Prolonging Health in Babies with Cystic Fibrosis

Neonatologist Juliette Madan MED ’00, MS (left), cares for a young patient at the Children’s Hospital at Dartmouth-Hitchcock.

“Newborn babies with CF are often indistinguishable from other newborns and are beautiful, healthy babies,” explains Juliette Madan MED ’00, MS, an associate professor of epidemiology and pediatrics at the Geisel School of Medicine and a neonatologist at Dartmouth-Hitchcock. The complications arise within the first weeks and months of life.

Abnormal populations of bacteria in the gut—known as dysbiosis—is a well-known complication of CF and contributes to impaired nutrient absorption. So Madan wondered, What if we could tailor the microbiome of babies with CF to delay or prevent dysbiosis, train their immune system, and prolong health?

To pursue that question, Madan and her scientific collaborator George O’Toole, PhD, professor of microbiology and immunology at Geisel, began studying the bacteria in the intestines and lungs of newborns and children with CF.
Madan started one of the first longitudinal CF infant cohorts in the country—a long-term study in which she has enrolled nearly every baby born with CF in New Hampshire since 2009. Her team collects intestinal and lung samples at regular intervals during the first years of life and then follows the children as they grow. The oldest participants are now 9 years old.

In collaboration with Geisel colleagues with expertise in bioinformatics and big data analysis, Madan and O’Toole have shown how bacteria in the intestines and lungs interact, and some of the mechanisms by which dysbiosis relates to the worsening of disease in individuals.
“The fact that a neonatologist can so easily and quickly partner with microbiologists and data scientists to pursue a brand new line of research is emblematic of the collaborative, nimble research culture of Dartmouth and its CF researchers and clinicians,” says Madan.

The research team has also identified how the CF microbiome differs from the microbiome of healthy infants and young children, which could point to potential treatments. By identifying the missing microbes in CF that are important to training the immune system, Madan and her team hope to identify probiotic treatments to benefit infants with CF—giving babies with CF a better chance at a long, healthy life.

Originally published in the Fall 2018 issue of Giving in Action: Report on Philanthropy.