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Dowell J, Bice Z, Yan K, Konduri GG. Hyperoxia-induced airflow restriction and Renin-Angiotensin System expression in a bronchopulmonary dysplasia mouse model. Physiol Rep 2024; 12:e15895. [PMID: 38163662 PMCID: PMC10758334 DOI: 10.14814/phy2.15895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/03/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Mechanisms underlying hyperoxia-induced airflow restriction in the pediatric lung disease Bronchopulmonary dysplasia (BPD) are unclear. We hypothesized a role for Renin-Angiotensin System (RAS) activity in BPD. RAS is comprised of a pro-developmental pathway consisting of angiotensin converting enzyme-2 (ACE2) and angiotensin II receptor type 2 (AT2), and a pro-fibrotic pathway mediated by angiotensin II receptor type 1 (AT1). We investigated associations between neonatal hyperoxia, airflow restriction, and RAS activity in a BPD mouse model. C57 mouse pups were randomized to normoxic (FiO2 = 0.21) or hyperoxic (FiO2 = 0.75) conditions for 15 days (P1-P15). At P15, P20, and P30, we measured airflow restriction using plethysmography and ACE2, AT1, and AT2 mRNA and protein expression via polymerase chain reaction and Western Blot. Hyperoxia increased airflow restriction P15 and P20, decreased ACE2 and AT2 mRNA, decreased AT2 protein, and increased AT1 protein expression. ACE2 mRNA and protein remained suppressed at P20. By P30, airflow restriction and RAS expression did not differ between groups. Hyperoxia caused high airflow restriction, increased pulmonary expression of the pro-fibrotic RAS pathway, and decreased expression of the pro-developmental in our BPD mouse model. These associated findings may point to a causal role for RAS in hyperoxia-induced airflow restriction.
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Affiliation(s)
| | - Zachary Bice
- Medical College of WisconsinMilwaukeeWisconsinUSA
| | - Ke Yan
- Medical College of WisconsinMilwaukeeWisconsinUSA
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2
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Deolmi M, Decarolis NM, Motta M, Makrinioti H, Fainardi V, Pisi G, Esposito S. Early Origins of Chronic Obstructive Pulmonary Disease: Prenatal and Early Life Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2294. [PMID: 36767660 PMCID: PMC9915555 DOI: 10.3390/ijerph20032294] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The main risk factor for chronic obstructive pulmonary disease (COPD) is active smoking. However, a considerable amount of people with COPD never smoked, and increasing evidence suggests that adult lung disease can have its origins in prenatal and early life. This article reviews some of the factors that can potentially affect lung development and lung function trajectories throughout the lifespan from genetics and prematurity to respiratory tract infections and childhood asthma. Maternal smoking and air pollution exposure were also analyzed among the environmental factors. The adoption of preventive strategies to avoid these risk factors since the prenatal period may be crucial to prevent, delay the onset or modify the progression of COPD lung disease throughout life.
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Affiliation(s)
- Michela Deolmi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Nicola Mattia Decarolis
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Matteo Motta
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 01451, USA
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Giovanna Pisi
- Cystic Fibrosis Unit, Pediatric Clinic, Az. Ospedaliera-Universitaria di Parma, Via Gramsci 14, 43124 Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43124 Parma, Italy
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3
