Necrotizing enterocolitis (NEC) afflicts approximately 10% of extremely preterm infants with high fatality. Inappropriate bacterial colonization with Enterobacteriaceae is implicated, but no specific pathogen has been identified. We identify uropathogenic E. coli (UPEC) colonization as a significant risk factor for the development of NEC and subsequent mortality. We describe a large-scale deep shotgun metagenomic sequence analysis of the early intestinal microbiome of 144 preterm and 22 term infants. Using a pan-genomic approach to functionally subtype the E. coli, we identify genes associated with NEC and mortality that indicate colonization by UPEC. Metagenomic multilocus sequence typing analysis further defined NEC-associated strains as sequence types often associated with urinary tract infections, including ST69, ST73, ST95, ST127, ST131, and ST144. Although other factors associated with prematurity may also contribute, this report suggests a link between UPEC and NEC and indicates that further attention to these sequence types as potential causal agents is needed.

Hospitalization for asthma occurs most often in children under 5 years of age, and children from low-income, minority families have higher morbidity and mortality rates from asthma than their more advantaged peers. This study measured the prevalence of asthma, asthma symptoms, and health care utilization among urban, predominantly minority, children enrolled in Head Start, an early education program for low-income children under 5 years of age. Parents of nonasthmatic children were asked about the presence of asthma symptoms in their children using the International Study on Asthma and Allergy in Children (ISAAC) questionnaire. Surveys asking about the history of asthma and allergy, health care access, and insurance coverage were administered to parents of children attending Head Start in southeastern Virginia. Questionnaires were completed by 671 (52%) parents of Head Start enrolled children. All children were 3 to 4 years of age. Among asthmatic children, 10 (9%) were hospitalized for asthma and 51 (46%) had been seen in the emergency department (ED) for asthma in the previous year. Asthmatic children saw their primary care physician more often (p < 0.001) than nonasthmatic children, however, an ED was the primary source of asthma medications for 13 (11%) children. The majority of asthmatic children (75%) were using a quick relief medication, but only 18% were using a long-term, controller medication. Parents of asthmatic children reported access barriers to care: 35 (30%) reported transportation problems; 27 (23%), problems with physician access; 18 (16%), financial or insurance problems; and 59 (50%), at least one barrier to preventive asthma care for their child. The study found that Head Start provides an important, and previously overlooked, setting for identifying preschool children at high risk for asthma and an opportunity for implementing asthma outreach and prevention programs.