al. Paediatrics 2007


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Shortly following birth, the previouslysterile infant gut begins to be

colonized by an array of bacteria that

are facultative anaerobes and strictanaerobes.


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Feeding practices Breast milk (contains bacteria)

Formula feeding ( with or without Bifidobacteria )

Mode of deliveryInfants born vaginally :

Acquired their gut flora from maternal vaginal and fecal flora

Environment also contributes within maternity wards,

nosocomial spread is shown to exist among

healthy newborn infants

Mothers faecally invaded perineum and vagina

lactobacilli, corynebacteria, staphylococci, streptococci,

micrococci, enterobacteria, peptococci, peptostreptococci, bacteroides,Propionibacterium spp. and Veillonella spp.

Minna MG, et al. J Paed.Gastroenterol and nutr. 1999


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Postnatal effects if child by passing the natural way

of delivery

Impact on gut microbiota

Initial gut microbiota colonization of newborn has

consequences for subsequent development and

maturation of the immune system on infants later

health


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Infants born by cesarean delivery :

Caesarean section: sterile

The environment is extremely important

especially if infants are separated from

their mother for long periode after birth

Minna MG, et al. J Paed.Gastroenterol and nutr. 1999


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The environment

Hospitalisationfrom other infants

via the nursing and medical staff

via air and equipment

Antibiotics affect microbes (good and bad

microbes)

Animals (household pets, farm animals)


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A real concern- the high number of

cesarean deliveries around the world


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Caesarean Section Rate

In United States = 29.1 % In Asia = 5-15 %

In Indonesia =

Government hospital = 11-15%

Private hospital = 30-40%


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Morbidity in women stillhigher :

27/1000 cesarean birth

Versus

9/1000 vaginal birth


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Gut microbiota is different and delayed in

cesarean delivered infants

Cesarean delivery Strict hygiene

No contact with maternal

microbiota

Bacteria mainly from hospital

environment

Decreased exposure to bacteriain early days of life

Vaginal deliveryExposure to bacteria from

maternal microbiota (e.g.fecal,vaginal)

Environment


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Bifidobacteria colonization is delayed in

caesarean deliveries

0

10

20

30

40

50

60

70

80

90

100

%

3 10 30 60 180days

Colonization rate by

Bifidobacterium-like bacteria

Vaginal Delivery (n=34) Cesarean Delivery (n=30)

delayed

[Gronlund MM et al, JPGN 1999; 28 (1): 19-25]

(*) p < 0.001

**


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.. also colonization rate ofBacteroides

fragilis is delayed biggest difference

Grnlund MM et al. JPGN 1999


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Impact of C-section on health

0

10

20

30

40

50

60

Infectious

diseaseRespiratorydisease

Digestivedisease

Vaginal Caesarian Vaginal Caesarian

1 month after birth 1 year after birth

%o

finfants

(Chang et al 2006)

*

* *

*

*

** P< 0.05


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An observational study Huurre A, et al. 2006

At one month of age :

Total gut bacterial cell count are higher in

vaginally delivered infants as compared to

cesarean delivered infants (p = 0.001) This distinction was due to the significant greater

number ofbifidobacteria in vaginally delivered

infants (p=0.001) but not the numbers of

clostridium, lactobacillior bacteriodes


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The most important determinants of the gut

microbiota composition in infants are:

The mode of delivery

Type of infant feeding

Infant hospitalization

Antibiotic use by the infant


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Infants born vaginally :

Acquired gut flora from maternal vaginal,

fecal flora and environment

Infants born by cesarean delivery

Acquired gut flora from environment

especially if infants are seperated from

their mothers for long period

bifidobacteria, B. fragilis colonization is

delayed in cesarean section


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More often suffer from infection and

sensitization compare with vaginal delivery

Microflora of breastfed infants is dominated

by populations of bifidobacteria as one

possible explanation for purported health

advantages


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Lunch Simp.-prof Dr.djauhariah a MAdjid

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