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Kim F, Eckels VB, Brachio SS, Brooks C, Ehret C, Gomez G, Shui JE, Villaraza-Morales S, Vargas D. Use of an airway bundle to reduce unplanned extubations in a neonatal intensive care unit. J Perinatol 2024; 44:314-320. [PMID: 38242961 DOI: 10.1038/s41372-024-01879-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Following the opening of an infant cardiac neonatal intensive care unit, our aim was to determine a baseline UE rate and implement initiatives to target a goal less than 0.5 UEs/100 ventilator days. METHODS We utilized the Model for Improvement. Key stakeholders included neonatal providers, nurses, and respiratory therapists. We focused on the creation of an airway bundle that addressed securement methods, communication and education. RESULTS From October 2017 to January 2018, our baseline UE rate was 0.92 UEs/100 ventilator days. Subsequent to the implementation of an airway bundle with high compliance, we observed a significant change in the centerline (0.45 to 0.02 UEs/100 ventilator days) during the spring of 2021, followed by a period of 480 days with no UEs. CONCLUSION In a unit where UEs were infrequent events, high compliance with an airway bundle led to a significantly sustained decrease in our UE rates.
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Affiliation(s)
- Faith Kim
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
- Columbia University Irving Medical Center, New York, NY, USA.
| | - Victoria Blancha Eckels
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Sandhya S Brachio
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Cristina Brooks
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Caitlin Ehret
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Gloria Gomez
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jessica E Shui
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sylvia Villaraza-Morales
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Diana Vargas
- Division of Neonatology, Department of Pediatrics, NewYork- Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
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2
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Bankoti K, Wang W, Amonkar GM, Xiong L, Shui JE, Zhao C, Van E, Mwase C, Park JA, Mou H, Fang Y, Que J, Bai Y, Lerou PH, Ai X. Airway Basal Stem Cells in COVID-19 Exhibit a Proinflammatory Signature and Impaired Mucocililary Differentiation. Am J Respir Cell Mol Biol 2024; 70:26-38. [PMID: 37699145 PMCID: PMC10768838 DOI: 10.1165/rcmb.2023-0104oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/12/2023] [Indexed: 09/14/2023] Open
Abstract
Airway basal stem cells (BSCs) play a critical role in epithelial regeneration. Whether coronavirus disease (COVID-19) affects BSC function is unknown. Here, we derived BSC lines from patients with COVID-19 using tracheal aspirates (TAs) to circumvent the biosafety concerns of live-cell derivation. We show that BSCs derived from the TAs of control patients are bona fide bronchial BSCs. TA BSCs from patients with COVID-19 tested negative for severe acute respiratory syndrome coronavirus 2 RNA; however, these so-termed COVID-19-exposed BSCs in vitro resemble a predominant BSC subpopulation uniquely present in patients with COVID-19, manifested by a proinflammatory gene signature and STAT3 hyperactivation. Furthermore, the sustained STAT3 hyperactivation drives goblet cell differentiation of COVID-19-exposed BSCs in an air-liquid interface. Last, these phenotypes of COVID-19-exposed BSCs can be induced in control BSCs by cytokine cocktail pretreatment. Taken together, acute inflammation in COVID-19 exerts a long-term impact on mucociliary differentiation of BSCs.
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Affiliation(s)
- Kamakshi Bankoti
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wei Wang
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gaurang M. Amonkar
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Linjie Xiong
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica E. Shui
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caiqi Zhao
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eric Van
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chimwemwe Mwase
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jin-Ah Park
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Hongmei Mou
- The Mucosal Immunology and Biology Research Center, Massachusetts General Hospital for Children, Boston, Massachusetts; and
| | - Yinshan Fang
- Columbia Center for Human Development, Columbia University Irving Medical Center, New York, New York
| | - Jianwen Que
- Columbia Center for Human Development, Columbia University Irving Medical Center, New York, New York
| | - Yan Bai
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul H. Lerou
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xingbin Ai
- Division of Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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3
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Wagner R, Amonkar GM, Wang W, Shui JE, Bankoti K, Tse WH, High FA, Zalieckas JM, Buchmiller TL, Zani A, Keijzer R, Donahoe PK, Lerou PH, Ai X. A Tracheal Aspirate-Derived Airway Basal Cell Model Reveals a Proinflammatory Epithelial Defect in Congenital Diaphragmatic Hernia. Am J Respir Crit Care Med 2023; 207:1214-1226. [PMID: 36731066 PMCID: PMC10161756 DOI: 10.1164/rccm.202205-0953oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RATIONALE Congenital diaphragmatic hernia (CDH) is characterized by incomplete closure of the diaphragm and lung hypoplasia. The pathophysiology of lung defects in CDH is poorly understood. OBJECTIVES To establish a translational model of human airway epithelium in CDH for pathogenic investigation and therapeutic testing. METHODS We developed a robust methodology of epithelial progenitor derivation from tracheal aspirates of newborns. Basal stem cells (BSCs) from CDH patients and preterm and term, non-CDH controls were derived and analyzed by bulk RNA-sequencing, ATAC-sequencing, and air-liquid-interface differentiation. Lung sections from fetal human CDH samples and the nitrofen rat model of CDH were subjected to histological assessment of epithelial defects. Therapeutics to restore epithelial differentiation were evaluated in human epithelial cell culture and the nitrofen rat model of CDH. MEASUREMENTS AND MAIN RESULTS Transcriptomic and epigenetic profiling of CDH and control BSCs reveals a proinflammatory signature that is manifested by hyperactive NF-κB and independent of severity and hernia size. In addition, CDH BSCs exhibit defective epithelial differentiation in vitro that recapitulates epithelial phenotypes found in fetal human CDH lung samples and fetal tracheas of the nitrofen rat model of CDH. Furthermore, blockade of NF-κB hyperactivity normalizes epithelial differentiation phenotypes of human CDH BSCs in vitro and in nitrofen rat tracheas in vivo. CONCLUSIONS Our findings have identified an underlying proinflammatory signature and BSC differentiation defects as a potential therapeutic target for airway epithelial defects in CDH.
