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Weinstock J, Xuchen X, Arroyo M, Aguilar H, Kahanowitch R, Gutierrez MJ, Nino G. The Next Frontier of Prematurity: Predicting Respiratory Morbidity During the First Two Years of Life in Extremely Premature Babies. Cureus 2022; 14:e23505. [PMID: 35494974 PMCID: PMC9045466 DOI: 10.7759/cureus.23505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background Advances in perinatal and neonatal medicine have led to an increasing number of infants surviving extreme prematurity (≤27 weeks gestational age, GA). The goal of this study was to examine the respiratory outcomes after neonatal intensive care unit (NICU) discharge of this vulnerable population. We hypothesized that the rates of respiratory hospitalizations are disproportionally higher in the subset of infants born ≤27 weeks GA relative to premature infants born 28-32 weeks GA. Methodology A retrospective longitudinal study of severe premature children (≤32 weeks GA, n = 183) was conducted. We subdivided our sample into extremely preterm infants (≤27 weeks GA; n = 101) and those born very preterm (28-32 weeks GA; n = 82). Our main outcome was the presence of respiratory hospitalizations within 24 months of NICU discharge. Results Extremely premature infants had more than three times higher odds of respiratory hospitalization at 24 months relative to infants born 28-32 weeks GA (adjusted odds ratio = 3.4; 95% confidence interval = 1.8, 6.4; p < 0.01). The increased risk of respiratory hospitalization in extremely premature infants was independent of GA. Regression models identified that the duration of supplemental oxygen and Black/African American ethnicity were significant predictors of respiratory hospitalizations in both prematurity groups independent of gender and birth weight. Conclusions The results support that babies born ≤27 weeks GA represent a distinct high-risk group of severely premature infants that needs novel preventive strategies and targeted interventions to improve their respiratory outcomes after NICU discharge.
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XuChen X, Weinstock J, Arroyo M, Salka K, Chorvinsky E, Abutaleb K, Aguilar H, Kahanowitch R, Rodríguez-Martínez CE, Perez GF, Gutierrez MJ, Nino G. Airway Remodeling Factors During Early-Life Rhinovirus Infection and the Effect of Premature Birth. Front Pediatr 2021; 9:610478. [PMID: 33718297 PMCID: PMC7952989 DOI: 10.3389/fped.2021.610478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Early rhinovirus (RV) infection is a strong risk factor for asthma development. Airway remodeling factors play a key role in the progression of the asthmatic condition. We hypothesized that RV infection in young children elicits the secretion of growth factors implicated in airway remodeling and asthma progression. Methods: We examined the nasal airway production of remodeling factors in children ( ≤ 2 years old) hospitalized due to PCR-confirmed RV infection. Airway remodeling proteins included: MMP-1, MMP-2, MMP-7, MMP-9, MMP-10, TIMP-1, TIMP-2, EGF, Angiopoietin-2, G-CSF, BMP-9, Endoglin, Endothelin-1, Leptin, FGF-1, Follistatin, HGF, HB-EGF, PLGF, VEGF-A, VEGF-C, VEGF-D, FGF-2, TGF-β1, TGF-β2, TGF-β3, PDGF AA, PDGF BB, SPARC, Periostin, OPN, and TGF-α. Results: A total of 43 young children comprising RV cases (n = 26) and uninfected controls (n = 17) were included. Early RV infection was linked to (1) enhanced production of several remodeling factors (e.g., HGF, TGFα), (2) lower MMP-9/TIMP-2 and MMP-2/TIMP-2 ratios, and (3) increased MMP-10/TIMP-1 ratios. We also found that relative to term infants, severely premature children had reduced MMP-9/TIMP-2 ratios at baseline. Conclusion: RV infection in young children elicits the airway secretion of growth factors implicated in angiogenesis, fibrosis, and extracellular matrix deposition. Our results highlight the potential of investigating virus-induced airway remodeling growth factors during early infancy to monitor and potentially prevent chronic progression of respiratory disorders in all ages.
