Comprehensive data including biomedical, environmental, psychosocial, demographic, physical and mental health of the mother, father and child and intercurrent morbidity are collected. Specimens (blood, urine, stool, respiratory) are longitudinally taken (figure 1 ). Urine cotinine, to investigate tobacco smoke exposure, is longitudinally measured. Monitors measuring nitrogen dioxide, sulfur dioxide, carbon monoxide, volatile organic compounds and particulate matter (PM10) exposure over 24 h to 2 weeks are placed in homes; electrostatic dust collectors collect household dust over 2 weeks.
Infant lung function, undertaken for the first time in an African setting, is measured at 6 weeks and annually at Paarl hospital. State-of-the-art measurements in unsedated children during sleep include tidal breathing, exhaled nitric oxide, forced oscillation technique and sulfur hexafluoride multiple breath washout. Lung function is also measured during a LRTI and 4–6 weeks thereafter. Chronic respiratory disease measurements include symptoms, clinical data, lung function and chest X-ray and ultrasound (during an LRTI).
Child neurodevelopmental outcomes are assessed longitudinally with a subsample of infants undergoing brain MRI.
All children have six monthly nasopharyngeal swabs (NPs) and stool specimens collected, while a subset intensive cohort have two weekly NPs and monthly stool samples in the first year. These specimens will enable longitudinal delineation of the child's nasopharyngeal and stool microbiome using targeted (bacterial culture, multiplex real-time PCR for viral and bacterial pathogens) and non-targeted approaches (16srRNA gene sequencing). A similar approach is used for detailed investigation of LRTI aetiology on NP and induced sputum specimens. The maternal microbiome (stool, vaginal, skin, breast milk, NPs) is also studied perinatally (figure 1 ). The predictive value of the child's microbiome for development of LRTI or chronic respiratory illness is a key area of study.
Specimens from mothers, fathers, children and the environment are processed in a central research laboratory and stored at −80°C, creating a large biobank for future studies.
Infant lung function, undertaken for the first time in an African setting, is measured at 6 weeks and annually at Paarl hospital. State-of-the-art measurements in unsedated children during sleep include tidal breathing, exhaled nitric oxide, forced oscillation technique and sulfur hexafluoride multiple breath washout. Lung function is also measured during a LRTI and 4–6 weeks thereafter. Chronic respiratory disease measurements include symptoms, clinical data, lung function and chest X-ray and ultrasound (during an LRTI).
Child neurodevelopmental outcomes are assessed longitudinally with a subsample of infants undergoing brain MRI.
All children have six monthly nasopharyngeal swabs (NPs) and stool specimens collected, while a subset intensive cohort have two weekly NPs and monthly stool samples in the first year. These specimens will enable longitudinal delineation of the child's nasopharyngeal and stool microbiome using targeted (bacterial culture, multiplex real-time PCR for viral and bacterial pathogens) and non-targeted approaches (16srRNA gene sequencing). A similar approach is used for detailed investigation of LRTI aetiology on NP and induced sputum specimens. The maternal microbiome (stool, vaginal, skin, breast milk, NPs) is also studied perinatally (
Specimens from mothers, fathers, children and the environment are processed in a central research laboratory and stored at −80°C, creating a large biobank for future studies.
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