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Journal of Pediatrics, The

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Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns: Secondary Analysis of a Randomized Trial - 22/06/18

Doi : 10.1016/j.jpeds.2018.02.032 
Katherine C. Wai, MD 1, Anna M. Hibbs, MD MSCE 2, Martina A. Steurer, MD, MAS 3, 4, Dennis M. Black, PhD 4, Jeanette M. Asselin, MS 5, Eric C. Eichenwald, MD 6, Philip L. Ballard, MD, PhD 3, Roberta A. Ballard, MD 3, Roberta L. Keller, MD 3, *
for the

Trial of Late Surfactant (TOLSURF) Study Group*

  List of additional members of the TOLSURF Study Group is available at www.jpeds.com (Appendix 1).
Suzanne Hamilton Strong, RN 7, Jill Immamura-Ching, RN 7, Margaret Orfanos-Villalobos, RN 7, Cassandra Williams, RN 7, David J. Durand, MD 8, 9, Jeffrey D. Merrill, MD 8, 9, Dolia Horton, RRT 8, 9, Loretta Pacello, RCP 8, 9, April Willard, RN 8, 9, William E. Truog, MD 10, Cheryl Gauldin, RN 10, Anne Holmes, RN 10, Patrice Johnson, RRT 10, Kerrie Meinert, RRT 10, Anne Marie Reynolds, MD 11, Janine Lucie, NNP 11, Patrick Conway 11, Michael Sacilowski 11, Michael Leadersdorff, RRT 11, Pam Orbank, RRT 11, Karen Wynn, NNP 11, Robin H. Steinhorn, MD 12, Maria deUngria, MD 12, Janine Yasmin Khan, MD 12, Karin Hamann, RN 12, Molly Schau, RN 12, Brad Hopkins, RRT 12, James Jenson, RRT 12, Carmen Garcia, RN 13, Aruna Parekh, MD 14, Jila Shariff, MD 14, Rose McGovern, RN 14, Jeff Adelman, RRT 14, Adrienne Combs, RN 14, Mary Tjersland, RRT 14, Dennis E. Mayock, MD 15, Elizabeth Howland 15, Susan Walker, RN 15, Jim Longoria, RRT 15, Holly Meo, RRT 15, Amir Khan, MD 16, Georgia McDavid, RN 16, Katrina Burson, RN, BSN 16, Richard Hinojosa, BSRT, RRT 16, Christopher Johnson, MBA, RRT 16, Karen Martin, RN, BSN 16, Sarah Martin, RN, BSN 16, Shawna Rogers, RN, BSN 16, Sharon Wright, MT 16, Mark L. Hudak, MD 17, Kimberly Barnette, RRT 17, Amanda Kellum, RRT 17, Michelle Burcke, RN 17, Christie Hayes, RRT 17, Stephanie Chadwick, RN 17, Danielle Howard, RN 17, Carla Kennedy, RRT 17, Renee Prince, RN 17, Jennifer Helderman, MD 18, T. Michael O'Shea, MD 18, Beatrice Stefanescu, MD 18, Kelly Warden, RN 18, Patty Brown, RN 18, Jennifer Griffin, RRT 18, Laura Conley, RRT 18, Catherine M. Bendel, MD 19, Michael Georgieff, MD 19, Bridget Davern 19, Marla Mills, RN 19, Sharon Ritter, RRT 19, Carol Wagner, MD 20, Rita M. Ryan, MD 20, Deanna Fanning, RN 20, Jimmy Roberson, RRT 20, Mark C. Mammel, MD 21, Andrea Lampland, MD 21, Pat Meyers, RRT 21, Angela Brey, RRT 21, Ellen M. Bendel-Stenzel, MD 22, Neil Mulrooney, MD 22, Cathy Worwa, RRT 22, Pam Dixon, RN, ANM 22, Gerald Ebert, RRT-NPS 22, Cathy Hejl, RRT 22, Molly Maxwell, RT 22, Kristin McCullough, RN 22, Ramasubbareddy Dhanireddy, MD 23, Mohammed T. El Abiad, MD 23, Ajay Talati, MD 23, Sheila Dempsey, RN 23, Kathy Gammage, RRT, MBA 23, Gayle Gower, RN 23, Kathy James, RRT 23, Pam LeNoue, RN 23, Victor J. McKay, MD 24, Suzi Bell, DNP 24, Dawn Bruton, RN, BSN, CCRP 24, Michelle Beaulieu, DNP 24, Richard Williams, RRT 24, Rajan Wadhawan, MD 25, Robin Barron-Nelson, RN 25, Shane Taylor, RRT 25, Sherry E. Courtney, MD 26, Carol Sikes, RN 26, Gary Lowe, RRT 26, Betty Proffitt, RRT 26, Elizabeth E. Rogers, MD 27, 28, Cheryl Chapin 27, 28, Hart Horneman 27, 28, Karin Hamann, RN 27, 28, Susan Kelley, RRT 27, 28, Karin Knowles, Nancy Newton, RN, MS 27, 28, Eric Vittinghoff, PhD 29, 30, Jean Hietpas 29, 30, Laurie Denton 29, 30, Lisa Palermo, MS 29, 30, Lucy Wu 29, 30
7 UCSF Benioff Children's Hospital, San Francisco, CA 
8 Alta Bates Summit Medical Center, Berkeley, CA 
9 UCSF Benioff Children's Hospital Oakland, Oakland, CA 
10 Children's Mercy Hospital, Kansas City, MO 
11 Women and Children's Hospital of Buffalo, Buffalo, NY 
12 Anne and Robert H. Lurie Children's Hospital/Northwestern University, Chicago, IL 
13 Texas Children's Hospital, Houston, TX 
14 Stony Brook University Hospital, Stony Brook, NY 
15 University of Washington, Seattle, WA 
16 University of Texas Health Science Center, Houston, TX 
17 University of Florida College of Medicine, Jacksonville, UF Health Shands Hospital, Wolfson Children's Hospital, Jacksonville, FL 
18 Wake Forest School of Medicine and Forsyth Medical Center, Winston Salem, NC 
19 University of Minnesota Amplatz Children's Hospital, Minneapolis, MN 
20 Medical University of South Carolina, Charleston, SC 
21 Children's Hospitals and Clinics of Minnesota, St. Paul, MN 
22 Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 
23 University of Tennessee Health Science Center, Memphis, TN 
24 All Children's Hospital, St. Petersburg, FL 
25 Florida Hospital for Children, Orlando, FL 
26 Arkansas Children's Hospital, University of Arkansas Medical Sciences, Little Rock, AK 
27 Clinical Coordinating Center 
28 Department of Pediatrics, University of California San Francisco, San Francisco, CA 
29 Data Coordinating Center 
30 Department of Epidemiology and Biostatistics , University of California San Francisco, San Francisco, CA 

