Increased Risk of Pneumonia and Bronchiolitis after Bacterial Colonization of the Airways as Neonates

Nadja Hawwa Vissing; Bo Lk Chawes; Hans Bisgaard

doi:10.1164/rccm.201302-0215oc

Increased Risk of Pneumonia and Bronchiolitis after Bacterial Colonization of the Airways as Neonates

Nadja Hawwa Vissing, Bo Lk Chawes, Hans Bisgaard

95 Citations (Scopus)

Abstract

Rationale: The frequency of pneumonia and bronchiolitis exhibits considerable variation in otherwise healthy children, and suspected risk factors explain only a minor proportion of the variation. We hypothesized that alterations in the airway microbiome in early life may be associated with susceptibility to pneumonia and bronchiolitis in young children. Objectives: To investigate the relation between neonatal airway colonization and pneumonia and bronchiolitis during the first 3 years of life. Methods: Participants comprised children of the Copenhagen Prospective Studies on Asthma in Childhood ₂₀₀₀ (COPSAC₂₀₀₀) cohort, a prospective birth cohort study of 411childrenborn tomothers with asthma. Aspirates from the hypopharynx at age 4 weeks were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Clinical information on pneumonia and bronchiolitis within the first 3 years of life was prospectively collected by the research physicians at the center. Analyses were adjusted for covariates associated with pneumonia and bronchiolitis and bacterial airway colonization. Measurements and Main Results: Hypopharyngeal aspirates and full clinical follow-up until 3 years of age were available for 265 children. Of these, 56 (21%) neonates were colonized with S. pneumoniae, H. influenzae, and/or M. catarrhalis at 4 weeks of age. Colonization with at least one of these microorganisms (but not S. aureus) was significantly associated with increased incidence of pneumonia and bronchiolitis (adjusted incidence rate ratio, 1.79 [1.29-2.48]; P < 0.005) independently of concurrent or later asthma. Conclusions: Neonatal airway colonizationwith S. pneumoniae, H. influenzae, or M. catarrhalis is associated with increased risk of pneumonia and bronchiolitis in early life independently of asthma. This suggests a role of pathogenic bacterial colonization of the airways in neonates for subsequent susceptibly to pneumonia and bronchiolitis.

Original language	English
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	188
Issue number	10
Pages (from-to)	1246-1252
Number of pages	7
ISSN	1073-449X
DOIs	https://doi.org/10.1164/rccm.201302-0215oc
Publication status	Published - 15 Nov 2013

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@article{004a2b9393bf48bd983ef67d76e51109,

title = "Increased Risk of Pneumonia and Bronchiolitis after Bacterial Colonization of the Airways as Neonates",

abstract = "Rationale: The frequency of pneumonia and bronchiolitis exhibits considerable variation in otherwise healthy children, and suspected risk factors explain only a minor proportion of the variation. We hypothesized that alterations in the airway microbiome in early life may be associated with susceptibility to pneumonia and bronchiolitis in young children. Objectives: To investigate the relation between neonatal airway colonization and pneumonia and bronchiolitis during the first 3 years of life. Methods: Participants comprised children of the Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC2000) cohort, a prospective birth cohort study of 411childrenborn tomothers with asthma. Aspirates from the hypopharynx at age 4 weeks were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Clinical information on pneumonia and bronchiolitis within the first 3 years of life was prospectively collected by the research physicians at the center. Analyses were adjusted for covariates associated with pneumonia and bronchiolitis and bacterial airway colonization. Measurements and Main Results: Hypopharyngeal aspirates and full clinical follow-up until 3 years of age were available for 265 children. Of these, 56 (21%) neonates were colonized with S. pneumoniae, H. influenzae, and/or M. catarrhalis at 4 weeks of age. Colonization with at least one of these microorganisms (but not S. aureus) was significantly associated with increased incidence of pneumonia and bronchiolitis (adjusted incidence rate ratio, 1.79 [1.29-2.48]; P < 0.005) independently of concurrent or later asthma. Conclusions: Neonatal airway colonizationwith S. pneumoniae, H. influenzae, or M. catarrhalis is associated with increased risk of pneumonia and bronchiolitis in early life independently of asthma. This suggests a role of pathogenic bacterial colonization of the airways in neonates for subsequent susceptibly to pneumonia and bronchiolitis.",

author = "Vissing, {Nadja Hawwa} and Chawes, {Bo Lk} and Hans Bisgaard",

year = "2013",

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doi = "10.1164/rccm.201302-0215oc",

language = "English",

volume = "188",

pages = "1246--1252",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

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TY - JOUR

T1 - Increased Risk of Pneumonia and Bronchiolitis after Bacterial Colonization of the Airways as Neonates