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Beqiraj-Zeqiraj Q, Thaçi Q, Sahiti F, Kovač Z, Raffay TM, Sopi RB. Rho-kinase inhibitors protect against neonatal hyperoxia-induced airway hyperreactivity in a rat pup model: Role of prostaglandin F 2α. Pediatr Pulmonol 2022; 57:1229-1237. [PMID: 35088947 DOI: 10.1002/ppul.25848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/06/2022] [Accepted: 01/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oxygen therapy in preterm neonates is associated with airway hyperreactivity. The role of Rho/Rho-kinase smooth muscle signaling in hyperoxia-induced airway hyperreactivity remains understudied. We hypothesized that inhibition of Rho-kinase will attenuate airway hyperreactivity induced by neonatal hyperoxia. METHODS Newborn rats were raised in hyperoxia (>95% O2 ) or ambient air (AA) for 7 days. Subgroups were injected with a Rho-kinase inhibitor: Y-27632 (10 mg·kg-1 ·day-1 ) or fasudil (10 mg·kg-1 ·day-1 ), or a FP receptor antagonist - AS604872 (30 mg·kg-1 ·day-1 ). After exposures, tracheal cylinders were prepared for in vitro wire myography. Contraction to methacholine or PGF2α was measured in the presence or absence of tissue-bath Y-27632, fasudil, or AS604872. Lung PGF2α levels, Rho-kinase protein level and Rho-kinase 1 activity were measured by ELISA. RESULTS Tracheal smooth muscle contraction was significantly greater in hyperoxic compared to AA groups. Both, Y-27632 and fasudil significantly decreased contractility to MCh or PGF2α in hyperoxic groups versus hyperoxic controls (p < 0.001), but did not alter AA group responses. Inhibition of FP receptors attenuated responses to PGF2α . Hyperoxia significantly increased lung PGF2α compared to AA (p < 0.01), but Rho-kinase inhibition did not influence PGF2α level. Rho-kinase protein level (p < 0.001) and activity (p < 0.01), were increased by hyperoxia, but blockade of FP receptor reduced the Rho-kinase 1 activity (p < 0.05) under hyperoxic condition. CONCLUSIONS This study demonstrates an active role of Rho/Rho-kinase signaling on hyperoxia-induced airway hyperreactivity. These findings suggest that Rho-kinase inhibitors might serve as an effective therapy for hyperoxia-induced airway hyperreactivity.
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Affiliation(s)
- Qendresa Beqiraj-Zeqiraj
- Department of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.,Pediatric Clinic, University Clinical Centre of Kosovo, Prishtina, Kosovo
| | - Qëndrim Thaçi
- Department of Premedical Courses, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Floran Sahiti
- Department of Premedical Courses, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Zdenko Kovač
- Department of Pathophysiology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Thomas M Raffay
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ramadan B Sopi
- Department of Premedical Courses, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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4
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Summary for Clinicians: Clinical Practice Guidelines for Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease. Ann Am Thorac Soc 2022; 19:873-879. [PMID: 35239469 DOI: 10.1513/annalsats.202201-007cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Accorsi BF, Friedrich FO, Corso AL, Rosa JPD, Jones MH. Intra-breath oscillometry for the evaluation of lung function in children and adolescents with a history of preterm birth. J Bras Pneumol 2022; 48:e20210290. [PMID: 35137869 PMCID: PMC8836632 DOI: 10.36416/1806-3756/e20210290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To assess respiratory system impedance (Zrs) and spirometric parameters in children and adolescents with and without a history of preterm birth. Methods: We evaluated a sample of 51 subjects between 11 and 14 years of age: 35 who had a history of preterm birth (preterm group) and 16 who had been born at term (full-term group). Lung function was measured by spirometry, spectral oscillometry, and intra-breath oscillometry. Results: Neither spirometry nor spectral oscillometry revealed any statistically significant differences between the preterm and full-term groups. However, intra-breath oscillometry demonstrated significant differences between the two groups in terms of the change in resistance, reactance at end-inspiration, and the change in reactance (p < 0.05 for all). Conclusions: Our findings suggest that abnormalities in Zrs persist in children and adolescents with a history of preterm birth and that intra-breath oscillometry is more sensitive than is spectral oscillometry. Larger studies are needed in order to validate these findings and to explore the impact that birth weight and gestational age at birth have on Zrs later in life.
