Incidence of atopy and childhood infections in uninfected term newborns with perinatal antibiotic exposure

围产期抗生素暴露的未感染足月新生儿中特应性和儿童期感染的发生率

• 批准号: 10223389
• 负责人: Sagori Mukhopadhyay
• 金额: $ 15.68万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10223389
• 关键词: 5 year old; Address; Admission activity; Affect; American; Antibiotic Therapy; Antibiotics; Asthma; Bacterial Infections; Benefits and Risks; Bioinformatics; Birth; Birthing Centers; Caring; Cell Differentiation process; Cessation of life; Child; Childhood; Clinical; Clinical Research; Communicable Diseases; Computerized Medical Record; Data; Databases; Development; Diagnosis; Discipline of obstetrics; Disease; Eczema; Electronic Health Record; Equilibrium; Exposure to; Food Hypersensitivity; Frequencies; Future; Goals; Health; Health Care Visit; Healthcare; High Prevalence; Hypersensitivity; Immune; Immune response; Immune system; Immunology; Incidence; Infant; Infection; Intravenous; Investigation; Knowledge; Life; Link; Live Birth; Measures; Mediating; Mentors; Methods; Microbiology; Morbidity - disease rate; Mothers; Necrotizing Enterocolitis; Neonatal; Neonatology; Newborn Infant; Office Visits; Outcome; Pediatric Hospitals; Perinatal; Perinatal Epidemiology; Pharmacy facility; Phenotype; Philadelphia; Physicians; Pregnancy; Premature Infant; Prevention approach; Primary Health Care; Reporting; Resistance; Risk; Safety; Sepsis; Services; Stimulus; System; Term Birth; Time; United States; Visit; Woman; atopy; clinical Diagnosis; clinical data repository; clinical practice; cohort; cost; dysbiosis; early childhood; early onset; epidemiology study; follow-up; gut microbiome; host microbiota; infancy; infant gut microbiome; intrapartum; longitudinal database; microbial; microbiota; neonatal immune system; neonatal infection; neonatal period; neonate; perinatal period; prenatal; prevent; prophylactic; trend

PROJECT SUMMARY/ABSTRACT Multiple clinical studies have found an association between antibiotic exposures in infancy and atopic disorders. Studies have also demonstrated a reduced resistance to subsequent infections after antibiotic therapy for culture-negative infection. Past studies have focused on either prenatal antibiotics given to the mother during pregnancy, or on childhood antibiotics, with little investigation of perinatal antibiotic exposure given to mothers at the time of labor and to neonates immediately after birth. Antibiotic effect on childhood diseases is likely mediated by alteration of host microflora diversity, adversely impacting the development of immune responses. The immediate period after birth is a critical time for immune system interaction with key microflora taxa and alterations are most likely to have enduring effects. Perinatal antibiotics have been shown to cause significant changes in the neonatal gut microbiome that persist for weeks after birth. The increasing use of intrapartum and neonatal antibiotics to prevent early-onset neonatal bacterial infection means that ~30% of newborns are now exposed to antibiotics around the time of birth. This widespread use of perinatal antibiotics may have a significant effect of childhood outcomes of atopic and infectious diseases that has not yet been investigated. We hypothesize that perinatal antibiotic exposures will be associated with a higher incidence of atopic diseases and pediatric office visits due to physician-diagnosed infection. Our first specific aim will address the relationship of perinatal antibiotics to the clinical diagnosis of atopic disorders in the first five years of life. Our second specific aim is to measure the impact of perinatal antibiotics on non-preventative care office visits due to the commonest physician-diagnosed childhood infections. To achieve our aims, we will form a birth cohort of term infants delivered from 2007-2012 at the 2 main birthing centers referring newborns to The Children’s Hospital of Philadelphia (CHOP) pediatric care network. We will leverage CHOP’s large integrated electronic health records from over 31 centers to follow infants from their birthing admissions until 5 years of age and form a detailed longitudinal database spanning obstetrical, neonatal and childhood health care data. Using this database we will determine the difference in incidence of any atopic diagnosis and episodes of non-preventative health visits due to infections among infants with and without exposure to perinatal antibiotics. Perinatal antibiotic exposures are provided to mothers and their newborns with the assumption that they constitute safe approaches to the prevention of a neonatal infection, a low incidence but high morbidity disease. The results of our study may have a profound impact the perceived safety of early antibiotic exposures, and could result in a major revision of newborn clinical practice.

