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Hernandez-Leyva AJ, Rosen AL, Tomera CP, Lin EE, Akaho EH, Blatz AM, Otto WR, Logan J, Young LR, Harris RM, Kau AL, John ARO. Developmental progression of the nasopharyngeal microbiome during childhood and association with the lower airway microbiome. medRxiv 2023:2023.09.18.23295747. [PMID: 37790477 PMCID: PMC10543049 DOI: 10.1101/2023.09.18.23295747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background The upper (URT) and lower (LRT) respiratory tract feature distinct environments and responses affecting microbial colonization but investigating the relationship between them is technically challenging. We aimed to identify relationships between taxa colonizing the URT and LRT and explore their relationship with development during childhood. Methods We employed V4 16S rDNA sequencing to profile nasopharyngeal swabs and tracheal aspirates collected from 183 subjects between 20 weeks and 18 years of age. These samples were collected prior to elective procedures at the Children's Hospital of Philadelphia over the course of 20 weeks in 2020, from otherwise healthy subjects enrolled in a study investigating potential reservoirs of SARS-CoV-2. Findings After extraction, sequencing, and quality control, we studied the remaining 124 nasopharyngeal swabs and 98 tracheal aspirates, including 85 subject-matched pairs of samples. V4 16S rDNA sequencing revealed that the nasopharynx is colonized by few, highly-abundant taxa, while the tracheal aspirates feature a diverse assembly of microbes. While no taxa co-occur in the URT and LRT of the same subject, clusters of microbiomes in the URT correlate with clusters of microbiomes in the LRT. The clusters identified in the URT correlate with subject age across childhood development. Interpretations The correlation between clusters of taxa across sites may suggest a mutual influence from either a third site, such as the oropharynx, or host-extrinsic, environmental features. The identification of a pattern of upper respiratory microbiota development across the first 18 years of life suggests that the patterns observed in early childhood may extend beyond the early life window.
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Affiliation(s)
- Ariel J Hernandez-Leyva
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Anne L Rosen
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Christopher P Tomera
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Elaina E Lin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia PA
| | - Elikplim H Akaho
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia PA
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County
| | - Allison M Blatz
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia PA
- Division of Critical Care Medicine, Department of Pediatrics, Nemours Children's Hospital, Wilmington DE
| | - William R Otto
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia PA
- Division of Infectious Disease, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joey Logan
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia PA
| | - Lisa R Young
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia PA
| | - Rebecca M Harris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia PA
| | - Andrew L Kau
- Division of Allergy and Immunology, Department of Medicine and Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Audrey R Odom John
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia PA
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide the latest evidence for delivering safe and effective anesthesia care for pediatric patients with coronavirus disease 2019 (COVID-19) and to highlight continuing gaps in the literature. RECENT FINDINGS Safe and efficient care of pediatric patients with COVID-19 can be delivered with the proper planning, coordination, supplies, and staff preparation. From the start of the pandemic, pediatric anesthesiologists from around the world contributed important insights and shared experience as to how best to adapt anesthesia care for children with COVID-19 requiring general anesthesia and sedation. Although initial efforts focused on creating safe airway management processes, the role of anesthesiologists as perioperative leaders quickly extended to ensuring well-coordinated management of COVID-19 patients throughout the hospital for procedures, including preprocedure testing, patient transport, operating room setup, and ensuring the safety of staff. Several important areas remain not well studied including, the timing of rescheduling elective procedures following COVID-19 infection, the perioperative implications of re-infection, and future considerations of managing vaccinated children. SUMMARY Pediatric anesthesia care can be safely delivered to children with COVID-19 and after COVID-19 infection. More attention needs to be focused on the perioperative management of COVID-19 children in recovery requiring anesthesia.
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Affiliation(s)
- Jonathan M Tan
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles
- Department of Anesthesiology, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
| | - Nicola Disma
- Unit for Research & Innovation, Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genoa, Italy
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children
- Department of Anesthesiology and Pain Medicine, Termerty Faculty of Medicine, University of Toronto, Ontario, Canada
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