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Affiliation(s)
| | - Gaurang M Amonkar
- Massachusetts General Hospital, 2348, Neonatology, Boston, Massachusetts, United States
| | - Wei Wang
- Massachusetts General Hospital, 2348, Neonatology, Boston, Massachusetts, United States
| | - Jessica E Shui
- Massachusetts General Hospital, 2348, Neonatology, Boston, Massachusetts, United States
| | - Kamakshi Bankoti
- Massachusetts General Hospital, 2348, Neonatology, Boston, Massachusetts, United States
| | - Wai Hei Tse
- University of Manitoba Faculty of Medicine, 12359, Winnipeg, Manitoba, Canada
| | - Frances A High
- Massachusetts General Hospital, 2348, Pediatric Surgery, Boston, Massachusetts, United States.,Boston Children's Hospital, 1862, Boston, Massachusetts, United States
| | - Jill M Zalieckas
- Children's Hospital Boston Department of Surgery, 483909, Surgery, Boston, Massachusetts, United States
| | | | - Augusto Zani
- The Hospital for Sick Children, 7979, Developmental and Stem Cell Biology Program, Toronto, Ontario, Canada.,The Hospital for Sick Children, 7979, Division of General and Thoracic Surgery, Toronto, Ontario, Canada.,The Hospital for Sick Children, 7979, Department of Surgery, Toronto, Ontario, Canada
| | - Richard Keijzer
- University of Manitoba and Manitoba Institute of Child Health, Surgery, Pediatrics & Child Health, Physiology (adjunct), Winnipeg, Manitoba, Canada
| | - Patricia K Donahoe
- Massachusetts General Hospital, 2348, Pediatric Surgery, Boston, Massachusetts, United States
| | - Paul Hubert Lerou
- Massachusetts General Hospital, 2348, Neonatology, Boston, Massachusetts, United States
| | - Xingbin Ai
- Massachusetts General Hospital, 2348, Neonatology, Boston, Massachusetts, United States;
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4
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Rostomian L, Angelidou A, Sullivan K, Melvin PR, Shui JE, Telefus Goldfarb I, Bartolome R, Chaudhary N, Singh R, Vaidya R, Steele T, Yanni D, Patrizi S, Culic I, Parker MG, Belfort MB. The Effects of COVID-19 Hospital Practices on Breastfeeding Initiation and Duration Postdischarge. Breastfeed Med 2022; 17:736-744. [PMID: 35731120 DOI: 10.1089/bfm.2022.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Early in the COVID-19 pandemic, many birth hospitals separated SARS-CoV-2-positive mothers from their newborn infants and advised against breastfeeding to decrease postnatal SARS-CoV-2 transmission. Information on how these practices impacted breastfeeding postdischarge is limited. Objectives: In a statewide sample of SARS-CoV-2-positive mothers, we aimed to determine the extent to which (1) mother-infant separation and (2) a lack of breastfeeding initiation in-hospital were associated with breast milk feeding postdischarge. Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 187 women who tested positive for SARS-CoV-2 from 14 days before to 72 hours after delivery (March 1-July 31, 2020) and their newborn infants. We abstracted chart data from the delivery hospitalization on main exposure variables (mother-infant separation, in-hospital breast milk feeding [expressed milk feeding and/or direct breastfeeding]) and from outpatient visits until 30 days postdischarge. We evaluated associations of in-hospital practices with outcomes up to 30 days postdischarge, adjusting for confounders using multivariable logistic and linear regression. Results: Mother-infant separation in-hospital was associated with a shorter duration of any breast milk feeding (regression coefficient estimate -5.29 days, 95% confidence intervals [CI] [-8.89 to -1.69]). Direct breastfeeding in-hospital was associated with higher odds of any breast milk feeding (adjusted odds ratios [AOR] 5.68, 95% CI [1.65-23.63]) and direct breastfeeding (AOR 8.19, 95% CI [2.99-24.91]) postdischarge; results were similar for any breast milk feeding in-hospital. Conclusions: Perinatal hospital care practices implemented early in the COVID-19 pandemic, specifically mother-infant separation and prevention of breast milk feeding initiation, were associated with adverse effects on breast milk feeding outcomes assessed up to 1 month postdischarge.
