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研究还表明，使用抗生素后对后续感染的抵抗力会降低。过去的研究主要集中在产前给予抗生素。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出生后不久的时期是免疫系统与关键相互作用的关键时期。微生物群落和改变最有可能对围产期抗生素产生持久影响。导致新生儿肠道微生物组发生显着变化，并在出生后持续数周。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% 的新生儿在出生时会接触到抗生素，这种情况在围产期广泛使用。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进行调查，我们发现围产期抗生素暴露与较高的风险有关。特应性疾病的发生率和因医生诊断的感染而导致的儿科就诊。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我们的第二个具体目标是衡量围产期抗生素对非预防性药物的影响。为了实现我们的目标，我们将因最常见的医生诊断的儿童感染而前往护理办公室就诊。形成一个出生队列，由 2007 年至 2012 年在 2 个主要分娩中心分娩的足月婴儿组成，转介新生儿费城儿童医院 (CHOP) 的儿科护理网络我们将利用 CHOP 的庞大儿科护理网络。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的差异。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向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，但我们的研究结果可能会对早期的安全性产生深远的影响。抗生素暴露，并可能导致新生儿临床实践的重大修改。