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Affiliation(s)
- Bruna Freire Accorsi
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Frederico Orlando Friedrich
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Andréa Lúcia Corso
- . Departamento de Neonatologia e Pediatria, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Juliana Pontes da Rosa
- . Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
| | - Marcus Herbert Jones
- . Programa de Pós-Graduação em Pediatria e Saúde da Criança, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,. Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS), Brasil
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6
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Goulden N, Cousins M, Hart K, Jenkins A, Willetts G, Yendle L, Doull I, Williams EM, Hoare Z, Kotecha S. Inhaled Corticosteroids Alone and in Combination With Long-Acting β2 Receptor Agonists to Treat Reduced Lung Function in Preterm-Born Children: A Randomized Clinical Trial. JAMA Pediatr 2022; 176:133-141. [PMID: 34902004 PMCID: PMC8669602 DOI: 10.1001/jamapediatrics.2021.5111] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/03/2021] [Indexed: 12/05/2022]
Abstract
Importance Decreases in future lung function are a hallmark of preterm birth, but studies for management of decreased lung function are limited. Objective To determine whether 12 weeks of treatment with inhaled corticosteroids (ICS) alone or in combination with long-acting β2 agonists (LABA) improves spirometry and exercise capacity in school-aged preterm-born children who had percent predicted forced expiratory volume in 1 second (%FEV1) less than or equal to 85% compared with inhaled placebo treatment. Design, Setting, and Participants A double-blind, randomized, placebo-controlled trial was conducted to evaluate ICS and ICS/LABA against placebo. Preterm-born children (age, 7-12 years; gestation ≤34 weeks at birth) who did not have clinically significant congenital, cardiopulmonary, or neurodevelopmental abnormalities underwent spirometry, exercise testing, and measurement of fractional exhaled nitric oxide before and after treatment. A total of 144 preterm-born children at the Children's Hospital for Wales in Cardiff, UK, were identified and enrolled between July 1, 2017, and August 31, 2019. Interventions Each child was randomized to 1 of 3 cohorts: fluticasone propionate, 50 μg, with placebo; fluticasone propionate, 50 μg, with salmeterol, 25 μg; or placebo inhalers, all given as 2 puffs twice daily for 12 weeks. Children receiving preexisting ICS treatment underwent washout prior to randomization to ICS or ICS/LABA. Main Outcomes and Measures The primary outcome was between-group differences assessed by adjusted pretreatment and posttreatment differences of %FEV1 using analysis of covariance. Intention-to-treat analysis was conducted. Results Of 144 preterm-born children who were identified with %FEV1 less than or equal to 85%, 53 were randomized. Treatment allocation was 20 children receiving ICS (including 5 with prerandomization ICS), 19 children receiving ICS/LABA (including 4 with prerandomization ICS), and 14 children receiving placebo. The mean (SD) age of children was 10.8 (1.2) years, and 29 of the randomized children (55%) were female. The posttreatment %FEV1 was adjusted for sex, gestation, bronchopulmonary dysplasia, intrauterine growth restriction, pretreatment corticosteroid status, treatment group, and pretreatment values. Posttreatment adjusted means for %FEV1, using analysis of covariance, were 7.7% (95% CI, -0.27% to 15.72%; P = .16) higher in the ICS group and 14.1% (95% CI, 7.3% to 21.0%; P = .002) higher in the ICS/LABA group compared with the placebo group. Active treatment decreased the fractional exhaled nitric oxide and improved postexercise bronchodilator response but did not improve exercise capacity. One child developed cough when starting inhaler treatment; no other adverse events reported during the trial could be attributed to the inhaler treatment. Conclusions and Relevance The results of this randomized clinical trial suggest that combined ICS/LABA treatment is beneficial for prematurity-associated lung disease in children. Trial Registration EudraCT number: 2015-003712-20.
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Affiliation(s)
- Nia Goulden
- NWORTH, Bangor University, Bangor, United Kingdom
| | - Michael Cousins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Kylie Hart
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | | | - Gill Willetts
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Louise Yendle
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Iolo Doull
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - E. Mark Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Zoe Hoare
- NWORTH, Bangor University, Bangor, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
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7
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Satar M, Güven T, Şimşek H, Ufuk Altıntaş D. Premature Infants have no Higher Risk of Atopy and Respiratory Functions Compared to Control at 4-6 Years of Age. Curr Pediatr Rev 2022; 19:99-104. [PMID: 35440310 DOI: 10.2174/1573396318666220417183655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/24/2021] [Accepted: 01/24/2022] [Indexed: 01/28/2023]
Abstract
AIMS This study aimed to evaluate the respiratory functions and atopy conditions of preterm infants treated with aminophylline or caffeine for apnea in NICU in early childhood. MATERIALS AND METHODS This is a retrospective cohort study. In this study, 27 patients aged 4 to 6 years hospitalized in NICU for prematurity and 26 healthy children were included. The subjects were evaluated for fx5, phadiatope, total IgE levels, skin tests, and respiratory function tests. RESULTS There was no statistically significant difference among groups in terms of fx5, phadiatope, total IgE levels, and skin test results. Moreover, no statistically significant difference was found among the groups in terms of FVC, FEV1, FEV1/ FVC, PEF, MEF75, MEF50, MEF25, and MEF25-75 values in respiratory function tests. Preterm neonates with bronchopulmonary dysplasia (BPD) had higher FEV1 values compared to ones without BPD (p=0.02). CONCLUSION Preterm infants treated with aminophylline or caffeine did not have a higher risk of atopy and had similar respiratory function tests compared to healthy infants at 4-6 years old. However, FEV1 values were higher in infants with BPD. These results suggested that respiratory functions could be affected in the long-term follow-up of premature infants with BPD.