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Affiliation(s)
- Lara Rostomian
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. USA
| | - Asimenia Angelidou
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Katherine Sullivan
- UMass Memorial Health Center, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Patrice R Melvin
- Office of Health Equity and Inclusion, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica E Shui
- Division of Newborn Medicine, Department of Pediatrics, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ilona Telefus Goldfarb
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Ruby Bartolome
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Neha Chaudhary
- Division of Newborn Medicine, Tufts Children's Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rachana Singh
- Division of Newborn Medicine, Tufts Children's Hospital, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ruben Vaidya
- Department of Pediatrics, UMass Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Tina Steele
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. USA
| | - Diana Yanni
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Silvia Patrizi
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. USA
| | - Ivana Culic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. USA
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5
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Shui JE, Wang W, Liu H, Stepanova A, Liao G, Qian J, Ai X, Ten V, Lu J, Cardoso WV. Prematurity alters the progenitor cell program of the upper respiratory tract of neonates. Sci Rep 2021; 11:10799. [PMID: 34031475 PMCID: PMC8144386 DOI: 10.1038/s41598-021-90093-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/29/2021] [Indexed: 11/09/2022] Open
Abstract
The impact of prematurity on human development and neonatal diseases, such as bronchopulmonary dysplasia, has been widely reported. However, little is known about the effects of prematurity on the programs of stem cell self-renewal and differentiation of the upper respiratory epithelium, which is key for adaptation to neonatal life. We developed a minimally invasive methodology for isolation of neonatal basal cells from nasopharyngeal (NP) aspirates and performed functional analysis in organotypic cultures to address this issue. We show that preterm NP progenitors have a markedly distinct molecular signature of abnormal proliferation and mitochondria quality control compared to term progenitors. Preterm progenitors had lower oxygen consumption at baseline and were unable to ramp up consumption to the levels of term cells when challenged. Although they formed a mucociliary epithelium, ciliary function tended to decline in premature cells as they differentiated, compared to term cells. Together, these differences suggested increased sensitivity of preterm progenitors to environmental stressors under non-homeostatic conditions.
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Affiliation(s)
- Jessica E Shui
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wei Wang
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Helu Liu
- Columbia Center for Human Development, Pulmonary Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 650 West 168th Street, BB 8-812, New York, NY, 10032, USA
| | - Anna Stepanova
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Grace Liao
- Columbia Center for Human Development, Pulmonary Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 650 West 168th Street, BB 8-812, New York, NY, 10032, USA
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Jun Qian
- Columbia Center for Human Development, Pulmonary Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 650 West 168th Street, BB 8-812, New York, NY, 10032, USA
| | - Xingbin Ai
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vadim Ten
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Jining Lu
- Division of Lung Diseases, NHLBI, NIH, Bethesda, MD, USA
| | - Wellington V Cardoso
- Columbia Center for Human Development, Pulmonary Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 650 West 168th Street, BB 8-812, New York, NY, 10032, USA.
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6
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Angelidou A, Sullivan K, Melvin PR, Shui JE, Goldfarb IT, Bartolome R, Chaudhary N, Vaidya R, Culic I, Singh R, Yanni D, Patrizi S, Hudak ML, Parker MG, Belfort MB. Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts. JAMA Netw Open 2021; 4:e217523. [PMID: 33890989 PMCID: PMC8065376 DOI: 10.1001/jamanetworkopen.2021.7523] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE The incidence of mother-to-newborn SARS-CoV-2 transmission appears low and may be associated with biological and social factors. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. OBJECTIVE To ascertain the percentage of neonates who were born to mothers with positive SARS-CoV-2 test results during the birth hospitalization, the clinical and sociodemographic factors associated with neonatal test result positivity, and the clinical and virological outcomes for newborns during hospitalization and 30 days after discharge. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study included 11 academic or community hospitals in Massachusetts and mother-neonate dyads whose delivery and discharge occurred between March 1, 2020, and July 31, 2020. Eligible dyads were identified at each participating hospital through local COVID-19 surveillance and infection control systems. Neonates were born to mothers with positive SARS-CoV-2 test results within 14 days before to 72 hours after delivery, and neonates were followed up for 30 days after birth hospital discharge. EXPOSURES Hypothesized maternal risk factors in neonatal test result positivity included maternal COVID-19 symptoms, vaginal delivery, rooming-in practice, Black race or Hispanic ethnicity, and zip code-derived social vulnerability index. Delivery indicated by worsening maternal COVID-19 symptoms was hypothesized to increase the risk of adverse neonatal health outcomes. MAIN OUTCOMES AND MEASURES Primary outcomes for neonates were (1) positive SARS-CoV-2 test results, (2) indicators of adverse health, and (3) clinical signs and viral testing. Test result positivity was defined as at least 1 positive result on a specimen obtained by nasopharyngeal swab using a polymerase chain reaction-based method. Clinical and testing data were obtained from electronic medical records of nonroutine health care visits within 30 days after hospital discharge. RESULTS The cohort included 255 neonates (mean [SD] gestational age at birth, 37.9 [2.6] weeks; 62 [24.3%] with low birth weight or preterm delivery) with 250 mothers (mean [SD] age, 30.4 [6.3] years; 121 [48.4%] were of Hispanic ethnicity). Of the 255 neonates who were born to mothers with SARS-CoV-2 infection, 225 (88.2%) were tested for SARS-CoV-2 and 5 (2.2%) had positive results during the birth hospitalization. High maternal social vulnerability was associated with higher likelihood of neonatal test result positivity (adjusted odds ratio, 4.95; 95% CI, 1.53-16.01; P = .008), adjusted for maternal COVID-19 symptoms, delivery mode, and rooming-in practice. Adverse outcomes during hospitalization were associated with preterm delivery indicated by worsening maternal COVID-19 symptoms. Of the 151 newborns with follow-up data, 28 had nonroutine clinical visits, 7 underwent SARS-CoV-2 testing, and 1 had a positive result. CONCLUSIONS AND RELEVANCE The findings emphasize the importance of both biological and social factors in perinatal SARS-CoV-2 infection outcomes. Newborns exposed to SARS-CoV-2 were at risk for both direct and indirect adverse health outcomes, supporting efforts of ongoing surveillance of the virus and long-term follow-up.
