Jan Sherman

Paneth cells and antibacterial host defense in neonatal small intestine.

ABSTRACT Paneth cells are specialized epithelia in the small bowel that secrete antimicrobial proteins. Paneth cells are vital to the innate immunity of the small bowel in adult mammals, but their role during neonatal infection of the small bowel is not well established. Dithizone selectively damages Paneth cells, and when dithizone-treated newborn rats are infected enterally with Escherichia coli, the numbers of E. coli cells in their jejunal and ileal lavage fluid are significantly increased compared to controls. The data support that Paneth cells are necessary for neonatal antibacterial defense.

Lactoferrin and necrotizing enterocolitis.

PURPOSE OF REVIEW There is an intense interest among neonatal caregivers as to whether lactoferrin given enterally may reduce the incidence of necrotizing enterocolitis in preterm infants. This review presents scientific and clinical evidence that lactoferrin alleviates or prevents this life-threatening disease. RECENT FINDINGS Preclinical studies in neonatal rats showed that lactoferrin given orally before enteral infection with pathogenic Escherichia coli reduced bacteremia and mortality. A multicentered clinical trial found that very low-birth weight preterm infants given bovine lactoferrin had a significant reduction in late-onset sepsis; there was also a trend towards a diminished incidence of necrotizing enterocolitis. Although multicentered trials of lactoferrin use in preterm infants are near completion, regulatory burdens required to bring lactoferrin to the bedside may limit its availability. SUMMARY Extremely preterm infants should receive colostrum, a natural lactoferrin concentrate, immediately after birth and, ideally, continue on breast milk throughout the hospital stay. This practice appears well tolerated, but additional experience will tell us whether this practice reduces the prevalence of necrotizing enterocolitis.

E-Mentoring for Doctor of Nursing Practice Students: A Pilot Program.

BACKGROUND The growing number of online Doctor of Nursing Practice (DNP) programs, steady attrition rates, and shortage of faculty created an opportunity to explore the use of distance-mediated mentoring. METHOD Twenty first-year DNP Nursing Leadership students were matched with DNP-prepared mentors in a formalized e-mentoring program. The Ideal Mentor Scale was used to determine what students desired most from the mentoring relationship in addition to midpoint and end-of-program surveys. RESULTS Quantitative analysis revealed mentors and mentees found the relationship to be beneficial (p < .05). Mentees (89%) and mentors (92%) noted the program supplied adequate resources, and the majority of students would recommend the program. CONCLUSION Having a mentor leads to both mentor- and mentee-perceived benefits. Recommendations include continuing to seek ways to improve the communication and commitment between the mentor and mentee in order to receive reciprocal program benefits. [J Nurs Educ. 2016;55(8):458-462.].

Early Persistent Blood Eosinophilia in Necrotizing Enterocolitis is a Predictor of Late Complications

Background: Eosinophils infiltrate intestinal tissue during necrotizing enterocolitis (NEC) and adult bowel diseases. We theorized that epithelial damage causes eosinophilic activation and recruitment at NEC onset. Objective: We studied the relationship between persistent blood eosinophilia and medical or surgical complications during NEC. Methods: NEC cases and controls at MU Childrens Hospital (2008-2013) underwent review. A Likert scale measured NEC severity. We utilized an SPSS database for statistical analyses. Results: Of 50 NEC cases, infants in group 1 (n = 15) had eosinophilia <2 days after onset and those in group 2 (n = 25) had NEC but no persistent eosinophilia. Group 3 (n = 46) consisted of controls, i.e. infants without NEC matched for birth weight and gestational age and group 4 (n = 4) of preterm infants with infection and ≤5 days of eosinophilia. Hematologic assessment defined persistent eosinophilia as ≥5% eosinophils for ≥5 days after NEC onset. Absolute eosinophil counts were 2 times higher in group 1 than in group 2 (p = 0.002). The mean duration of eosinophilia was 8 days in group 1 versus 1 day in group 2 (p < 0.001). A Likert score of NEC severity was 3-fold higher in group 1 than in group 2 (p < 0.001). Compared to group 2, group 1 infants were 8 times more likely to have hepatic fibrosis or intestinal strictures. Conclusions: Early persistent blood eosinophilia is not currently a predictor of complications after the onset of NEC. This biomarker identifies immature infants at a high risk for adverse outcomes during NEC convalescence.

