Bacterial colonization of neonates may predict childhood asthma

In neonates, colonization of the hypopharyngeal region with certain types of bacteria may predict the development of recurrent wheeze and asthma in early childhood, researchers report in the Oct. 11 issue of the New England Journal of Medicine.

Hans Bisgaard, MD, of Copenhagen University Hospital in Copenhagen, Denmark, and colleagues obtained and cultured hypopharyngeal samples from 321 asymptomatic infants at age 1 month and followed them until age 5.

The researchers found that neonatal colonization with one or more of three organisms-Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae-was associated with persistent wheeze (HR, 2.40), acute severe exacerbation of wheeze (HR, 2.99) and hospitalization for wheeze (HR, 3.85). When the children were age 5, the researchers found that neonatal colonization was associated with a higher prevalence of asthma (33% vs. 10%) and the reversibility of airway resistance after beta 2-agonist administration (23% vs. 18%).

The author of an accompanying editorial writes, "In my opinion, the data presented by Bisgaard and colleagues may be interpreted to suggest that bacterial colonization of the hypopharynx in the first 4 weeks of life indicates a defective innate immune response very early in life, which promotes the development of asthma."

Bisgaard H, Hermansen MN, Buchvald F, et al. Childhood asthma after bacterial colonization of the airway in neonates. N Engl J Med. 2007;357:1487-1495.