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MESH Headings
- Adult
- COVID-19/diagnosis
- COVID-19/epidemiology
- COVID-19/transmission
- COVID-19 Testing/methods
- COVID-19 Testing/statistics & numerical data
- Delivery, Obstetric/methods
- Delivery, Obstetric/statistics & numerical data
- Female
- Gestational Age
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/virology
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Male
- Massachusetts/epidemiology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Outcome/epidemiology
- Premature Birth/epidemiology
- Risk Factors
- SARS-CoV-2/isolation & purification
- Socioeconomic Factors
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Affiliation(s)
- Asimenia Angelidou
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Precision Vaccines Program, Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Katherine Sullivan
- UMass Memorial Health Center, University of Massachusetts Medical School, Worcester
| | - Patrice R Melvin
- Center for Applied Pediatric Quality Analytics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jessica E Shui
- Department of Pediatrics, Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ilona Telefus Goldfarb
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ruby Bartolome
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Neha Chaudhary
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ruben Vaidya
- Department of Pediatrics, University of Massachusetts Medical School-Baystate, Springfield
| | - Ivana Culic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rachana Singh
- Division of Newborn Medicine, Tufts Children's Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Diana Yanni
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Silvia Patrizi
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark L Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Lu J, Zhu X, Shui JE, Xiong L, Gierahn T, Zhang C, Wood M, Hally S, Love JC, Li H, Crawford BC, Mou H, Lerou PH. Rho/SMAD/mTOR triple inhibition enables long-term expansion of human neonatal tracheal aspirate-derived airway basal cell-like cells. Pediatr Res 2021; 89:502-509. [PMID: 32365352 DOI: 10.1038/s41390-020-0925-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/26/2020] [Accepted: 04/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia remains one of the most common complications of prematurity, despite significant improvements in perinatal care. Functional modeling of human lung development and disease, like BPD, is limited by our ability to access the lung and to maintain relevant progenitor cell populations in culture. METHODS We supplemented Rho/SMAD signaling inhibition with mTOR inhibition to generate epithelial basal cell-like cell lines from tracheal aspirates of neonates. RESULTS Single-cell RNA-sequencing confirmed the presence of epithelial cells in tracheal aspirates obtained from intubated neonates. Using Rho/SMAD/mTOR triple signaling inhibition, neonatal tracheal aspirate-derived (nTAD) basal cell-like cells can be expanded long term and retain the ability to differentiate into pseudostratified airway epithelium. CONCLUSIONS Our data demonstrate that neonatal tracheal aspirate-derived epithelial cells can provide a novel ex vivo human cellular model to study neonatal lung development and disease. IMPACT Airway epithelial basal cell-like cell lines were derived from human neonatal tracheal aspirates. mTOR inhibition significantly extends in vitro proliferation of neonatal tracheal aspirate-derived basal cell-like cells (nTAD BCCs). nTAD BCCs can be differentiated into functional airway epithelium. nTAD BCCs provide a novel model to investigate perinatal lung development and diseases.
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Affiliation(s)
- Junjie Lu
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Xiaobo Zhu
- Department of Neonatology, Children's Medical Center, the Second Hospital of Shandong University, 250033, Jinan, Shangdong, China
| | - Jessica E Shui
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Linjie Xiong
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Todd Gierahn
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Cheng Zhang
- Center for Individualized Medicine, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Michael Wood
- Mucosal Immunology & Biology Research Center, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Suzanne Hally
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - J Christopher Love
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Hu Li
- Center for Individualized Medicine, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, 55905, USA
| | - Benjamin C Crawford
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Hongmei Mou
- Mucosal Immunology & Biology Research Center, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Paul H Lerou
- Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
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8
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Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, Appleman L, Chiu ML, Fialkowski A, De La Flor D, Lima R, Bordt EA, Yockey LJ, D'Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A. Reply. J Pediatr 2021; 228:317-319. [PMID: 32971143 PMCID: PMC7505093 DOI: 10.1016/j.jpeds.2020.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Lael M Yonker
- Mucosal Immunology and Biology Research Center, Department of Pediatrics
| | - Anne M Neilan
- Department of Pediatrics and Department of Internal Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Yannic Bartsch
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge; Harvard Medical School, Boston, Massachusetts
| | - Ankit B Patel
- Department of Medicine, Renal Division, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - James Regan
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | - Puneeta Arya
- Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Gootkind
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Grace Park
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anita St John
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lori Appleman
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle L Chiu
- Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts
| | | | - Denis De La Flor
- Mucosal Immunology and Biology Research Center, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Rosiane Lima
- Mucosal Immunology and Biology Research Center, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Evan A Bordt
- Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts
| | - Laura J Yockey
- Department of Internal Medicine, Vincent Center for Reproductive Biology
| | - Paolo D'Avino
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie Fischinger
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Harvard Medical School, Cambridge, Massachusetts
| | - Jessica E Shui
- Department of Pediatrics, Massachusetts General Hospital
| | - Paul H Lerou
- Department of Pediatrics, Massachusetts General Hospital
| | - Joseph V Bonventre
- Department of Medicine, Renal Division, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Xu G Yu
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Harvard Medical School, Cambridge, Massachusetts; Department of Infectious Diseases, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Edward T Ryan
- Department of Pediatrics and Department of Internal Medicine, Massachusetts General Hospital; Harvard Medical School; Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Daniel Irimia
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Andrea G Edlow
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology
| | | | - Jonathan Z Li
- Department of Infectious Diseases, Brigham and Women's Hospital
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Department of Pediatrics, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts
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9
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Sullivan K, Belfort MB, Melvin P, Angelidou A, Peaceman A, Shui JE, Vaidya R, Singh R, Bartolome R, Patrizi S, Chaudhary N, Goldfarb IT, Culic I, Yanni D, Gupta M, Hudak M, Parker MG. Leveraging the Massachusetts perinatal quality collaborative to address the COVID-19 pandemic among diverse populations. J Perinatol 2021; 41:2674-2683. [PMID: 34226648 PMCID: PMC8255338 DOI: 10.1038/s41372-021-01136-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE We leveraged the Massachusetts perinatal quality collaborative (PQC) to address the COVID-19 pandemic. Our goals were to: (1) implement perinatal practices thought to reduce mother-to-infant SARS-CoV-2 transmission while limiting disruption of health-promoting practices and (2) do so without inequities attributable to race/ethnicity, language status, and social vulnerability. METHODS Main outcomes were cesarean and preterm delivery, rooming-in, and breastfeeding. We examined changes over time overall and according to race/ethnicity, language status, and social vulnerability from 03/20-07/20 at 11 hospitals. RESULTS Of 255 mothers with SARS-CoV-2, 67% were black or Hispanic and 47% were non-English speaking. Cesarean decreased (49% to 35%), while rooming-in (55% to 86%) and breastfeeding (53% to 72%) increased. These changes did not differ by race/ethnicity, language, or social vulnerability. CONCLUSIONS Leveraging the Massachusetts PQC led to rapid changes in perinatal care during the COVID-19 crisis in a short time, representing a novel use of statewide PQC structures.