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Affiliation(s)
- Xilei XuChen
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Jered Weinstock
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Maria Arroyo
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Kyle Salka
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Elizabeth Chorvinsky
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Karima Abutaleb
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Hector Aguilar
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Ryan Kahanowitch
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
| | - Carlos E Rodríguez-Martínez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.,Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Geovanny F Perez
- Division of Pediatric Pulmonology, Oishei Children's Hospital, University at Buffalo, Buffalo, NY, United States
| | - Maria J Gutierrez
- Division of Pediatric Allergy and Immunology, Johns Hopkins University, Baltimore, MD, United States
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC, United States
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Arroyo M, Salka K, Chorvinsky E, Xuchen X, Abutaleb K, Perez GF, Weinstock J, Gaviria S, Gutierrez MJ, Nino G. Airway mir-155 responses are associated with TH1 cytokine polarization in young children with viral respiratory infections. PLoS One 2020; 15:e0233352. [PMID: 32442188 PMCID: PMC7244143 DOI: 10.1371/journal.pone.0233352] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/04/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND MicroRNAs (miRs) control gene expression and the development of the immune system and antiviral responses. MiR-155 is an evolutionarily-conserved molecule consistently induced during viral infections in different cell systems. Notably, there is still an unresolved paradox for the role of miR-155 during viral respiratory infections. Despite being essential for host antiviral TH1 immunity, miR-155 may also contribute to respiratory disease by enhancing allergic TH2 responses and NFkB-mediated inflammation. The central goal of this study was to define how airway miR-155 production is related to TH1, TH2, and pro-inflammatory cytokine responses during naturally occurring viral respiratory infections in young children. METHODS Normalized nasal airway levels of miR-155 and nasal protein levels of IFN-γ, TNF-α, IL-1β, IL-13, IL-4 were quantified in young children (≤2 years) hospitalized with viral respiratory infections and uninfected controls. These data were linked to individual characteristics and respiratory disease parameters. RESULTS A total of 151 subjects were included. Increased miR-155 levels were observed in nasal samples from patients with rhinovirus, RSV and all respiratory viruses analyzed. High miR-155 levels were strongly associated with high IFN-γ production, increased airway TH1 cytokine polarization (IFN-γ/IL-4 ratios) and increased pro-inflammatory responses. High airway miR-155 levels were linked to decreased respiratory disease severity in individuals with high airway TH1 antiviral responses. CONCLUSIONS The airway secretion of miR-155 during viral respiratory infections in young children is associated with enhanced antiviral immunity (TH1 polarization). Further studies are needed to define additional physiological roles of miR-155 in the respiratory tract of human infants and young children during health and disease.
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Affiliation(s)
- Maria Arroyo
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Kyle Salka
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Elizabeth Chorvinsky
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Xilei Xuchen
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Karima Abutaleb
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Geovanny F. Perez
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Jered Weinstock
- Department of Pediatrics, Division of Pediatric Pulmonology, University at Buffalo, The State University of New York, Buffalo, NY, United States of America
| | - Susana Gaviria
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Maria J. Gutierrez
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | - Gustavo Nino
- Department of Pediatrics, Division of Pediatric Pulmonary and Sleep Medicine, Children’s National Medical Center, George Washington University, Washington, DC, United States of America
- Division of Pediatric Allergy and Immunology, Johns Hopkins University, Baltimore, MD, United States of America
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Arroyo M, Salka K, Perez GF, Rodríguez-Martínez CE, Castro-Rodriguez JA, Gutierrez MJ, Nino G. Phenotypical Sub-setting of the First Episode of Severe Viral Respiratory Infection Based on Clinical Assessment and Underlying Airway Disease: A Pilot Study. Front Pediatr 2020; 8:121. [PMID: 32300576 PMCID: PMC7142213 DOI: 10.3389/fped.2020.00121] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/06/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: Viral bronchiolitis is a term often used to group all infants with the first episode of severe viral respiratory infection. However, this term encompasses a collection of different clinical and biological processes. We hypothesized that the first episode of severe viral respiratory infection in infants can be subset into clinical phenotypes with distinct outcomes and underlying airway disease patterns. Methods: We included children (≤2 years old) hospitalized for the first time due to PCR-confirmed viral respiratory infection. All cases were categorized based on primary manifestations (wheezing, sub-costal retractions and hypoxemia) into mild, hypoxemia or wheezing phenotypes. We characterized these phenotypes using lung-X-rays, respiratory outcomes and nasal protein levels of antiviral and type 2 cytokines (IFNγ, IL-10, IL-4, IL-13, IL-1β, and TNFα). Results: A total of 50 young children comprising viral respiratory infection cases (n = 41) and uninfected controls (n = 9) were included. We found that 22% of viral respiratory infection cases were classified as mild (n = 9), 39% as hypoxemia phenotype (n = 16) and 39% as wheezing phenotype (n = 16). Individuals in the hypoxemia phenotype had more lung opacities, higher probability of PICU admission and prolonged hospitalizations. Subjects in the wheezing phenotype had higher probability of recurrent sick visits. Nasal cytokine profiles showed that individuals with recurrent sick visits in the wheezing phenotype had increased nasal airway levels of type 2 cytokines (IL-13/IL-4). Conclusion: Clinically-based classification of the first episode of severe viral respiratory infection into mild, hypoxemia or wheezing phenotypes provides critical information about respiratory outcomes, lung disease patterns and underlying airway immunobiology.
