3 systems grow together for baby’s respiratory health

A new multidisciplinary study by researchers at the University of Rochester Medical Center has found that the co-development of three systems, the gut microbiome, the respiratory system and the immune system, is correlated with a baby’s respiratory health. , and an infant may have negative respiratory disorders. results if the development of any of these systems is disrupted.

The study, “Aberrant Developmental Trajectories of Newborn T Cells and Microbiota Predict Respiratory Compromise in Infancy”, was published in iScience (cell press) and was co-authored by Kristin Scheible, MD, associate professor in the departments of Pediatrics and Microbiology and Immunology, and Andrew McDavid, Ph.D., in the department of Biostatistics and Computational Biology.

The project examined 148 preterm and 119 term infants from birth to one year of age to examine the development of the microbiome, immune and respiratory systems and how this co-development affects a child’s health. These systems usually develop simultaneously and in sync with the baby during its first year of life.

The study found that disruption of any of the three systems led to greater respiratory morbidity in infants. Additionally, the baby’s postmenstrual age (or weeks from conception) was a more accurate benchmark for predicting disruption of any of the systems than time since birth.

“When a baby is born, it’s usually considered day zero for that child. Instead, we modeled it with the baby’s age from the day of conception,” Scheible said. of a baby at 2 months is not the same for a baby born at 32 weeks as for a baby born at 42 years old.”

The implications of using postmenstrual age as a benchmark could potentially change how clinicians view the risks and benefits of immune or microbial therapies, such as antibiotics or probiotics. This study found that antibiotics or prenatal infections disrupt the developmental trajectory. If babies are exposed to antibiotics – especially premature ones – it increases their risk of respiratory disease in the first year of life.

Additionally, caregivers should consider the use of pro and prebiotics, according to Scheible. These interventions may not work when introduced at an inappropriate developmental time, and clinicians should consider using postmenstrual age as a measure of willingness to see benefit from therapies targeting the microbiome and immune system. .

“When you take a baby born prematurely and remove all the protections from the mother, like the placenta, it’s critical to know what’s happening to underdeveloped systems like the microbiome and the immune system. Interventions such as intubation, central lines, oxygen and antibiotics are implemented and influence their development, and the impact of disruption to these systems can reverberate more widely during these critical first two weeks. for the baby,” Scheible said.

At this point, the study found that when the fetus is exposed to antibiotics or infection just before birth, the normal developmental trajectory of the T cell population is disrupted, and this disruption predicts respiratory microbial colonization and subsequent respiratory illness. Additionally, the study authors found that when the microbiome, immune system, or respiratory system are disrupted, the three systems are no longer on a parallel developmental path and it takes several years for the affected system to catch up. delay.

“We were able to model and measure immune and microbiome development and compare it with the patient’s clinical history, and asynchrony of these systems leads directly to poorer respiratory outcomes,” McDavid said.

Further research will be needed to validate these findings and to pinpoint the mechanisms linking microbial-immune co-development. If confirmed, these findings could have major implications for determining the risks/benefits of perinatal antibiotic administration, the optimal timing for immune and microbiota targeting interventions, and for predicting potential respiratory morbidity in infants. exposed preterm and born at term.

“We have not yet found a magic formula to determine who will develop the disease. The usefulness is to suggest other models or interventions that can be tested to try to see how the immune system or the microbiome can be changed in what age-appropriate window,” McDavid said.

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