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Affiliation(s)
- Katherine Sullivan
- Department of Pediatrics, UMass Memorial Health Center, UMass Memorial Medical School, Worcester, MA, USA.
| | - Mandy B. Belfort
- grid.62560.370000 0004 0378 8294Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Patrice Melvin
- grid.2515.30000 0004 0378 8438Center for Applied Pediatric Quality Analytics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Asimenia Angelidou
- grid.38142.3c000000041936754XDepartment of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA ,grid.2515.30000 0004 0378 8438Precision Vaccines Program, Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA USA
| | - Aviel Peaceman
- grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA USA
| | - Jessica E. Shui
- grid.32224.350000 0004 0386 9924Department of Pediatrics, Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ruben Vaidya
- grid.266683.f0000 0001 2166 5835Department of Pediatrics, University of Massachusetts Medical Center-Baystate, Springfield, MA USA
| | - Rachana Singh
- grid.266683.f0000 0001 2166 5835Department of Pediatrics, University of Massachusetts Medical Center-Baystate, Springfield, MA USA ,grid.415195.d0000 0004 0387 3237Department of Pediatrics, Tufts Children’s Hospital, Boston, MA USA
| | - Ruby Bartolome
- grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA USA
| | - Silvia Patrizi
- grid.62560.370000 0004 0378 8294Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Neha Chaudhary
- grid.38142.3c000000041936754XDepartment of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA ,grid.239475.e0000 0000 9419 3149Department of Pediatrics, Cambridge Health Alliance, Cambridge, MA USA
| | - Ilona Telefus Goldfarb
- grid.32224.350000 0004 0386 9924Deparatment of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ivana Culic
- grid.38142.3c000000041936754XDepartment of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Diana Yanni
- grid.38142.3c000000041936754XDepartment of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Munish Gupta
- grid.38142.3c000000041936754XDepartment of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Mark Hudak
- grid.413116.00000 0004 0625 1409Department of Pediatrics, University of Florida Health, University of Florida College of Medicine, Jacksonville, FL USA
| | - Margaret G. Parker
- grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA USA
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10
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Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, Appleman L, Chiu ML, Fialkowski A, De la Flor D, Lima R, Bordt EA, Yockey LJ, D'Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A. Reply. J Pediatr 2021; 228:320-323. [PMID: 32956696 PMCID: PMC7500434 DOI: 10.1016/j.jpeds.2020.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Lael M Yonker
- Mucosal Immunology and Biology Research Center; Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Anne M Neilan
- Department of Pediatrics; Department of Internal Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Yannic Bartsch
- Ragon Institute of Massachusetts General Hospital, MIT and Harvard Medical School, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ankit B Patel
- Renal Division, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - James Regan
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | - Puneeta Arya
- Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Gootkind
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Grace Park
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Anita St John
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Lori Appleman
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Michelle L Chiu
- Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | | | - Denis De la Flor
- Mucosal Immunology and Biology Research Center; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Rosiane Lima
- Mucosal Immunology and Biology Research Center; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Evan A Bordt
- Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Laura J Yockey
- Department of Internal Medicine; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Paolo D'Avino
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie Fischinger
- Ragon Institute of Massachusetts General Hospital, MIT and Harvard Medical School, Cambridge, Massachusetts
| | - Jessica E Shui
- Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Paul H Lerou
- Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Joseph V Bonventre
- Renal Division, Department of Medicine, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Xu G Yu
- Ragon Institute of Massachusetts General Hospital, MIT and Harvard Medical School, Cambridge, Massachusetts; Department of Infectious Diseases, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Edward T Ryan
- Department of Pediatrics; Department of Internal Medicine, Massachusetts General Hospital; Harvard Medical School; Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ingrid V Bassett
- Department of Internal Medicine, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Daniel Irimia
- Center for Engineering in Medicine, Department of Surgery, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Andrea G Edlow
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology; Vincent Center for Reproductive Biology, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Galit Alter
- Vincent Center for Reproductive Biology, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
| | - Jonathan Z Li
- Department of Infectious Diseases, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center; Department of Pediatrics, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts
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11
