1
|
Djeddi D, Stephan-Blanchard E, Léké A, Ammari M, Delanaud S, Lemaire-Hurtel AS, Bach V, Telliez F. Effects of Smoking Exposure in Infants on Gastroesophageal Reflux as a Function of the Sleep-Wakefulness State. J Pediatr 2018; 201:147-153. [PMID: 30041936 DOI: 10.1016/j.jpeds.2018.05.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/14/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine whether perinatal smoking exposure is associated with gastroesophageal reflux (GER)-related changes in sleep-wakefulness states in neonates. STUDY DESIGN Thirty-one neonates, referred for the investigation of suspected GER, were recruited and underwent multichannel impedance-pH monitoring and synchronized 8- to 12-hour polysomnography. The infants' exposure to tobacco smoke was estimated by means of a urine cotinine assay. The total number, frequency (h-1), and mean duration (minutes) of GER-pH (reflux events detected by the pH electrode only) and GER-imp (reflux events with bolus movement detected by impedance) events were determined. Intergroup differences (smoking-exposed group vs nonexposed group) were probed with nonparametric, unpaired Mann-Whitney U tests. A χ2 test was used to assess a possible intergroup difference in bolus retrograde migration during GER-imp events. RESULTS According to the urine cotinine assay, 21 of the 31 neonates had been exposed to cigarette smoke during the perinatal period. The number (and frequency) of GER-imp was significantly greater (P = .016) in the exposed group (29 [0-90]) than in the nonexposed group (12 [2-35]). Migration of the esophageal bolus from the distal segment to the most proximal segment was significantly more frequent (P = .016) in the exposed group (83% of GER) than in the nonexposed group (41%). The GER pattern associated with smoking exposure was particularly obvious during Rapid eye movement sleep. CONCLUSIONS The more frequent occurrence and greater proximal migration of GER-imp in the smoking-exposed group (especially during rapid eye movement sleep) may have clinical relevance. Smoking exposure is a preventable risk factor for limiting the occurrence of GER in neonates.
Collapse
Affiliation(s)
- Djamal Djeddi
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France; Pediatric Gastroenterology and Nutrition Unit, Amiens University Medical Center, Amiens, France
| | - Erwan Stephan-Blanchard
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - André Léké
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France; Pediatric Gastroenterology and Nutrition Unit, Amiens University Medical Center, Amiens, France; Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
| | - Mohamed Ammari
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - Stephane Delanaud
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | | | - Véronique Bach
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
| | - Frédéric Telliez
- PériTox Laboratory (UMR-I 01), University Health Research Center, Faculty of Medicine, Jules Verne University of Picardy, Amiens, France.
| |
Collapse
|
2
|
Bastianini S, Lo Martire V, Silvani A, Zoccoli G, Berteotti C, Lagercrantz H, Arner A, Cohen G. Long-term cardiovascular reprogramming by short-term perinatal exposure to nicotine's main metabolite cotinine. Acta Paediatr 2018; 107:638-646. [PMID: 29224235 DOI: 10.1111/apa.14181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/04/2017] [Indexed: 01/06/2023]
Abstract
AIM Gather 'proof-of-concept' evidence of the adverse developmental potential of cotinine (a seemingly benign biomarker of recent nicotine/tobacco smoke exposure). METHODS Pregnant C57 mice drank nicotine- or cotinine-laced water for 6 wks from conception (NPRE = 2% saccharin + 100 μg nicotine/mL; CPRE = 2% saccharin + 10 μg cotinine/mL) or 3 wks after birth (CPOST = 2% saccharin + 30 μg cotinine/mL). Controls drank 2% saccharin (CTRL). At 17 ± 1 weeks (male pups; CTRL n = 6; CPOST n = 6; CPRE n = 8; NPRE n = 9), we assessed (i) cardiovascular control during sleep; (ii) arterial reactivity ex vivo; and (iii) expression of genes involved in arterial constriction/dilation. RESULTS Blood cotinine levels recapitulated those of passive smoker mothers' infants. Pups exposed to cotinine exhibited (i) mild bradycardia - hypotension at rest (p < 0.001); (ii) attenuated (CPRE , p < 0.0001) or reverse (CPOST ; p < 0.0001) BP stress reactivity; (iii) adrenergic hypocontractility (p < 0.0003), low protein kinase C (p < 0.001) and elevated adrenergic receptor mRNA (p < 0.05; all drug-treated arteries); and (iv) endothelial dysfunction (NPRE only). CONCLUSION Cotinine has subtle, enduring developmental consequences. Some cardiovascular effects of nicotine can plausibly arise via conversion into cotinine. Low-level exposure to this metabolite may pose unrecognised perinatal risks. Adults must avoid inadvertently exposing a foetus or infant to cotinine as well as nicotine.
Collapse
Affiliation(s)
- Stefano Bastianini
- Department of Biomedical and Neuromotor Sciences (PRISM Lab); Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Viviana Lo Martire
- Department of Biomedical and Neuromotor Sciences (PRISM Lab); Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences (PRISM Lab); Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Giovanna Zoccoli
- Department of Biomedical and Neuromotor Sciences (PRISM Lab); Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Chiara Berteotti
- Department of Biomedical and Neuromotor Sciences (PRISM Lab); Alma Mater Studiorum; Università di Bologna; Bologna Italy
| | - Hugo Lagercrantz
- Department of Women's and Children's Health; Neonatal Unit; Karolinska Institutet; Stockholm Sweden
| | - Anders Arner
- Department of Physiology and Pharmacology (Genetic Physiology); Karolinska Institutet; Stockholm Sweden
| | - Gary Cohen
- Department of Women's and Children's Health; Neonatal Unit; Karolinska Institutet; Stockholm Sweden
- Centre for Sleep Health and Research; Sleep Investigation Laboratory; Royal North Shore Hospital; Sydney Australia
| |
Collapse
|