Longitudinal dynamics of respiratory microbiome composition in infants after tracheostomy placement

Area of Science:

• Pediatric Respiratory Medicine
• Microbiome Research
• Infant Health

Background:

• Abnormal respiratory microbiomes are linked to artificial airways in children.
• The timing and persistence of these microbiome disruptions after infant tracheostomy are not well-defined.

Purpose of the Study:

• To prospectively characterize airway microbiome dynamics in infants following new tracheostomy placement.
• To understand the impact of tracheostomy on the developing infant airway microbiome.

Main Methods:

• Prospective longitudinal study of 15 hospitalized infants (<=12 months) undergoing tracheostomy.
• Collection of 84 tracheal aspirate samples from day 1 up to 4 months post-procedure.
• 16S rRNA sequencing to analyze airway microbiome composition and diversity.

Main Results:

• Tracheostomy induced immediate and sustained airway microbiome shifts.
• Staphylococcus abundance increased post-tracheostomy, peaking around 40 days.
• Alpha diversity decreased significantly within 30 days, returning to baseline by 90 days.
• Beta diversity showed marked compositional changes and ongoing divergence up to 4 months.
• Microbiome structure was significantly associated with time since tracheostomy and clinical factors like home mechanical ventilation (HMV).

Conclusions:

• Tracheostomy causes rapid and prolonged disruption of the infant airway microbiome.
• This highlights a window of vulnerability in early life with implications for respiratory health.
• Findings support the need for individualized care strategies in infants with tracheostomies.