College aantekening Minor Challenges in Women and Child Healthcare deel 2
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Course
Minor Womens Healthcare
Institution
Vrije Universiteit Amsterdam (VU)
Dit zijn de aantekeningen van het tweede deel van de Minor Challenges in Women and Child Healthcare aan de Vrije Universiteit Amsterdam, van de studie geneeskunde. De tekst is zowel in het Engels als in het Nederlands geschreven (afhankelijk van hoe de lesgevende arts presenteerde). De aantekeninge...
Minor Women and Children healthcare part 2
Inhoudsopgave
Inhoudsopgave 1
WEEK 1 2
Microbiota: friend or enemy 2
Development of the neonatal gut microbiome (MAMI study) 4
The scent of necrotizing enterocolitis and sepsis and the characterisation of the
microbiota 7
Neonatal sepsis: diagnostic challenges 10
Pediatric Research and Evaluation Network (PREN) Amsterdam 12
Neonatal sepsis: NeoPInS 18
Research in children, is it allowed? 18
RCTs Standard and Advanced Analyses 19
WEEK 2 27
Encefalitis 27
Trauma 31
Secure Residential Youth Care 34
Antisocial behaviour 36
Suicide in teens 36
113 38
Prevention in youth mental health 39
Addiction in adolescents 41
Psychological effects of COVID lockdown 46
Anorexia nervosa 47
ADHD 48
,WEEK 1
Microbiota: friend or enemy
Afgelopen 10 jaar sterke afname van infecties, hoe kan dat?
- Vaccinatie
- Antibioticagebruik
Sterke toename auto-immuunziektes, hoe kan dat?
- Voedingspatroon?
- Medicatiegebruik?
dysbiotic drift in modern society!
Manipulation of the microbiota:
- 2 muizen die verschillend microbioom kregen getransplanteerd maar zelfde voeding
werd 1tje dik en 1tje dun.
Some facts:
- Colon 10 billion bacteria
- > 1000 different species
- 60% feces: total weight 1,5 kg
- Microbiome > million genes
- Human 23.000 genes
Diversity of the human microbiome:
- Door moleculaire technieken kan je bacteriën in kaart brengen.
- Meerderheid van de bacteriën zijn niet kweekbaar.
,Functions intestinal microbiota:
- Metabolic
o Fermentation, production vitamins and essential amino acids.
- Protective role against infections
o Prevention colonization pathogens (low pH production fatty acids, production
antimicrobial factors, antioxidants and pro-inflammatory cytokines (TNF-alfa, IL-6)
- Immunity
o IgA induction, cellular en mucosal immunity, lymphoid organogenesis
Which disease are linked to microbiota:
- Astma
- Allergie
- Obesitas, diabetes
- Coeliakie?
- Microbioom speelt misschien ook rol bij gedrag
Vorming microbioom:
- Genetische
- Medicatie
- Voeding
Hoe krijg je microbioom:
- Vertical transmission
o Evidence for shared strains between mother and child
o Family members have more similar microbiota than unrelated people
o Claims have been made for true vertical transmission: in-utero transmission of
bacteria
o Meconium and amniotic fluid: sterile?
- Environmental acquisition
o Not extensively studied in humans
o In pigs environmental acquisition is important in …
Mother-infant transmission of human microbiota
- Sommige bacteriën blijven, sommige verdwijnen.
Hoe diverser een microbioom, hoe beter.
HOW to measure?
Culture
- pro: living micro-organisms: characterization ab-resistance
- contra: >90% intestinal microbiota not cultivable
Sequencing
- pro: loads of information
- contra: complex to standardize, time-consuming, expensive
IS-pro
- pro: standardized, fast
- contra: novel technique, limited experience, not all detected peaks can
be linked to known species yet
, IBD:
- Enterale nutrition as therapy kan darmen weer gezond maken.
Manipulation:
- Antibiotica schopt hele microbioom door de war je moet hier zuinig mee zijn.
- Meer dan 3 kuren tijdens zwangerschap, is grotere kans IBD baby.
In summary:
- Microbiota associated with health and disease
- Colonization dynamic process, characterized by ‘critical windows’
- Currently available probiotics not individualized, available probiotics not
disease-specific
- Microbiota promising as diagnostic tool
Development of the neonatal gut microbiome (MAMI study)
Microbioom; alle micro-organismes die zich op ons bevinden, meeste in de darm
- 10^13-14 microorganisms
- 1000-10000 different bacteria
- Colonization starts around birth
Functions microbiota
- Digestion of food
- Priming immune system; als je geboren wordt is het immuunsysteem nog naïef, het
microbioom helpt hiermee om het immuunsysteem te laten wennen aan bacteriën
- Protection against pathogens
- Synthesis of essential vitamins
Pathofysiologie => NEC (necrotiserende enterocolitis), astma, allergieën, DM, coeliakie etc.
Perinatal factors influencing the microbiota
- Feeding (breast feeding vs formula)
- Skin contact
- Genetics
- Gestational age
- Perinatal AB
- Way of delivery (vaginal or C-section)
Bij blootstelling aan AB
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