1 Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 
2 Department of Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, OH 
3 Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, CA 
4 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 
5 Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, CA 
6 Department of Pediatrics, The University of Pennsylvania, Philadelphia, PA 

*Reprint requests: Roberta L. Keller, MD, UCSF Benioff Children's Hospital, UCSF Box 0734, San Francisco, CA 94143.UCSF Benioff Children's HospitalUCSF Box 0734San FranciscoCA94143

Abstract

Objective

To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship.

Study design

We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis.

Results

Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively.

Conclusions

Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences.

Trial registration

ClinicalTrials.gov: NCT01022580.

Le texte complet de cet article est disponible en PDF.

Keywords : asthma, socioeconomic factors, prematurity

Abbreviations : BPD, ELGAN, ETS, iNO, RSV, SES, TOLSURF


Plan


 TOLSURF was funded through cooperative agreements with NHLBI (U01 HL094338 and U01 HL094355). Consistent with this, Dr Carol Blaisdell, the NHLBI Scientific Officer and an employee of NHLBI was present and participated in all TOLSURF Steering Committee meetings as a nonvoting member. K.W. was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI (UL1 TR000004). ONY, Inc provided Infasurf and IKARIA, Inc provided inhaled nitric oxide and its delivery system for the conduct of the TOLSURF. Neither company was involved in study design, data collection, analysis or interpretation, manuscript writing, or the decision to submit any manuscript for publication. The authors declare no conflicts of interest.
 Portions of this study were presented as an abstract at the Pediatric Academic Societies annual meeting, May 6-9, San Francisco, California.


© 2018  Elsevier Inc. Tous droits réservés.
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Vol 198

P. 201 - juillet 2018 Retour au numéro
Article précédent Article précédent
  • Initial Metabolic Profiles Are Associated with 7-Day Survival among Infants Born at 22-25 Weeks of Gestation
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