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Doctors Test Bacterial Smear After Cesarean Sections To Bolster Babies' Microbiomes

Oct 30, 2018
Originally published on November 21, 2018 12:08 pm

Danielle Vukadinovich is sitting up in a hospital bed at the Inova Women's Hospital in Falls Church, Va., waiting to give birth.

"I feel good, I'm excited!" says Vukadinovich, 35, of Annandale, Va., "Nervous, but good!"

Vukadinovich is getting a cesarean section today. It's the second time for her — she underwent the surgical procedure 19 months ago when her twins were born.

This time Danielle wants to try something different, something that might sound strange. As soon as her daughter is born, a doctor will wipe fluid from Danielle's birth canal or a sterile solution that serves as a placebo all over her baby's body.

"I haven't told many people about this yet," Vukadinovich says, laughing. "I understand why people would be like, 'Oh my gosh. That's so weird.' But I don't think it's yucky. It's normal. It's natural really."

The procedure, known as "vaginal seeding," is designed to help babies develop healthy microbiomes — the collection of friendly bacteria that inhabit every person's body. Some people call it a "bacterial baptism."

"It's a little bit like that baby's first dunk," says Shira Levy, the microbiome research manager at the Inova hospital. "That's their first religious experience. You know, they get the water and that changes their spirituality.

"In this case, they get the bacteria and that changes their microbiome," Levy says. "This is their first microbiome experience."

The procedure was developed in response to the sharp rise in C-section births in recent years. That increase has been accompanied by more cases of asthma, allergies, eczema, obesity, and other diseases.

The theory is that the rise in these diseases might be happening, in part, because babies aren't getting exposed to their mother's microbes the way they would if they were passing naturally through the birth canal.

"We think that one of the reasons that babies born by C-section are at increased risk for these diseases is because they don't receive that first beneficial exposure to their mother's vaginal microbiome," says Suchitra Hourigan, a pediatric gastroenterologist at Inova.

One very small study indicated that swabbing C-section babies with their mother's microbes immediately after birth could make their microbiomes develop more like those of babies born vaginally.

But the appeal of vaginal seeding has outpaced evidence that it is safe and effective.

Some couples have started trying vaginal seeding on their own. Vukadinovich jokes that she considered doing it herself. After all, she says, she's a nurse and her husband is a high school biology teacher.

"I even told my mom: 'Nobody has to know. My husband would help me out,' " she says, laughing. "But I try not to take unnecessary risks."

Vukadinovich knows the procedure could be risky. Babies could be inadvertently exposed to disease-causing microbes, such as herpes virus or streptococcus bacteria.

In fact, medical groups such as the American College of Obstetrics and Gynecology warn women against doing this. "While there are data to suggest that there may be some scientific plausibility to the concept, it is not without significant risks," says Neil Silverman, a clinical professor of obstetrics and gynecology at the UCLA School of Medicine, who represents ACOG. The group notes that mothers also transfer microbes to their newborns through skin-to-skin contact and breastfeeding.

So Vukadinovich was thrilled when she found out she could be part of the first study the Food and Drug Administration is allowing to rigorously test whether the procedure is safe and helps improve babies' health.

"Who knows what's going to happen with the results? But if it does show something positive, I just think that would be great for kids and parents," she says.

Hourigan, who's helping lead the study, agrees. "Just to be able to reduce one risk factor for obesity, especially when there are such high [C-section rates] in the U.S., would be huge," she says.

In the study, half of the babies will get swabbed with their mother's microbes; half will get swabbed with a sterile solution. All of the mothers will be carefully screened for dangerous infections.

All of the babies will then be followed for three years to see if they become obese or develop other health problems. A similar study is starting at the Icahn School of Medicine at Mount Sinai in New York City.

Vukadinovich agreed to let an NPR reporter and photographer observe her baby's birth and the swabbing. It's the first time journalists have been allowed to watch a baby go through the study.

Evelyn Marie is born

As the nurses wheel Vukadinovich into the operating room, Hourigan, Levy and Dr. Varsha Deopujari follow. Deopujari, the study's clinical manager, will do the actual swabbing.

Inside the OR, everyone quickly takes their places. As the surgeon starts, Hourigan explains what's happening. It goes very fast.

"An incision is being made into mom, and they are getting ready to take out the baby," Hourigan says. "They can see the head. And the head is now coming out of the C-section incision. Baby's head is out."