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Yonker LM, Neilan AM, Bartsch Y, Patel AB, Regan J, Arya P, Gootkind E, Park G, Hardcastle M, St John A, Appleman L, Chiu ML, Fialkowski A, De la Flor D, Lima R, Bordt EA, Yockey LJ, D'Avino P, Fischinger S, Shui JE, Lerou PH, Bonventre JV, Yu XG, Ryan ET, Bassett IV, Irimia D, Edlow AG, Alter G, Li JZ, Fasano A. Pediatric Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Clinical Presentation, Infectivity, and Immune Responses. J Pediatr 2020; 227:45-52.e5. [PMID: 32827525 PMCID: PMC7438214 DOI: 10.1016/j.jpeds.2020.08.037] [Citation(s) in RCA: 224] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES As schools plan for re-opening, understanding the potential role children play in the coronavirus infectious disease 2019 (COVID-19) pandemic and the factors that drive severe illness in children is critical. STUDY DESIGN Children ages 0-22 years with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presenting to urgent care clinics or being hospitalized for confirmed/suspected SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) at Massachusetts General Hospital were offered enrollment in the Massachusetts General Hospital Pediatric COVID-19 Biorepository. Enrolled children provided nasopharyngeal, oropharyngeal, and/or blood specimens. SARS-CoV-2 viral load, ACE2 RNA levels, and serology for SARS-CoV-2 were quantified. RESULTS A total of 192 children (mean age, 10.2 ± 7.0 years) were enrolled. Forty-nine children (26%) were diagnosed with acute SARS-CoV-2 infection; an additional 18 children (9%) met the criteria for MIS-C. Only 25 children (51%) with acute SARS-CoV-2 infection presented with fever; symptoms of SARS-CoV-2 infection, if present, were nonspecific. Nasopharyngeal viral load was highest in children in the first 2 days of symptoms, significantly higher than hospitalized adults with severe disease (P = .002). Age did not impact viral load, but younger children had lower angiotensin-converting enzyme 2 expression (P = .004). Immunoglobulin M (IgM) and Immunoglobulin G (IgG) to the receptor binding domain of the SARS-CoV-2 spike protein were increased in severe MIS-C (P < .001), with dysregulated humoral responses observed. CONCLUSIONS This study reveals that children may be a potential source of contagion in the SARS-CoV-2 pandemic despite having milder disease or a lack of symptoms; immune dysregulation is implicated in severe postinfectious MIS-C.
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Key Words
- ace2, angiotensin-converting enzyme
- covid-19, coronavirus disease-19
- ipo8, importin-8
- irb, institutional review board
- mgh, massachusetts general hospital
- mis-c, multisystem inflammatory syndrome in children
- nt-probnb, n-terminal pro b-type natriuretic peptide
- rbd, receptor binding domain
- rsv, respiratory syncytial virus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Lael M Yonker
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Anne M Neilan
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Yannic Bartsch
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Ankit B Patel
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA
| | - James Regan
- Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Puneeta Arya
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Grace Park
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Anita St John
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lori Appleman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Michelle L Chiu
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | | | - Denis De la Flor
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Rosiane Lima
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Evan A Bordt
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Laura J Yockey
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA
| | - Paolo D'Avino
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA
| | - Stephanie Fischinger
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Jessica E Shui
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Paul H Lerou
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Joseph V Bonventre
- Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Department of Medicine, Renal Division, Boston, MA
| | - Xu G Yu
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Edward T Ryan
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
| | - Ingrid V Bassett
- Harvard Medical School, Boston, MA; Department of Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Irimia
- Harvard Medical School, Boston, MA; Center for Engineering in Medicine, Department of Surgery, Boston, MA
| | - Andrea G Edlow
- Harvard Medical School, Boston, MA; Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Massachusetts General Hospital Boston, Boston, MA
| | - Galit Alter
- Harvard Medical School, Boston, MA; Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Harvard Medical School, Cambridge, MA
| | - Jonathan Z Li
- Harvard Medical School, Boston, MA; Department of Infectious Diseases, Brigham and Women's Hospital, Boston, MA
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
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12
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Lima R, Gootkind EF, De la Flor D, Yockey LJ, Bordt EA, D'Avino P, Ning S, Heath K, Harding K, Zois J, Park G, Hardcastle M, Grinke KA, Grimmel S, Davidson SP, Forde PJ, Hall KE, Neilan AM, Matute JD, Lerou PH, Fasano A, Shui JE, Edlow AG, Yonker LM. Establishment of a pediatric COVID-19 biorepository: unique considerations and opportunities for studying the impact of the COVID-19 pandemic on children. BMC Med Res Methodol 2020; 20:228. [PMID: 32917141 PMCID: PMC7483494 DOI: 10.1186/s12874-020-01110-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. Methods A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic. Results Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. Conclusions Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.
