Upper Airway Microbial Development During the First Year of Life

With the prevalence of asthma increasing each decade, our focus has shifted from treatment to
understanding the pathogenesis of asthma so we may develop methods of prevention. With the
advent of new bacterial detection techniques, we have the opportunity to examine the infant
microbiome prior to the development of wheezing and subsequent asthma. Based on our knowledge
that certain bacteria are associated with recurrent wheezing, we believe that an increase in
pathogenic bacteria alters the airway epithelium resulting in airway inflammation. This
chronic inflammation leads to airway obstruction, resulting in recurrent wheezing. By
prospectively following children up to two years we have the opportunity to determine if
changes seen in early infancy are established early and persist until 2 years of age. In
addition, we propose to determine if the microbiome contributes to airway obstruction and
episodes of wheezing with respiratory illness. This study tests the hypothesis that an
increase in pathogenic bacteria within the infant airway leads to increased airway
inflammation, decreased airway function and ultimately airway obstruction throughout the
first one to two years of life.

The study has 3 Cohorts:

Cohort 1: Newborns with asthmatic mothers with enrollment from May 7, 2014 to June 1, 2016.
Newborns from this cohort meet the below inclusion and exclusion criteria, however they
follow a study visit schedule that follows them for 18 months (+/- 6 months).

Cohort 2: Newborns with asthmatic mothers with enrollment from June 2, 2016 going forward.
Newborns from this cohort meet the below inclusion and exclusion criteria, however they
follow a study visit schedule that follows them for 12 months (+/- 2 months).

Cohort 3: Newborns with healthy parents without atopy from June 2, 2016 going forward.
Newborns from this cohort meet the below inclusion and exclusion criteria, however they
follow a study visit schedule that follows them for 12 months (+/- 2 months).

Once enrolled, study procedures will consist of: collection of nasal swabs and fluid, stool
specimens, and throat swabs, at enrollment visit (first week of life), 3-5 weeks of age
(Visit 2), 3-5 months (Visit 3), and 12 months +/- 2 months (Visit 4); blood draw at Visits 3
and 4; spirometry will be performed at Visits 2, 3 and 4: non-sedated infant pulmonary
function tests will be conducted at all visits for all cohorts; at Visits 3 and 4, sedated
infant pulmonary function tests are optional for Cohorts 1 and 2 only. Finally, surveys will
be completed about every two months starting at about two months, then four weeks after Visit
3, and about every 8 weeks until Visit 4, to review infection history, medication (including
antibiotics) history and wheezing history.

Inclusion Criteria:

1. Moms age 14 and older (will sign Informed Consent Statement (ICS), not an assent)

2. Mother of child enrolled must have a physician diagnosis of asthma or being treated
for asthma (for 140 subjects; 40 subjects will be recruited from mothers and fathers
without atopy - asthma, eczema, seasonal allergies)

3. Child must be enrolled during first week of life

4. Signed informed consent from parent(s) or legal guardian(s)

Exclusion Criteria:

1. Child has a history of wheezing or underlying lung disease

2. Respiratory complications at birth (airway support higher then nasal cannula)

3. Born earlier then 37 weeks gestation

4. Congenital heart defects (not including Patent Ductus Arteriosus (PDA),
hemodynamically insignificant Ventricular Septal Defect (VSD) or Atrial Septal Defect
(ASD)

5. Underlying neuromuscular disease

6. Severe upper airway obstruction, sleep apnea, tracheomalacia, or laryngomalacia

7. Hydrocephalus

8. History of seizures

9. History of arrhythmia and baseline oxygenation level <90% on room air

10. Infant is non-viable

11. Severe gastroesophageal reflux

12. Prior chest surgery or structural abnormalities of the lungs or chest wall

13. Has a history of adverse reaction to chloral hydrate

14. Ward of the state

15. Any physical finding(s) that would compromise the safety of the subject or the quality
of the study data as determined by the site investigator