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Affiliation(s)
- Maria Arroyo
- Division of Pediatric Pulmonary and Sleep Medicine. Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Kyle Salka
- Division of Pediatric Pulmonary and Sleep Medicine. Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Geovanny F. Perez
- Division of Pediatric Pulmonary and Sleep Medicine. Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Carlos E. Rodríguez-Martínez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Jose A. Castro-Rodriguez
- Division of Pediatrics, Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Maria J. Gutierrez
- Division of Pediatric Allergy and Immunology, Johns Hopkins University, Baltimore, MD, United States
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine. Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, DC, United States
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Arroyo M, Salka KP, Perez GF, Rodriguez-Martinez CE, Castro-Rodriguez JA, Nino G. Bedside clinical assessment predicts recurrence after hospitalization due to viral lower respiratory tract infection in young children. J Investig Med 2019; 68:756-761. [PMID: 31806672 DOI: 10.1136/jim-2019-001024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2019] [Indexed: 12/13/2022]
Abstract
Infants requiring hospitalization due to a viral lower respiratory tract infection (LRTI) have a high risk of developing recurrent respiratory illnesses in early life and asthma beyond childhood. Notably, all validated clinical scales for viral LRTI have focused on predicting acute severity instead of recurrence. We present a novel clinical approach combining individual risk factors with bedside clinical parameters to predict recurrence after viral LRTI hospitalization in young children. A retrospective longitudinal cohort of young children (≤3 years) designed to define clinical predictive factors of recurrent respiratory illnesses within 12 months after hospitalization due to PCR-confirmed viral LRTI. Data collection was through electronic medical record. We included 138 children hospitalized with viral LRTI. Using automatic stepwise logistic model selection, we found that the strongest predictors of recurrence in infants hospitalized for the first time were severe prematurity (≤32 weeks' gestational age, OR=5.19; 95% CI 1.76 to 15.32; p=0.002) and a clinical score that weighted hypoxemia, subcostal retractions and wheezing (OR=3.33; 95% CI 1.59 to 6.98; p<0.001). After the first hospitalization, the strongest predictors of subsequent episodes were wheezing (OR=5.62; 95% CI 1.03 to 30.62; p=0.04) and family history of asthma (OR=5.39; 95% CI 1.04 to 27.96; p=0.04). We found that integrating individual risk factors (eg, prematurity or family history of asthma) with bedside clinical assessment (eg, wheezing, subcostal retractions or hypoxemia) can predict the risk of recurrence after viral LRTI hospitalization in infants. This strategy may enable clinically oriented subsetting of infants with viral LRTI based on individual predictors for recurrent respiratory illnesses during early life.
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Affiliation(s)
- Maria Arroyo
- Pediatric Pulmonary and Sleep Medicine, Childrens National Medical Center, Washington, DC, USA
| | - Kyle P Salka
- Pediatric Pulmonary and Sleep Medicine, Childrens National Medical Center, Washington, DC, USA
| | - Geovanny F Perez
- Department of Pulmonary, Children's National Health System, Washington, DC, USA
| | - Carlos E Rodriguez-Martinez
- Universidad Nacional de Colombia, Bogota, Colombia.,Universidad El Bosque Facultad de Medicina, Bogota, Colombia
| | | | - Gustavo Nino
- Childrens National Medical Center, Washington, DC, USA
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