Upper Airway Microbial Development During the First Year of Life

Study Overview
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Brief Summary
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This study tests the hypothesis that an increase in pathogenic bacteria within the infant airway leads to increased airway inflammation, decreased airway function and ultimately airway obstruction throughout the first one to two years of life.

Detailed Description
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With the prevalence of asthma increasing each decade, our focus has shifted from treatment to understanding the pathogenesis of asthma so we may develop methods of prevention. With the advent of new bacterial detection techniques, we have the opportunity to examine the infant microbiome prior to the development of wheezing and subsequent asthma. Based on our knowledge that certain bacteria are associated with recurrent wheezing, we believe that an increase in pathogenic bacteria alters the airway epithelium resulting in airway inflammation. This chronic inflammation leads to airway obstruction, resulting in recurrent wheezing. By prospectively following children up to two years we have the opportunity to determine if changes seen in early infancy are established early and persist until 2 years of age. In addition, we propose to determine if the microbiome contributes to airway obstruction and episodes of wheezing with respiratory illness. This study tests the hypothesis that an increase in pathogenic bacteria within the infant airway leads to increased airway inflammation, decreased airway function and ultimately airway obstruction throughout the first one to two years of life. The study has 3 Cohorts: Cohort 1: Newborns with asthmatic mothers with enrollment from May 7, 2014 to June 1, 2016. Newborns from this cohort meet the below inclusion and exclusion criteria, however they follow a study visit schedule that follows them for 18 months (+/- 6 months). Cohort 2: Newborns with asthmatic mothers with enrollment from June 2, 2016 going forward. Newborns from this cohort meet the below inclusion and exclusion criteria, however they follow a study visit schedule that follows them for 12 months (+/- 2 months). Cohort 3: Newborns with healthy parents without atopy from June 2, 2016 going forward. Newborns from this cohort meet the below inclusion and exclusion criteria, however they follow a study visit schedule that follows them for 12 months (+/- 2 months). Once enrolled, study procedures will consist of: collection of nasal swabs and fluid, stool specimens, and throat swabs, at enrollment visit (first week of life), 3-5 weeks of age (Visit 2), 3-5 months (Visit 3), and 12 months +/- 2 months (Visit 4); blood draw at Visits 3 and 4; spirometry will be performed at Visits 2, 3 and 4: non-sedated infant pulmonary function tests will be conducted at all visits for all cohorts; at Visits 3 and 4, sedated infant pulmonary function tests are optional for Cohorts 1 and 2 only. Finally, surveys will be completed about every two months starting at about two months, then four weeks after Visit 3, and about every 8 weeks until Visit 4, to review infection history, medication (including antibiotics) history and wheezing history.

Official Title
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Upper Airway Microbial Development During the First Year of Life

Conditions
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Asthma

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Moms age 14 and older (will sign Informed Consent Statement (ICS), not an assent) Mother of child enrolled must have a physician diagnosis of asthma or being treated for asthma (for 140 subjects; 40 subjects will be recruited from mothers and fathers without atopy - asthma, eczema, seasonal allergies) Child must be enrolled during first week of life Signed informed consent from parent(s) or legal guardian(s) Exclusion Criteria: Child has a history of wheezing or underlying lung disease Respiratory complications at birth (airway support higher then nasal cannula) Born earlier then 37 weeks gestation Congenital heart defects (not including Patent Ductus Arteriosus (PDA), hemodynamically insignificant Ventricular Septal Defect (VSD) or Atrial Septal Defect (ASD) Underlying neuromuscular disease Severe upper airway obstruction, sleep apnea, tracheomalacia, or laryngomalacia Hydrocephalus History of seizures History of arrhythmia and baseline oxygenation level <90% on room air Infant is non-viable Severe gastroesophageal reflux Prior chest surgery or structural abnormalities of the lungs or chest wall Has a history of adverse reaction to chloral hydrate Ward of the state Any physical finding(s) that would compromise the safety of the subject or the quality of the study data as determined by the site investigator

Ages Eligible for Study
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Minimum Age: 1 Minute
Maximum Age: 1 Week

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Cohort 1 Newborns with asthmatic mothers<br>Infants born to mothers who have diagnosis of Asthma that were enrolled in study from 5/7/14 to 6/1/16. | |
| Cohort 2 Newborns with asthmatic mothers<br>Infants born to mothers who have a diagnosis of Asthma with enrollment from June 2, 2016 going forward. | |
| Cohort 3 Newborns with healthy parents<br>Infants born to healthy parents without atopy (asthma, eczema, seasonal allergies) from June 2, 2016 going forward. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in airway bacteria diversity during first 12 months of life. | Will use microbiome diversity measurements to determine if changes in diversity occur over time. | Birth and 12 months (+/- 2 months) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in inflammatory markers (IL-4, IL-5 and IL-13) during first 12 months of life. | c. Determine if the microbiome at age 18 months (+/- 6 months) is associated with decreased lung function and/or increased inflammatory markers. | Birth and 12 months (+/- 2 months) | 
| Change in airway function measurements FEV0.5 during 12 months of life. | Pulmonary measurements will be obtained. We will look at changes over time in FEV0.5. | Birth and 12 months (+/- 2 months) |