AU - Vissing, Nadja Hawwa

AU - Chawes, Bo Lk

AU - Bisgaard, Hans

PY - 2013/11/15

Y1 - 2013/11/15

N2 - Rationale: The frequency of pneumonia and bronchiolitis exhibits considerable variation in otherwise healthy children, and suspected risk factors explain only a minor proportion of the variation. We hypothesized that alterations in the airway microbiome in early life may be associated with susceptibility to pneumonia and bronchiolitis in young children. Objectives: To investigate the relation between neonatal airway colonization and pneumonia and bronchiolitis during the first 3 years of life. Methods: Participants comprised children of the Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC2000) cohort, a prospective birth cohort study of 411childrenborn tomothers with asthma. Aspirates from the hypopharynx at age 4 weeks were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Clinical information on pneumonia and bronchiolitis within the first 3 years of life was prospectively collected by the research physicians at the center. Analyses were adjusted for covariates associated with pneumonia and bronchiolitis and bacterial airway colonization. Measurements and Main Results: Hypopharyngeal aspirates and full clinical follow-up until 3 years of age were available for 265 children. Of these, 56 (21%) neonates were colonized with S. pneumoniae, H. influenzae, and/or M. catarrhalis at 4 weeks of age. Colonization with at least one of these microorganisms (but not S. aureus) was significantly associated with increased incidence of pneumonia and bronchiolitis (adjusted incidence rate ratio, 1.79 [1.29-2.48]; P < 0.005) independently of concurrent or later asthma. Conclusions: Neonatal airway colonizationwith S. pneumoniae, H. influenzae, or M. catarrhalis is associated with increased risk of pneumonia and bronchiolitis in early life independently of asthma. This suggests a role of pathogenic bacterial colonization of the airways in neonates for subsequent susceptibly to pneumonia and bronchiolitis.

AB - Rationale: The frequency of pneumonia and bronchiolitis exhibits considerable variation in otherwise healthy children, and suspected risk factors explain only a minor proportion of the variation. We hypothesized that alterations in the airway microbiome in early life may be associated with susceptibility to pneumonia and bronchiolitis in young children. Objectives: To investigate the relation between neonatal airway colonization and pneumonia and bronchiolitis during the first 3 years of life. Methods: Participants comprised children of the Copenhagen Prospective Studies on Asthma in Childhood 2000 (COPSAC2000) cohort, a prospective birth cohort study of 411childrenborn tomothers with asthma. Aspirates from the hypopharynx at age 4 weeks were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. Clinical information on pneumonia and bronchiolitis within the first 3 years of life was prospectively collected by the research physicians at the center. Analyses were adjusted for covariates associated with pneumonia and bronchiolitis and bacterial airway colonization. Measurements and Main Results: Hypopharyngeal aspirates and full clinical follow-up until 3 years of age were available for 265 children. Of these, 56 (21%) neonates were colonized with S. pneumoniae, H. influenzae, and/or M. catarrhalis at 4 weeks of age. Colonization with at least one of these microorganisms (but not S. aureus) was significantly associated with increased incidence of pneumonia and bronchiolitis (adjusted incidence rate ratio, 1.79 [1.29-2.48]; P < 0.005) independently of concurrent or later asthma. Conclusions: Neonatal airway colonizationwith S. pneumoniae, H. influenzae, or M. catarrhalis is associated with increased risk of pneumonia and bronchiolitis in early life independently of asthma. This suggests a role of pathogenic bacterial colonization of the airways in neonates for subsequent susceptibly to pneumonia and bronchiolitis.

U2 - 10.1164/rccm.201302-0215oc

DO - 10.1164/rccm.201302-0215oc

M3 - Journal article

C2 - 24090102

SN - 1073-449X

VL - 188

SP - 1246

EP - 1252

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 10

ER -

Increased Risk of Pneumonia and Bronchiolitis after Bacterial Colonization of the Airways as Neonates

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