Bacterial Colonization within the First Six Weeks of Life and Pulmonary Outcome in Preterm Infants <1000 g

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 &lt;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.

MSC Based Therapies to Prevent or Treat BPD—A Narrative Review on Advances and Ongoing Challenges

“…These actions observed for BPD animal models are in line with the main actions described for EV in general [ 102 ]. In the context of EV delivery to the immature lung, further drivers of BPD as infections and microbial dysbiosis have not been evaluated so far [ 103 , 104 ]. However, promising studies have been conducted on the treatment of neonatal sepsis [ 105 ].…”

Oxygen Toxicity to the Immature Lung—Part I: Pathomechanistic Understanding and Preclinical Perspectives

“…A further dimension that deserves more detailed clarification is the microbial colonization in utero and after birth. Clear associations have been demonstrated with the extent of lung injury, but the few preclinical studies so far do not deliver congruent results [16,17]. Therefore, this review is restricted to the available research data, mostly on isolated ROS toxicity, but important studies combining hyperoxic and infectious injury are cited where appropriate.…”

Gut microbiota and bronchopulmonary dysplasia

“…9 Paradoxically, however, Althouse et al 56 reported that although MAE caused gut dysbiosis, this did not dramatically exacerbate the hyperoxia lung injury phenotype. Other studies have indicated that the lung microbiota is more likely to influence BPD severity than the gut microbiota, 57 suggesting that the correlation between gut microbiota and BPD needs further investigation.…”