Prematurity, chorioamnionitis, and the development of recurrent wheezing: A prospective birth cohort study - 15/08/11
, Yunxian Yu, MD, PhD b, Rachel E. Story, MD, MPH a, Jacqueline A. Pongracic, MD a, Ruchi Gupta, MD b, Colleen Pearson, BA c, Kathryn Ortiz, BA c, Howard C. Bauchner, MD c, Xiaobin Wang, MD, MPH, ScD b
Reprint requests: Rajesh Kumar, MD, Children’s Memorial Hospital, 2300 Children’s Plaza, Box #60, Chicago, IL 60614.Abstract |
Background |
Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants’ airways.
Objective |
To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing.
Methods |
The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 ± 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (≥2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (<33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis.
Results |
Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema.
Conclusion |
We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects.
Le texte complet de cet article est disponible en PDF.Key words : Chorioamnionitis, prematurity, recurrent wheezing
Abbreviations used : BMC, IOM, IRB, OR
Plan
| The parent study was supported in part by the March of Dimes Perinatal Epidemiology Research Initiative grants (PI: Wang, 20-FY02-56), the National Institute of Environmental Health Sciences (PI: Wang, R21 ES011666), and the National Institute of Child Health and Human Development (PI: Wang, R01 HD041702). The follow-up study was supported in part by the Food Allergy Project. |
|
| Disclosure of potential conflict of interest: R. Kumar has received research support from the National Institutes of Health. The rest of the authors have declared that they have no conflict of interest. |
Vol 121 - N° 4
P. 878 - avril 2008 Retour au numéro
Article précédent
- The burden of disease associated with filaggrin mutations: A population-based, longitudinal birth cohort study
- John Henderson, Kate Northstone, Simon P. Lee, Haihui Liao, Yiwei Zhao, Marcus Pembrey, Somnath Mukhopadhyay, George Davey Smith, Colin N.A. Palmer, W. H. Irwin McLean, Alan D. Irvine
- Asthma costs and utilization in a managed care organization
- Robert S. Zeiger, Joel W. Hay, Richard Contreras, Wansu Chen, Virginia P. Quinn, Brian Seal, Michael Schatz
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?