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The meconium microbiome may provide insight into intrauterine and peripartum exposures and the very earliest intestinal pioneering microbes. Prenatal antibiotics have been associated with later obesity in children, which is thought to be driven by microbiome dependent mechanisms. However, there is little data regarding associations of prenatal or peripartum antibiotic exposure, with or without cesarean section (CS), with the features of the meconium microbiome. In this study, 16S ribosomal RNA gene sequencing was performed on bacterial DNA of meconium samples from 105 infants in a birth cohort study. After multivariable adjustment, delivery mode (p = 0.044), prenatal antibiotic use (p = 0.005) and peripartum antibiotic use (p &lt, 0.001) were associated with beta diversity of the infant meconium microbiome. CS (vs. vaginal delivery) and peripartum antibiotics were also associated with greater alpha diversity of the meconium microbiome (Shannon and Simpson, p &lt, 0.05). Meconium from infants born by CS (vs. vaginal delivery) had lower relative abundance of the genus Escherichia (p &lt, 0.001). Prenatal antibiotic use and peripartum antibiotic use (both in the overall analytic sample and when restricting to vaginally delivered infants) were associated with differential abundance of several bacterial taxa in the meconium. Bacterial taxa in the meconium microbiome were also differentially associated with infant excess weight at 12 months of age, however, sample size was limited for this comparison. In conclusion, prenatal and peripartum antibiotic use along with CS delivery were associated with differences in the diversity and composition of the meconium microbiome. Whether or not these differences in the meconium microbiome portend risk for long-term health outcomes warrants further exploration.

INTRODUCTION: Gastrointestinal (GI) symptoms can be the first presenting finding in children infected with the severe acute respiratory syndrome coronavirus-2 (SARSCoV- 2) The novel coronavirus disease 2019 (COVID-19) has a higher rate of mortality and critical illness in adults, however, severe presentations in children are increasingly reported Patients with chronic illness are at a higher risk of complications from the infection, but there is no data in patients sickle cell disease (SCD) METHODS: A 12-year-old African American boy with SCD, subtype HbSS, presented with acute worsening hematemesis, 2 days of non-bloody diarrhea, and back pain that responded a dose of ibuprofen He had a history of splenectomy and multiple episodes of acute chest syndrome (ACS) and vaso-occlusive crises On presentation, he was febrile, tachycardic, and hypotensive, without signs of respiratory distress His hemoglobin had dropped to 4 1 g/ dL His nasopharyngeal swab was positive for SARS-CoV-2 He required multiple blood transfusions and other supportive measures to treat his shock state Esophagoduodenoscopy (EGD) showed diffuse hemorrhagic gastropathy without ulcerations, but no biopsy was taken RESULTS: The patient's presenting symptoms of diarrhea and fever were consistent with published data on children with COVID-19 He also had leukocytosis, elevated inflammatory markers, and an abnormal coagulation profile These are seen in more severe cases and are currently described under the multisystem inflammatory syndrome of children His respiratory status remained stable despite having multiple ACS episodes in the past Upper GI bleeding is not yet described in pediatric COVID-19 Most cases of upper GI bleeding in children are attributed to NSAIDs exposure, but it's unlikely that one dose of ibuprofen causes such severe bleeding Histopathologic samples from COVID-19 patients show evidence of lymphocytic infiltrate and interstitial edema in the gastric mucosa, with detection of SARS-CoV-2 nucleocapsid protein in gastric epithelial cells We hypothesize that the severe hemorrhagic gastritis resulted from SARS-CoV-2-induced coagulopathy and viral invasion This was further compounded by the acute insult from an NSAID and the underlying mucosal infarction and vascular congestion from sickling