Intimate Partner Violence: Enhancing Vigilance of Screening, Treatment, and Referral in the Primary Care Setting.

Between 1.5 and 5.3 million women are physically and/or sexually assaulted per year by an intimate partner. Intimate partner violence (IPV) is an enormous public health problem, costing an estimated US

PO-0603 Lactoferrin And Nicu Environment Affect Faecal Bacteria Of Preterm Infants

8.3 billion dollars annually. Screening for IPV is a standard of care recommended by the United States Preventive Services Task Force and other organizations; however, the literature demonstrates a deficiency in health care provider preparedness, comfort, and consistency. The objective of this study was that 35% of women, ages 16 to 55 years, will be screened for IPV at every patient encounter and a safety plan including available resources discussed and/or dispersed with 100% of identified IPV victims. Providers are more apt to change and maintain IPV screening recommendations when sequenced training sessions are conducted and when held accountable. Educational services and resources from an IPV professional, a valid screening tool with guidance from a written protocol, and transformation of the practice environment are needed to foster change. Two evidence-based professional development programs, administered 6 weeks apart, were utilized to increase the providers’ ability to identify and address IPV. A written protocol that included a flowchart, safety plan, national and local abuse hotline numbers, and a referral network was utilized. Safety materials were strategically positioned throughout the clinic. To identify victims, patient subjects completed the Partner Violence Screening tool. A single-sample, pre-test/post-test study design with systematic random sampling was utilized. A total of 692 subjects were evaluated. Results of a chisquare test of independence demonstrated statistical significance (p < .001, odds ratio [OR] = 1.47; 95% CI [1.3, 1.7]. There was a statistically significant difference between preand post-test groups and a small to moderate improvement in screening from the combined intervention (phi = .2). All (100%) postintervention disclosures of IPV victimization received intervention from their provider. The clinical implications for increased IPV screening are staggering. 658186WJNXXX10.1177/0193945916658186Western Journal of Nursing ResearchThomas et al research-article2016

Protective Proteins in Mammalian Milks: Lactoferrin Steps Forward

Background and aims The effects of lactoferrin [LF] on neonatal gut bacteria is unknown. We theorised LF has a greater impact on gut microbiota than the NICU environment. Methods Ten very preterm infants received enteral recombinant human lactoferrin [rhLF], while 11 infants received placebo for the first 28 days of life. We collected a faecal sample on day 21. We sequenced amplicons made from the V1 – V3 region of bacterial 16 S rRNA in faeces. QIIME and mothur processed filtered reads to classify operational taxonomy units [OTUs] with >97% sequence similarity. Statistical analyses used SPSS. Results Mean faecal OTUs per infant were higher in NICU1 (mean = 63,284) versus NICU2 (48,080, p < 0.001). Reasons for higher OTUs in NICU1 were less antibiotics versus NICU2 (mean = 4.7 vs. 9.5 d, p < 0.002); NICU1 used early enteral nutrition in NICU1, while infants in NICU2 received more parenteral nutrition (p < 0.007). Veillonella as a marker of gut microbiome maturity was higher in NICU1 (mean OTUs = 13,146 versus NICU2 = 1909, p < 0.04). A placebo-treated infant with necrotizing enterocolitis had 58,071 OTUs of Enterobacter hormaechei in the faeces. Infants given placebo had more E. hormaechei (mean OTUs = 23,661) versus rhLF-treated babies (mean = 2330, p < 0.03). Two neonatal pathogens, S. aureus and Pseudomonas, were lower in the faeces of rhLF-treated infants (p < 0.03 and p < 0.01, respectively). Conclusions rhLF modulates gut bacteria of preterm infants. The NICU habitat also significantly affects the intestinal microbiome. Research must show if bovine LF also reduces faecal pathogens in very preterm infants.