项目概要/摘要 多项临床研究发现婴儿期抗生素暴露与特应性过敏之间存在关联 失调。研究还表明，使用抗生素后对后续感染的抵抗力会降低 培养阴性感染的治疗。过去的研究主要集中在产前抗生素 母亲在怀孕期间或儿童时期服用抗生素，很少对围产期抗生素暴露进行调查 在分娩时给予母亲和出生后立即给予新生儿。抗生素对儿童的影响 疾病可能是由宿主微生物群多样性的改变介导的，对宿主的发育产生不利影响 免疫反应。出生后不久的时期是免疫系统与关键免疫系统相互作用的关键时期。 微生物群落和改变最有可能产生持久影响。围产期抗生素已被证明 引起新生儿肠道微生物群的显着变化，并在出生后持续数周。不断增加的 使用产时和新生儿抗生素来预防早发性新生儿细菌感染意味着约 30% 的新生儿在出生时就会接触抗生素。这种广泛使用的围产期 抗生素可能对特应性和传染病的儿童结局产生显着影响，但这种影响尚未出现 尚未被调查。我们假设围产期抗生素暴露与较高的 特应性疾病的发生率和因医生诊断的感染而到儿科就诊的情况。我们的第一个具体 目标将首先解决围产期抗生素与特应性疾病临床诊断的关系 五年的生活。我们的第二个具体目标是衡量围产期抗生素对非预防性妊娠的影响 由于最常见的医生诊断的儿童感染而前往护理办公室就诊。为了实现我们的目标，我们将 form a birth cohort of term infants delivered from 2007-2012 at the 2 main birthing centers referring newborns 费城儿童医院 (CHOP) 儿科护理网络。我们将利用 CHOP 的大型 整合来自超过 31 个中心的电子健康记录，跟踪婴儿从出生到 5 点的情况 年龄并形成涵盖产科、新生儿和儿童健康的详细纵向数据库 护理数据。使用该数据库，我们将确定任何特应性诊断和治疗的发生率差异 由于接触或未接触过接触过的婴儿感染而导致的非预防性健康就诊事件 围产期抗生素。为母亲及其新生儿提供围产期抗生素暴露 假设它们是预防新生儿感染的安全方法，虽然发生率低，但 高发病率疾病。我们的研究结果可能会对早期的安全感产生深远的影响 抗生素暴露，并可能导致新生儿临床实践的重大修改。

项目成果

Intrapartum group B Streptococcal prophylaxis and childhood weight gain.

• DOI: 10.1136/archdischild-2020-320638
• 发表时间: 2021-11
• 期刊: Archives of disease in childhood. Fetal and neonatal edition
• 作者: Mukhopadhyay S;Bryan M;Dhudasia MB;Quarshie W;Gerber JS;Grundmeier RW;Koebnick C;Sidell MA;Getahun D;Sharma AJ;Spiller MW;Schrag SJ;Puopolo KM
• 通讯作者: Puopolo KM

Breast Milk and Saliva for Postnatal Cyto†megalovirus Screening among Very Low Birth Weight Infants.

母乳和唾液用于极低出生体重婴儿产后巨细胞病毒筛查。

• DOI: 10.1097/inf.0000000000003671
• 发表时间: 2022
• 期刊: The Pediatric infectious disease journal
• 作者: Mukhopadhyay,Sagori;Itell,HannahL;Hartman,Erica;Woodford,Emily;Dhudasia,MirenB;Steppe,JustinT;Valencia,Sarah;Roark,Hunter;Wade,KellyC;Weimer,KristinED;Permar,SallieR;Puopolo,KarenM
• 通讯作者: Puopolo,KarenM

Neonatal blood culture inoculant volume: feasibility and challenges.

• DOI: 10.1038/s41390-021-01484-9
• 发表时间: 2021-11
• 期刊: Pediatric research
• 影响因子: 3.6
• 作者: Woodford EC;Dhudasia MB;Puopolo KM;Skerritt LA;Bhavsar M;DeLuca J;Mukhopadhyay S
• 通讯作者: Mukhopadhyay S

Association of Infection in Neonates and Long-Term Neurodevelopmental Outcome.

新生儿感染与长期神经发育结果的关联。

• DOI: 10.1016/j.clp.2021.03.001
• 发表时间: 2021-06
• 期刊: Clinics in perinatology
• 影响因子: 2.1
• 作者: Sewell E;Roberts J;Mukhopadhyay S
• 通讯作者: Mukhopadhyay S

Improving Compliance With Revised Newborn Hepatitis B Vaccination Policy.

• DOI: 10.1542/hpeds.2021-005969
• 发表时间: 2021-12-01
• 期刊: Hospital pediatrics
• 作者: Pulsifer, Allene;Puopolo, Karen M;Skerritt, Lauren;Dhudasia, Miren B;Pyle, Beth Ann;Schumacher, Aida;Mukhopadhyay, Sagori
• 通讯作者: Mukhopadhyay, Sagori