Photo: Wikimedia Commons / Kókay Szabolcs
Eight months pregnant and stressed-out was how I found myself roughly two years ago, sitting in front of the computer screen. I was on the Air Canada website, attempting to book a flight from Vancouver to Winnipeg so I could visit family six weeks after my daughter’s due date. But I was terrified to click on “Book Flight.”
Everyone knows that airplane cabins are festering clouds of germs, right? There’s science to back that up: one study of microbes inside airplanes found that circulating cabin air contained an abundance of opportunistic pathogenic inhabitants of the human respiratory tract and oral cavity. So if I brought a newborn with a still-developing immune system on board, would I be putting her life in danger? She wouldn’t even have had her first vaccinations yet. What kind of monster would I be for taking her on this flight?
At the time, my knowledge about the infant immune system was based mainly on what my health care practitioners had told me--which was practically nothing. I had even asked a nurse about airplane flights, specifically, and she said she didn’t know whether or not it was a good idea. That probably accounted for why I couldn’t bring myself to click the button that committed me to the flight.
What I failed to realize at the time was how much the recent research on the human microbiome—the bacteria that live on and inside us--was relevant to the issue. It just required putting together a few scientific pieces.
When a baby is born, she is more-or-less a microbial blank slate. Recent research calls into question the age-old assumption that babies are completely bacteria-free in the womb, but it’s clear that the main bacterial exposure comes during and after birth.) So the act of coming into the world is of great importance to a baby’s health, because the moment she hits the birth canal, she is exposed to a diverse set of bacteria that colonize her tiny -- Tender makes me think of food -- body.
The baby’s immune system is indeed immature at that point, leaving her vulnerable to infections. In fact, a new study actually found evidence of immunosuppression in newborns, which is probably because the baby needs to remain “vulnerable to,” or open to, good bacteria taking up residence. It seems excessive inflammation caused by a sensitive immune system would do more harm than good at that point.
The microbes that colonize a newborn’s body in the first weeks basically are her immune system. When the right kinds of good bacteria are present, pathogens have more difficulty getting a foothold.
So what gives a newborn a healthy collection of microbes that provide immunity? Studies consistently find that infants who have been delivered vaginally, rather than by cesarean section, have microbiomes that contain a greater number of species. Ditto for those who were breastfed--they got a bunch of good bacteria packed into every meal (though certain probiotics can easily substitute). Gestational age at birth also seems to matter, as the colonization happens differently in a preterm baby’s gut -- Are there other ways these bacteria could be acquired? I don't think we necessarily need to guilt mothers who delivered via c-section or who can't/don't want to breastfeed --. Other bacteria, both good and bad, come from the baby’s environment--the people and surfaces that she touches.
The science seemed to say that as long as baby’s good bacteria are thriving, the chances of her getting a terrible bacterial infection on an airplane flight should be quite low. Great news.
But on the other hand, there’s still a problem. Despite the gargantuan importance of the microbiome early in life--with some calling it the “forgotten organ” of the human body and arguing that the effects of early microbial colonization last a lifetime--why are health practitioners not prepared for questions about it? My (anecdotal) survey of friends who’ve recently had babies uncovered not a single report of a care provider who had brought up the topic. It’s a huge oversight, given the volume of research on the topic over the past two years or so. Doctors, nurses, and midwives need to get up-to-date on this, and quickly. Especially because a few good ideas are bouncing around that may help save some newborns from serious infections. In my case, giving me all the facts might just have saved me from unnecessary anxiety.
The end of the story is this: I took the flight, and the baby was fine. In fact, we took 18 flights the first year, and all of them were fine. The risk of taking a baby on an airplane, or anywhere that’s microbially unfamiliar, can be mitigated by ensuring good colonization in those early weeks.
Unfortunately, I can’t say the same for the risk of dirty looks from fellow passengers when your baby cries. Good luck with that, parents.
Kristina Campbell, a.k.a. “The Intestinal Gardener”intestinalgardener.blogspot.ca