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

基本信息

批准号：
9314655
负责人：
Sagori Mukhopadhyay
金额：
$ 15.99万
依托单位：
CHILDREN'S HOSP OF PHILADELPHIA
依托单位国家：
美国
项目类别：
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/9314655
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 warehouse clinical practice cohort cost early childhood early onset epidemiology study follow-up gut microbiome infancy intrapartum longitudinal database microbial microbiota neonatal immune system neonate prenatal prevent prophylactic trend

项目摘要

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.

项目摘要/摘要多项临床研究发现，婴儿期抗生素暴露与特应性疾病。研究还表明，抗生素后对随后感染的抗性降低培养 - 阴性感染的治疗。过去的研究集中于给予的任何一种产前抗生素母亲在怀孕期间或儿童期抗生素，几乎没有研究围产期抗生素分娩时和新生儿在出生后立即给予母亲。抗生素对童年疾病可能是通过改变宿主菌群多样性的改变来介导的，从而不利地影响免疫反应。出生后的近期是与钥匙的免疫系统相互作用的关键时期微生物类群和改变最有可能产生持久影响。已显示围产期抗生素在出生后数周持续数周的新生儿肠道微生物组引起显着变化。增加使用内部和新生儿抗生素预防早期发作的新生儿感染意味着约30％现在，新生儿在出生时就暴露于抗生素。围产期的这种宽度使用抗生素可能对没有特征性和感染性疾病的童年结局产生重大影响尚未调查。我们假设围产期抗生素暴露将与较高的由于物理诊断的感染而导致的特应性疾病和小儿办公室就诊的发生率。我们的第一个特定 AIM将解决围产期抗生素与第一个特应性疾病的临床诊断的关系五年生命。我们的第二个具体目的是衡量围产期抗生素对非预先鉴定的影响护理办公室访问由于最常见的身体诊断儿童感染。为了实现我们的目标，我们将成立于2007年至2012年在两个主要生日中心送达新生儿的生日婴儿的生日群体到费城儿童医院（CHOP）儿科护理网络。我们将利用Chop的大型来自31多个中心的整合电子健康记录，跟随婴儿从生日入院到5岁年龄并形成跨越产科，新生儿和儿童健康的详细纵向数据库护理数据。使用此数据库，我们将确定任何特应诊断的发生率差异和由于有或没有暴露的婴儿感染引起的非预防健康访问的发作围产期抗生素。向母亲及其新生儿提供围产期抗生素暴露假设它们构成了预防新生儿感染的安全方法，这是一个低事件，但高发病疾病。我们研究的结果可能会产生深远的影响。抗生素暴露，可能会导致新生儿临床实践的重大修订。