**6. Impacts on infant microbiome assembly**

and during initial breastfeeding, also the newborn gut is colonized with microbes that built

When newborn transits to a life outside a womb, it must adapt to many new circumstances. One is metabolic transition, which is not as dramatic as, for example, changes in cardiopulmonary systems, but equally complex and essential for survival. As Colson [35] notices cardiopulmonary, immune and thermal adaptations are well documented, but most texts fail to

Just after birth, as soon as the umbilical cord ceases to pulsate, placental circulation stops. This means that the constant supply of maternal nutrition especially glucose transferred via the placenta stops. Before the birth, no significant production of glucose has been demonstrated [36]. In utero insulin is being used as a growth hormone instead of being a metabolic regulator. Colson [35] explains that the processes of lipogenesis (formation and storage of fat in the form of adipose tissue) and glycogenesis (formation and storage of glucose in the form of glycogen in the liver, cardiac muscle and brain) are replaced by the metabolic pathways of neonatal life. These are glycogenolysis (breakdown of glycogen), lipolysis (breakdown of fats), gluconeogenesis (endogenous glucose production) and ketogenesis (formation of ketone bodies).These pathways imply a metabolic switch at birth from glucose to fat and therefore a diet initially lower in carbohydrate and high in fats. It is true that while neonatal blood glucose levels immediately fall in almost all healthy infants, it must adapt to intermittent feeding, digestion and intestinal absorption of nutrients (adapted from Colson, p. 13). The fetus prepares for his transition mainly by storing glycogen, producing catecholamines and depositing brown and white fat [37]. After the birth, hepatic glycogen stores are mobilized and hepatic synthesis of glucose from noncarbohydrate substrates enuses. This substrate enters the citric acid cycle and produces adenosine triphosphate, which serves as the energy source for the brain [37]. These events actually allow baby to gradually mobilize glucose to meet energy requirements. So-called transient neonatal hypoglycemia is a process of normal adaptation to extrauterine life, and it is important that we realize that in first 3–4 h healthy newborn could have low

Colson [35] exposes several practices that stand behind understanding of the normal meta-

**1.** Metabolic transition is not generally taught in midwifery and medical curricula as part of normal postnatal adaptation from fetus to neonate. Descriptions of metabolic changes are

**2.** Research has shown that patterns of metabolic adaptation are different according to whether the baby is breastfed or has artificial feeds and this is largely ignored in midwifery and pediatric assessment. Mixed feeding is common in the first three days postnatal even

absent or sparse. When present, they are usually rooted in pathology.

when the mother wants to breastfeed exclusively.

describe the normal physiological metabolic transition from fetus to neonate.

normal gastrointestinal flora.

16 Selected Topics in Neonatal Care

blood glucose levels.

bolic physiology:

**5. A metabolic perspective**

The human body is colonized by a vast number of microbes, collectively referred to as the human microbiota. The average human has over 100 trillion microbes in and on their body, and many of the latest discoveries are challenging previously held ideas about good and bad bacteria. Funkhouser and Bordenstein [39] say that the human microbiota comprises only 1–3% of an individual's total body mass, outnumbering human cells 10 to 1 and adding over 8 million genes to our set of 22,000. At the beginning of the twentieth century, French pediatrician Henry Tissier said that human infants develop within a sterile environment and acquire their initial bacterial inoculum while traveling through the maternal birth canal but now the sterile womb hypothesis remains dogma. The intrauterine environment during healthy pregnancy has been presumed to be free of, although recent evidence of microbes presents in the amniotic fluid, umbilical cord blood, fetal membranes and placenta of healthy term pregnancies after both vaginal and C-section delivery has challenged this belief [40]. It is known by now that human infants are colonized with maternal vaginal and fecal microbes as they exit the birth. The way how is known to have long-term consequences on mothers and child health. This is especially important considering immune-mediated diseases. For example, children born via C-section are significantly more likely to develop allergic rhinitis, asthma, celiac disease, type 1 diabetes and inflammatory bowel disease [40].

