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7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
1/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
2/22
Djauhariah Arifuddin Madjid
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
3/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
4/22
Breastmilk bacteria should thus be
considered an important source of
bacteria in the establishment of
infantile intestinal microbiota
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
5/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
6/22
Shortly following birth, the previouslysterile infant gut begins to be
colonized by an array of bacteria that
are facultative anaerobes and strictanaerobes.
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
7/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
8/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
9/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
10/22
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)
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
11/22
A real concern- the high number of
cesarean deliveries around the world
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
12/22
Caesarean Section Rate
In United States = 29.1 % In Asia = 5-15 %
In Indonesia =
Government hospital = 11-15%
Private hospital = 30-40%
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
13/22
Morbidity in women stillhigher :
27/1000 cesarean birth
Versus
9/1000 vaginal birth
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
14/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
15/22
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
**
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
16/22
.. also colonization rate ofBacteroides
fragilis is delayed biggest difference
Grnlund MM et al. JPGN 1999
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
17/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
18/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
19/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
20/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
21/22
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
7/27/2019 Lunch Simp.-prof Dr.djauhariah a MAdjid
22/22