Background Pathological features of the airway in young childrenwith severe recurrent wheeze suggest an association betweenbacterial colonization and the initiating events of early asthma.We conducted a study to investigate a possible association betweenbacterial colonization of the hypopharynx in asymptomatic neonatesand later development of recurrent wheeze, asthma, and allergyduring the first 5 years of life.
Methods The subjects were children from the Copenhagen ProspectiveStudy on Asthma in Childhood birth cohort who were born to motherswith asthma. Aspirates from the hypopharyngeal region of asymptomatic1-month-old infants were cultured for Streptococcus pneumoniae,Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcusaureus. Wheeze was monitored prospectively on diary cards duringthe first 5 years of life. Blood eosinophil count and totalIgE and specific IgE were measured at 4 years of age. Lung functionwas measured and asthma was diagnosed at 5 years of age.
Results Hypopharyngeal samples were cultured from 321 neonatesat 1 month of age. Twenty-one percent of the infants were colonizedwith S. pneumoniae, M. catarrhalis, H. influenzae, or a combinationof these organisms; colonization with one or more of these organisms,but not colonization with S. aureus, was significantly associatedwith persistent wheeze (hazard ratio, 2.40; 95% confidence interval[CI], 1.45 to 3.99), acute severe exacerbation of wheeze (hazardratio, 2.99; 95% CI, 1.66 to 5.39), and hospitalization forwheeze (hazard ratio, 3.85; 95% CI, 1.90 to 7.79). Blood eosinophilcounts and total IgE at 4 years of age were significantly increasedin children colonized neonatally with S. pneumoniae, M. catarrhalis,H. influenzae, or a combination of these organisms, but specificIgE was not significantly affected. The prevalence of asthmaand the reversibility of airway resistance after 2-agonist administrationat 5 years of age were significantly increased in the childrencolonized neonatally with these organisms as compared with thechildren without such colonization (33% vs. 10% and 23% vs.18%, respectively).
Conclusions Neonates colonized in the hypopharyngeal regionwith S. pneumoniae, H. influenzae, or M. catarrhalis, or witha combination of these organisms, are at increased risk forrecurrent wheeze and asthma early in life.
Source Information
From the Danish Pediatric Asthma Center, Copenhagen University Hospital, Gentofte, Copenhagen. Address reprint requests to Dr. Bisgaard at the Danish Pediatric Asthma Center, Copenhagen University Hospital, Hellerup, Niels Andersens Vej 65, DK-2900 Gentofte, Copenhagen, Denmark, or at bisgaard{at}copsac.dk.
Asthma and Neonatal Airway Colonization
Michelow I. C., Fracchia M. S., Kinane T. B., Stallings A. P., Commins S. P., Platts-Mills T. A.E., Hughes-Davies T., Nanan R. K.H., Peek M. J., Bisgaard H., Bønnelykke K., Pipper C., von Mutius E.
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N Engl J Med 2008;
358:423-425, Jan 24, 2008.
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