ability to effectively breastfeed. Full breastfeeding can of course be established successfully after a cesarean section also. The beginning of the milk secretion can be delayed after caesarean section, however, there is no rule. It is important to know that a child for successful feeds need to have a search reflexes, reflexes of swallow and sucking reflex which is instinctive. The way of the childbirth does not have influence per this. It is true that the first feed is postponed as a mother is put to sleep during an intervention. Clinical staff has to help her to add a child only after a certain time, when a mother is wake and she is aware of herself and surroundings. There are qualified professionals working in various medical institutions that hold a specific and additional knowledge about lactation and breastfeeding. With breastfeeding, the 'good bacteria' from the mother's body with a calm environment create good conditions for the development and strengthening of the child's immune system. The WHO and UNICEF are recommending three important breastfeeding activities: (1) early breastfeeding and skinto-skin contact with mother just after the birth; (2) exclusive breastfeeding to baby's age of 6 months without other food or liquids and (3) continued breastfeeding to baby's age of 2 years or even more. Meantime, the child can get complementary foods like soft foods and liquids, etc. [45–47]. Early breastfeeding and skin-to-skin contact immediately after birth keep a baby warm and have positive influence on their immune system. Despite that breastmilk is the best food with antibodies for baby's development, it also has effects on mother's ability of continuing exclusive breastfeeding. Mothers who breastfeed also have a (1) early initiation of breastfeeding—place newborns skin-to-skin with their mother immediately after birth, and support mothers to initiate breastfeeding within the baby's first hour of life; (2) exclusive breastfeeding—provide only breastmilk to infants from birth until 6 months of age, with no other food or liquids (including water); (3) continued breastfeeding—breastfeeding until age 2 or longer, in addition to adequate and safe solid, semisolid or soft foods (also called complementary foods) [45–47]. Immediate skin-to-skin contact and starting breastfeeding early keeps a baby warm, builds his or her immune system, promotes bonding, boosts a mother's milk supply and increases the chances that she will be able to continue exclusive breastfeeding. Breastmilk is more than just food for babies—it is also a potent medicine for disease prevention that is tailored to the needs of each child. The 'first milk'—or colostrum—is rich in antibodies to protect babies from disease and death, lower risk of developing breast and ovarian cancers.

Neonatal Care in the First Hour of Life http://dx.doi.org/10.5772/intechopen.69600 19

Breastfeeding can also delay mother's ovulation [13, 47].

One of the important factor that contributes to good establishment of breastfeeding is adding of the newborn to the mother's chest as soon as possible after birth, advisably to first half an hour or at least in hour after childbirth. If mother needs an advice or help during this time, it is very important that she gets it. First of feeds is introducing the first food and the first immunization to a child which further encourages the production of colostrum. Baby's sucking reflex is expressed the most during the first hour after a birth. It is awaken during skin-to-skin contact and care. If the mother is breastfeeding the newborn immediately after birth, the hormonal balance during pregnancy is established for a long time, which very favorable impacts on mother's overall health being. In addition, under the influence of the hormone oxytocin, which is secreted, while a newborn stimulates mother's nipples, the uterus intensively cramps and quickly returns to its original size. And this reduces the likelihood of severe bleeding after childbirth. Oxytocin, which increases significantly during skin-to-skin care, promotes

Besides mode of delivery, breastfeeding also provides a route of maternal microbial transmission. Breast milk was considered sterile at first, but in colostrum collected aseptically already harbors hundreds of bacterial species [39].

To ensure the best maternal transmission of beneficial microbes, Reed [41] has made following suggestions:


The complex symbiosis between humans and microbes is important for our health, and breastfeeding benefits the health and well-being of infants. Maternal transmission is also a key factor in shaping the structure of the microbiome in animal species over evolutionary time, since microbes that promote host fitness, especially in females, will simultaneously increase their odds of being transferred to the next generation; therefore, it is essential to create optimal conditions to achieve the transmission.
