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Oluwafemi O, Manoharan S, Xie L, Pro G, Patel RS, Delclos GL, Gelfand A, Messiah SE, Lopez DS, Patel J. Assessing the Role of Asthma on the Relationship between Neurodevelopmental Disabilities and Adverse Birth Outcomes. Pediatr Neurol 2024; 156:131-138. [PMID: 38776595 DOI: 10.1016/j.pediatrneurol.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/07/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Investigating asthma as an effect modifier between adverse birth outcomes and neurodevelopmental disabilities (NDDs) across different races is crucial for tailored interventions and understanding variable susceptibility among diverse populations. METHODS Data were collected through the National Survey of Children's Health. This cross-sectional study included 131,774 children aged 0 to 17 years. Study exposures comprised adverse birth outcomes including preterm birth and low birth weight. Weighted prevalence estimates and odds ratios with 95% confidence intervals (CIs) among children with and without adverse birth outcomes were calculated for NDDs including attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, seizure, and several others including behavior problems. Adjusted odds ratios were stratified by asthma status and separate interactions were assessed for each outcome. RESULTS Of 131,774 participants, 10,227 were born low birth weight (9.12%; 95% CI: 8.77% to 9.49%), 14,058 were born preterm (11.35%; 95% CI: 10.94% to 11.76%), and 16,166 participants had asthma (11.97%; 95% CI: 11.58% to 12.37%). There were 68,100 males (51.11%), 63,674 females (48.89%), 102,061 non-Hispanic Whites (NHW) (66.92%), 8,672 non-Hispanic Blacks (NHB) (13.97%), and 21,041 participants (19.11%) categorized as other. NHB children with adverse birth outcomes had higher prevalence of several NDDs compared to NHW children. CONCLUSIONS Asthma was not shown to be an effect modifier of the association between adverse birth outcomes and NDDs. Nevertheless, these results suggest that NDDs are more prevalent within US children with adverse birth outcomes, with higher rates among NHB compared to NHW children. These findings support screening for NDDs in pediatric health care settings among patients with adverse birth outcomes, particularly among those from ethnic minority backgrounds.
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Affiliation(s)
- Omobola Oluwafemi
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, UTHealth Houston School of Public Health, Houston, Texas
| | - Sneha Manoharan
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; The University of North Texas Health Science Center, Fort Worth, Texas
| | - Luyu Xie
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas
| | - George Pro
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Southern Public Health and Criminal Justice Research Center at University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rikinkumar S Patel
- Department of Child and Adolescent Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - George L Delclos
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, UTHealth Houston School of Public Health, Houston, Texas
| | - Andrew Gelfand
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah E Messiah
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas
| | - David S Lopez
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas
| | - Jenil Patel
- Center for Pediatric Population Health, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth Houston School of Public Health, Dallas, Texas; Department of Epidemiology, Human Genetics and Environmental Sciences, Southwest Center for Occupational and Environmental Health, UTHealth Houston School of Public Health, Houston, Texas.
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Litt JS, Johnson S, Marlow N, Tiemeier H. Impaired pulmonary function mediates inattention in young adults born extremely preterm. Acta Paediatr 2023; 112:254-260. [PMID: 36330674 DOI: 10.1111/apa.16586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022]
Abstract
AIM To test whether poor childhood pulmonary function explains the relationship between extremely preterm (EP) birth and attention-deficit/hyperactivity disorder (ADHD) symptoms in young adulthood. METHODS EPICure birth cohort participants include children born <26 weeks' gestation in the United Kingdom and Ireland in 1995 and their term-born classmates. Predictor was EP birth. Outcomes were inattention/hyperactivity subscale z-scores at 19 years. Forced expiratory volume (FEV1) z-scores in childhood and young adulthood were mediators. We used recursive path analysis to determine the direct effect of EP birth on inattention/hyperactivity and its indirect effect through pulmonary function. RESULTS Ninety EP and 47 term-born participants had pulmonary function testing at 11 and 19 years. Inattention z-scores were higher in the EP group (mean difference 0.55 [95% CI 0.11, 0.99]) but not hyperactivity. Compared to term-born peers, EP participants had lower FEV1 z-scores at 11 (mean difference-1.35 [95% CI -1.72, -0.98]) and 19 (mean difference-1.29 [95% CI -1.65, -0.92]). Path models revealed that childhood pulmonary function explained the relationship between EP birth and inattention. CONCLUSIONS Extremely preterm young adults have increased risk for inattention compared to term-born peers. Poor pulmonary function appears to underlie this risk. The mechanisms responsible remain unclear and warrant further study.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Annesi CA, Levin JC, Litt JS, Sheils CA, Hayden LP. Long-term respiratory and developmental outcomes in children with bronchopulmonary dysplasia and history of tracheostomy. J Perinatol 2021; 41:2645-2650. [PMID: 34290373 PMCID: PMC8294252 DOI: 10.1038/s41372-021-01144-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The long-term morbidity among children with severe bronchopulmonary dysplasia who require tracheostomy (tBPD) relative to those without tracheostomy (sBPD) is not well characterized. We compared childhood lung function and neurodevelopmental outcomes in tBPD and sBPD. STUDY DESIGN Retrospective case-control study of N = 49 tBPD and N = 280 sBPD subjects in Boston Children's Hospital Preterm Lung Patient Registry and medical record. We compared NICU course, childhood spirometry, and neurodevelopmental testing. RESULT tBPD subjects were more likely than sBPD to be Black, have pulmonary hypertension, and have subglottic stenosis. tBPD subjects had lower maximal childhood FEV1 % predicted (β = -0.14) and FEV1/FVC (β = -0.08); spirometry curves were more likely to suggest fixed extrathoracic obstruction. tBPD subjects had greater cognitive and motor delays <24 months, and greater cognitive delays >24 months. CONCLUSION Compared to subjects with sBPD who did not require tracheostomy, tBPD subjects suffer from increased long-term impairment in respiratory function and neurodevelopment.
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Affiliation(s)
- Chandler A. Annesi
- grid.189504.10000 0004 1936 7558Boston University School of Medicine, Boston, MA USA
| | - Jonathan C. Levin
- grid.2515.30000 0004 0378 8438Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.2515.30000 0004 0378 8438Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Jonathan S. Litt
- grid.2515.30000 0004 0378 8438Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Catherine A. Sheils
- grid.2515.30000 0004 0378 8438Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA
| | - Lystra P. Hayden
- grid.2515.30000 0004 0378 8438Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Pediatrics, Harvard Medical School, Boston, MA USA ,grid.62560.370000 0004 0378 8294Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA USA
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