In less than a minute after the surgery starts, the baby girl is completely out. A nurse rushes the newborn to a nearby table to clear her breathing. After the baby is breathing smoothly, Deopujari starts swabbing with a gauze pad.

First, she swabs the baby's mouth, cheeks and face. After turning the gauze over to expose more bacteria, Deopujari wipes the baby's hands and arms. Next, she wipes down her chest, goes over her abdomen, up the other arm and then over her back.

"And the swabbing is now over," Hourigan says.

Deopujari hands the baby back to a nurse. Hourigan and her team quickly head out of the OR.

"That went perfectly," she says. "Baby came out and was crying. We waited until baby was stable, and the swabbing went just as planned."

Hourigan and her colleagues will swab 50 babies to make sure their procedure is safe. If it is, they plan to expand the study to 800 babies, who would randomly receive either the bacterial swab or a placebo, throughout the Inova hospital system.

The results could prove important. "We need more data and we need better data," says Silverman, of ACOG. "If it shows that there is a clear benefit, then this process can be re-evaluated."

The next morning, Vukadinovich, her husband, Nick, 41, and their new daughter are together in a hospital room.

"I'm good — feeling good today," she says, cradling her baby.

The couple doesn't know if their new daughter, who they would later name Evelyn Marie, was exposed to her mother's microbes or a sterile placebo solution. But they have their fingers crossed she was swabbed with bacteria.

"I really hope that she was," Vukadinovich says. "If there's a decreased chance of her having any health issues, that would be awesome."

Her husband, Nick, agrees.

"We're not terribly religious so we won't baptize with water — holy water," Nick says. "But since we're scientists, we like the idea of a bacterial baptism instead of a holy baptism — because now she's been initiated with bacteria, friendly bacteria, that should protect her down the road."

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

STEVE INSKEEP, HOST:

Some new parents have started giving their newborns what's being called a bacterial baptism. The idea is to try to help their babies develop healthy microbiomes, the collection of friendly bacteria that inhabit everyone's bodies. NPR health correspondent Rob Stein brings us this exclusive story about the birth of one of the first babies helping scientists test this procedure.

(SOUNDBITE OF HOSPITAL MACHINE BEEPING)

ROB STEIN, BYLINE: It's early in the morning at the Inova Women's Hospital in Falls Church, Va. Danielle Vukadinovich is waiting to give birth to a baby girl.

DANIELLE VUKADINOVICH: Hi. Danielle. Nice to meet you.

STEIN: Nice to meet you, too.

Danielle is having a caesarean section.

How you doing?

D. VUKADINOVICH: I feel good (laughter).

STEIN: Yeah?

D. VUKADINOVICH: Yeah. Excited, nervous, (laughter), but good.

STEIN: Danielle has agreed to try something that might sound a little, well, yucky - let a doctor wipe bacteria from Danielle's birth canal all over her baby's body as soon as she's born.

D. VUKADINOVICH: (Laughter). Yes. So I will tell you I haven't told many people about this (laughter) yet. And I understand why people would be like, oh, my gosh, that's so weird. But I'm OK with it. I don't think it's yucky. It's normal. It's, like, real - it's natural, really.

STEIN: Some people call it a bacterial baptism. Shira Levy is the microbiome research manager at the hospital.

SHIRA LEVY: It's a little bit like that baby's first dunk. That's their first religious experience. This is their first microbiome experience. You know, they get the water, and that changes their spirituality. In this case, they get the bacteria, and that changes their microbiome. (Laughter).

STEIN: The microbiome is the millions of friendly microbes that live in our bodies. Danielle's a nurse. She knows C-sections have skyrocketed. She also knows lots of diseases, like asthma, allergies, obesity, have spiked, maybe partly because babies aren't getting their mom's microbes during their birth.

D. VUKADINOVICH: When a baby is born through the vaginal canal and they get that first introduction of bacteria, it starts their immune system. The C-section's a very sterile procedure. You know, they're not getting that first kick in their immune system. And it just made sense that it's a possibility that, you know, this spike in C-sections is linked to possible health issues with our kids.

STEIN: Danielle heard about other moms trying bacterial baptisms on their own. So she thought, I am a nurse. My husband teaches high school biology.