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Affiliation(s)
- Rosiane Lima
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Division of Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth F Gootkind
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, MA, USA
| | - Denis De la Flor
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Laura J Yockey
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Evan A Bordt
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital, Boston, MA, USA
| | - Paolo D'Avino
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Shen Ning
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Katerina Heath
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Katherine Harding
- Department of Dermatology, Cutaneous Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jaclyn Zois
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Grace Park
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, MA, USA
| | - Margot Hardcastle
- Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, MA, USA
| | - Kathleen A Grinke
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Sheila Grimmel
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Susan P Davidson
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Pamela J Forde
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Kathryn E Hall
- Translational and Clinical Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Anne M Neilan
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Infectious Disease, Massachusetts General Hospital, Boston, MA, USA
| | - Juan D Matute
- Department of Pediatrics, Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Paul H Lerou
- Department of Pediatrics, Division of Neonatology and Newborn Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alessio Fasano
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Division of Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jessica E Shui
- Department of Pediatrics, Infectious Disease, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Andrea G Edlow
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Lael M Yonker
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA, USA. .,Department of Pediatrics, Pulmonary Division, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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13
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Lima R, Gootkind E, De La Flor D, Yockey L, Bordt E, D’Avino P, Ning S, Heath K, Harding K, Zois J, Park G, Hardcastle M, Grinke KA, Grimmel S, Forde PJ, Davidson SP, Hall KE, Neilan A, Matute JD, Lerou PH, Fasano A, Shui JE, Edlow AG, Yonker LM. Establishment of a Pediatric COVID-19 Biorepository: Unique Considerations and Opportunities for Studying the Impact of the COVID-19 Pandemic on Children. Res Sq 2020:rs.3.rs-42030. [PMID: 32818214 PMCID: PMC7430592 DOI: 10.21203/rs.3.rs-42030/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background COVID-19, the disease caused by the highly infectious and transmissible coronavirus SARS-CoV-2, has quickly become a morbid global pandemic. Although the impact of SARS-CoV-2 infection in children is less clinically apparent, collecting high-quality biospecimens from infants, children, and adolescents in a standardized manner during the COVID-19 pandemic is essential to establish a biologic understanding of the disease in the pediatric population. This biorepository enables pediatric centers world-wide to collect samples uniformly to drive forward our understanding of COVID-19 by addressing specific pediatric and neonatal COVID-19-related questions. Methods A COVID-19 biospecimen collection study was implemented with strategic enrollment guidelines to include patients seen in urgent care clinics and hospital settings, neonates born to SARS-CoV-2 infected mothers, and asymptomatic children. The methodology described here, details the importance of establishing collaborations between the clinical and research teams to harmonize protocols for patient recruitment and sample collection, processing and storage. It also details modifications required for biobanking during a surge of the COVID-19 pandemic. Results Considerations and challenges facing enrollment of neonatal and pediatric cohorts are described. A roadmap is laid out for successful collection, processing, storage and database management of multiple pediatric samples such as blood, nasopharyngeal and oropharyngeal swabs, sputum, saliva, tracheal aspirates, stool, and urine. Using this methodology, we enrolled 327 participants, who provided a total of 972 biospecimens. Conclusions Pediatric biospecimens will be key in answering questions relating to viral transmission by children, differences between pediatric and adult viral susceptibility and immune responses, the impact of maternal SARS-CoV-2 infection on fetal development, and factors driving the Multisystem Inflammatory Syndrome in Children. The specimens in this biorepository will allow necessary comparative studies between children and adults, help determine the accuracy of current pediatric viral testing techniques, in addition to, understanding neonatal exposure to SARS-CoV-2 infection and disease abnormalities. The successful establishment of a pediatric biorepository is critical to provide insight into disease pathogenesis, and subsequently, develop future treatment and vaccination strategies.
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14
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Shook LL, Shui JE, Boatin AA, Devane S, Croul N, Yonker LM, Matute JD, Lima RS, Schwinn M, Cvrk D, Gardner L, Azevedo R, Stanton S, Bordt EA, Yockey LJ, Fasano A, Li JZ, Yu XG, Kaimal AJ, Lerou PH, Edlow AG. Rapid establishment of a COVID-19 perinatal biorepository: early lessons from the first 100 women enrolled. BMC Med Res Methodol 2020; 20:215. [PMID: 32842979 PMCID: PMC7447612 DOI: 10.1186/s12874-020-01102-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/13/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Collection of biospecimens is a critical first step to understanding the impact of COVID-19 on pregnant women and newborns - vulnerable populations that are challenging to enroll and at risk of exclusion from research. We describe the establishment of a COVID-19 perinatal biorepository, the unique challenges imposed by the COVID-19 pandemic, and strategies used to overcome them. METHODS A transdisciplinary approach was developed to maximize the enrollment of pregnant women and their newborns into a COVID-19 prospective cohort and tissue biorepository, established on March 19, 2020 at Massachusetts General Hospital (MGH). The first SARS-CoV-2 positive pregnant woman was enrolled on April 2, and enrollment was expanded to SARS-CoV-2 negative controls on April 20. A unified enrollment strategy with a single consent process for pregnant women and newborns was implemented on May 4. SARS-CoV-2 status was determined by viral detection on RT-PCR of a nasopharyngeal swab. Wide-ranging and pregnancy-specific samples were collected from maternal participants during pregnancy and postpartum. Newborn samples were collected during the initial hospitalization. RESULTS Between April 2 and June 9, 100 women and 78 newborns were enrolled in the MGH COVID-19 biorepository. The rate of dyad enrollment and number of samples collected per woman significantly increased after changes to enrollment strategy (from 5 to over 8 dyads/week, P < 0.0001, and from 7 to 9 samples, P < 0.01). The number of samples collected per woman was higher in SARS-CoV-2 negative than positive women (9 vs 7 samples, P = 0.0007). The highest sample yield was for placenta (96%), umbilical cord blood (93%), urine (99%), and maternal blood (91%). The lowest-yield sample types were maternal stool (30%) and breastmilk (22%). Of the 61 delivered women who also enrolled their newborns, fewer women agreed to neonatal blood compared to cord blood (39 vs 58, P < 0.0001). CONCLUSIONS Establishing a COVID-19 perinatal biorepository required patient advocacy, transdisciplinary collaboration and creative solutions to unique challenges. This biorepository is unique in its comprehensive sample collection and the inclusion of a control population. It serves as an important resource for research into the impact of COVID-19 on pregnant women and newborns and provides lessons for future biorepository efforts.
