Abstract
Bronchopulmonary dysplasia (BPD) is a multifactorial disease mainly provoked by pre- and postnatal infections, mechanical ventilation, and oxygen toxicity. In severely affected premature infants requiring mechanical ventilation, association of bacterial colonization of the lung and BPD was recently disclosed. To analyze the impact of bacterial colonization of the upper airway and gastrointestinal tract on moderate/severe BPD, we retrospectively analyzed nasopharyngeal and anal swabs taken weekly during the first 6 weeks of life at a single center in n = 102 preterm infants <1000 g. Colonization mostly occurred between weeks 2 and 6 and displayed a high diversity requiring categorization. Analyses of deviance considering all relevant confounders revealed statistical significance solely for upper airway colonization with bacteria with pathogenic potential and moderate/severe BPD (p = 0.0043) while no link could be established to the Gram response or the gastrointestinal tract. Our data highlight that specific colonization of the upper airway poses a risk to the immature lung. These data are not surprising taking into account the tremendous impact of microbial axes on health and disease across ages. We suggest that studies on upper airway colonization using predefined categories represent a feasible approach to investigate the impact on the pulmonary outcome in ventilated and non-ventilated preterm infants.
Highlights
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of preterm infants leading to life-long restrictions in lung function even in infants who do not fulfill the clinical criteria of bronchopulmonary dysplasia (BPD) of dependency on mechanical ventilation or oxygen at a corrected age of 36 weeks of gestation [1,2]
BPD evokes from an inflammatory response in the immature lung that is dominated by pro-inflammatory cytokines and the influx of inflammatory cells causing dysregulation of the highly complex program of further lung development
To dissect the impact of specific patterns of microbial colonization and BPD, we focused our analysis on preterm infants with a birth weight
Summary
Bronchopulmonary dysplasia (BPD) is a chronic lung disease of preterm infants leading to life-long restrictions in lung function even in infants who do not fulfill the clinical criteria of BPD of dependency on mechanical ventilation or oxygen at a corrected age of 36 weeks of gestation [1,2]. BPD evokes from an inflammatory response in the immature lung that is dominated by pro-inflammatory cytokines and the influx of inflammatory cells causing dysregulation of the highly complex program of further lung development. Mechanical ventilation and oxygen toxicity constitute well accepted key drivers of the imbalance of pro-inflammatory properties and anti-inflammatory and lung growth promoting signaling pathways. The impact of pre- and postnatal infections on lung maturation was not established until recently. Meta-analyses clearly demonstrate the overall negative impact of infections on lung development [5,6]. Bacterial colonization can exert beneficial features inducing immunotolerance and modifying the corticosteroid stress response [7,8,9,10]
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