D. VUKADINOVICH: I even told my mom, maybe I can do this (laughter) myself. Nobody has to know. My husband would help me out. But it's - you know, again, I try not to take unnecessary risks.

STEIN: Danielle knows it could be dangerous. Babies could catch nasty infections by mistake. So she was thrilled when she found out she could be part of a study, the first study the Food and Drug Administration is allowing to test whether this is safe and helps babies.

D. VUKADINOVICH: I mean, who knows what's going to happen with the results? But if it does show something positive, I just think that would be great for kids and parents.

STEIN: Dr. Suchi Hourigan is with us. She's leading the study. Half the babies will get their mom's microbes. Half will get a placebo. All the moms will be carefully screened to make sure the microbes are safe.

SUCHI HOURIGAN: This could be huge. Just to be able to reduce one risk factor for obesity, especially when there are such high C-sections in the USA, would be huge.

UNIDENTIFIED NURSE #1: So can't wait to meet your little one.

STEIN: Just then nurse pops in and ushers us out so they can remove the gauze pad that's been inside Danielle collecting the friendly bacteria doctor will use to swab her baby. The doctors and nurses call it vaginal seeding.

UNIDENTIFIED NURSE #1: Yeah. Very excited. I did the first seeding.

D. VUKADINOVICH: You did?

UNIDENTIFIED NURSE #1: It's really cool.

STEIN: And now it's time for the C-section. As they wheel Danielle into the operating room, I follow along with Dr. Hourigan.

UNIDENTIFIED NURSE #1: Don't touch anything blue 'cause it's sterile.

UNIDENTIFIED NURSE #2: Are we ready to start?

STEIN: Everyone quickly takes their places, and the surgeon gets to work. Dr. Hourigan explains what's happening.

HOURIGAN: An incision is being made into Mom, and they are getting ready to take out the baby. They can see the head, and the head is now coming out of the C-section incision. Baby's head is out.

UNIDENTIFIED NURSE #3: Time, 8:38.

UNIDENTIFIED NURSE #4: Hello, little girl.

STEIN: It happens just that quick. The nurses rush the baby over to a table to clear her breathing.

UNIDENTIFIED NURSE #1: Oh, my goodness. You're beautiful. Rub you a little more.

STEIN: Once she's nice and pink, Dr. Varsha Deopujari gets to work with the gauze swab for the study.

HOURIGAN: Varsha is wiping the swab over baby's mouth, cheeks and face. She is going to turn the swab over to get more exposure to bacteria. And then she is now wiping the baby's hands and arms.

STEIN: She swabs down her chest, over her abdomen and up the other arm.

HOURIGAN: And then finally, baby's back is being wiped now. And the swabbing is now over.

STEIN: They hand the baby back to the nurse.

UNIDENTIFIED NURSE #1: She did beautifully with that.

STEIN: Dr. Hourigan and her team quickly head out of the operating room.

HOURIGAN: That went perfectly. Baby came out and was crying. We waited till baby was stable, and the swabbing went just as planned. Beautiful baby girl.

STEIN: The next morning, I stop by to check in on Danielle, her husband, Nick, and their new daughter. Hi. How you doing?

D. VUKADINOVICH: I'm good. Feeling good today.

STEIN: What a sweetie.

D. VUKADINOVICH: Yeah. She is. She's sweet.

STEIN: Danielle and Nick are still trying to decide on a name, and they don't actually know if their new daughter got Danielle's microbes or a sterile solution, but they have their fingers crossed she was swabbed with the microbes.

D. VUKADINOVICH: I really hope that she was and that, you know, she won't have any health issues. I think if there's a decreased chance of her having health issues, that would be awesome.

STEIN: Her husband, Nick, agrees.

NICK VUKADINOVICH: We're not terribly religious so we won't baptize with water, holy water. But we like the idea of a bacterial baptism instead of a holy baptism 'cause now she's been initiated with the bacteria, friendly bacteria, and that should protect her down the road.

D. VUKADINOVICH: I like that. It's nice.

STEIN: Dr. Hourigan will do this with 50 babies to make sure it's safe and then hopefully expand the study to 800 newborns who will be followed for three years to see if bacterial baptisms really do help them live better lives. And if you're wondering, Danielle and her husband, Nick, finally settled on a name, Evelyn Marie (ph).

Rob Stein, NPR News, Falls Church, Va. Transcript provided by NPR, Copyright NPR.