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Affiliation(s)
- Lydia L Shook
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Jessica E Shui
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Adeline A Boatin
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Samantha Devane
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Natalie Croul
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Lael M Yonker
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Juan D Matute
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Rosiane S Lima
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Muriel Schwinn
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Dana Cvrk
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Laurel Gardner
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Robin Azevedo
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Suzanne Stanton
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Evan A Bordt
- Department of Pediatrics, Lurie Center for Autism, Massachusetts General Hospital, Boston, MA, USA
| | - Laura J Yockey
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Alessio Fasano
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Z Li
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Xu G Yu
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Ragon Institute of the Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard University, Cambridge, MA, USA
| | - Anjali J Kaimal
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Paul H Lerou
- Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Andrea G Edlow
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
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Jensen TJ, Shui JE, Finck CM. The effect of meconium exposure on the expression and differentiation of amniotic fluid mesenchymal stem cells. J Neonatal Perinatal Med 2018; 10:313-323. [PMID: 28854517 PMCID: PMC5676976 DOI: 10.3233/npm-16141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The goal of this study was to determine if exposure to meconium would alter the phenotype of amniotic fluid mesenchymal stem cells (AF-MSCs) and the ability of these cells to be differentiated into distal airway type cells. METHODS: Meconium was collected, lyophilized and resuspended in PBS at 3 different concentrations (high, medium, and low). AF-MSCs were cultured in the presence of this meconium suspension for 8 hours and then analyzed for changes in gene expression. Additionally, AF-MSCs exposed to meconium were differentiated for 14 days using modified small airway growth medium (mSAGM) and gene expression was determined. As a spontaneous differentiation control, meconium exposed AF-MSCs were cultured in amniotic fluid stem cell medium (AF medium). RESULTS: After 8 hours of exposure in culture, AF-MSCs had increased expression of distal airway genes aquaporin 5 (AQP5) and surfactant protein c (SPC) when cultured in AF medium containing meconium. These gene expression levels were similar to that of AF-MSCs that were differentiated in mSAGM for 14 days. Furthermore, there was an up regulation of pluripotency genes NANOG and OCT4 in response to low meconium concentration for 8 hours. Following 14 days of culture in mSAGM, there was an upregulation of TTF1, SPC and AQP5 expression in the control, as well as in the low and medium meconium exposed groups indicating that these cells were still able to be differentiated. High meconium concentration did, however, appear to influence the level of distal airway gene expression after 14 days in mSAGM. After 14 days in AF medium, there was significant downregulation in pluripotency and mesenchymal markers as well as distal airway gene expression in all groups. CONCLUSION: The phenotype of AF-MSCs is modulated by meconium exposure; however, the cells were still able to differentiate into distal airway gene and protein expression. This result supports the hypothesis that progenitor cells exist in the amniotic fluid and the presence of meconium may affect their initial phenotype. However, these cells were still able to be differentiated to a distal lung phenotype.
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Affiliation(s)
- T J Jensen
- Department of Pediatrics, UConn Health, Farmington, CT, USA
| | - J E Shui
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - C M Finck
- Department of Surgery, Connecticut Children's Medical Center, Harford, CT, USA
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Shui JE, Messina M, Hill-Ricciuti AC, Maykowski P, Leone T, Sahni R, Isler JR, Saiman L. Impact of respiratory viruses in the neonatal intensive care unit. J Perinatol 2018; 38:1556-1565. [PMID: 30158678 PMCID: PMC7100236 DOI: 10.1038/s41372-018-0197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 07/05/2018] [Accepted: 07/30/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe the epidemiology and clinical impact of respiratory viruses in a neonatal intensive care unit (NICU). STUDY DESIGN We conducted a retrospective observational study of infants with respiratory viruses detected by multiplex reverse-transcriptase PCR from May 2012 to May 2017. The proportion of symptomatic vs. asymptomatic infants and associated morbidity were assessed. The association of infection prevention and control (IP&C) strategies and transmission was ascertained. RESULTS Respiratory viruses were detected in 83 infants representing 86 unique episodes during which infants remained asymptomatic in 15 (17%). Of the 71 symptomatic episodes, only 45% were associated with increased respiratory and/or nutritional support. Rhinovirus/enteroviruses were most common (69%) and involved nine of 12 transmission events. IP&C strategies including restricting visitors <12 years of age and screening exposed infants were associated with decreased transmission rates. CONCLUSIONS NICU patients can be asymptomatic carriers of respiratory viruses. Identification of such infants is important to prevent transmission in the NICU.
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Affiliation(s)
- Jessica E. Shui
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Maria Messina
- 0000000419368729grid.21729.3fDivision of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA ,0000 0000 8499 1112grid.413734.6Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY USA
| | - Alexandra C. Hill-Ricciuti
- 0000000419368729grid.21729.3fDivision of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Philip Maykowski
- 0000000419368729grid.21729.3fDivision of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA ,0000 0001 2168 186Xgrid.134563.6Present Address: University of Arizona College of Medicine–Phoenix, Phoenix, AZ USA
| | - Tina Leone
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Rakesh Sahni
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Joseph R. Isler
- 0000000419368729grid.21729.3fDivision of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY USA
| | - Lisa Saiman
- Division of Infectious Diseases, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA. .,Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, NY, USA.
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