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Affiliation(s)
- Mehmet Satar
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Tuğçe Güven
- Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hüseyin Şimşek
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Derya Ufuk Altıntaş
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
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8
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Cristea AI, Ren CL, Amin R, Eldredge LC, Levin JC, Majmudar PP, May AE, Rose RS, Tracy MC, Watters KF, Allen J, Austin ED, Cataletto ME, Collaco JM, Fleck RJ, Gelfand A, Hayes D, Jones MH, Kun SS, Mandell EW, McGrath-Morrow SA, Panitch HB, Popatia R, Rhein LM, Teper A, Woods JC, Iyer N, Baker CD. Outpatient Respiratory Management of Infants, Children, and Adolescents with Post-Prematurity Respiratory Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2021; 204:e115-e133. [PMID: 34908518 PMCID: PMC8865713 DOI: 10.1164/rccm.202110-2269st] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Premature birth affects millions of neonates each year, placing them at risk for respiratory disease due to prematurity. Bronchopulmonary dysplasia is the most common chronic lung disease of infancy, but recent data suggest that even premature infants who do not meet the strict definition of bronchopulmonary dysplasia can develop adverse pulmonary outcomes later in life. This post-prematurity respiratory disease (PPRD) manifests as chronic respiratory symptoms, including cough, recurrent wheezing, exercise limitation, and reduced pulmonary function. This document provides an evidence-based clinical practice guideline on the outpatient management of infants, children, and adolescents with PPRD. Methods: A multidisciplinary panel of experts posed questions regarding the outpatient management of PPRD. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. Results: The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Recommendations were developed for or against three common medical therapies and four diagnostic evaluations in the context of the outpatient management of PPRD. Conclusions: The panel developed recommendations for the outpatient management of patients with PPRD on the basis of limited evidence and expert opinion. Important areas for future research were identified.
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9
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Rhoads E, Montgomery GS, Ren CL. Wheezing in preterm infants and children. Pediatr Pulmonol 2021; 56:3472-3477. [PMID: 33580622 DOI: 10.1002/ppul.25314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 11/10/2022]
Abstract
Wheezing is a common outcome of preterm birth. This article will review the mechanisms, epidemiology, and treatment of wheezing in preterm children with and without a history of bronchopulmonary dysplasia.
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Affiliation(s)
- Eli Rhoads
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gregory S Montgomery
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Clement L Ren
- Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.,Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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10
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Sucre J, Haist L, Bolton CE, Hilgendorff A. Early Changes and Indicators Characterizing Lung Aging in Neonatal Chronic Lung Disease. Front Med (Lausanne) 2021; 8:665152. [PMID: 34136503 PMCID: PMC8200413 DOI: 10.3389/fmed.2021.665152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
Infants suffering from neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, are facing long-term consequences determined by individual genetic background, presence of infections, and postnatal treatment strategies such as mechanical ventilation and oxygen toxicity. The adverse effects provoked by these measures include inflammatory processes, oxidative stress, altered growth factor signaling, and remodeling of the extracellular matrix. Both, acute and long-term consequences are determined by the capacity of the immature lung to respond to the challenges outlined above. The subsequent impairment of lung growth translates into an altered trajectory of lung function later in life. Here, knowledge about second and third hit events provoked through environmental insults are of specific importance when advocating lifestyle recommendations to this patient population. A profound exchange between the different health care professionals involved is urgently needed and needs to consider disease origin while future monitoring and treatment strategies are developed.
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Affiliation(s)
- Jennifer Sucre
- Mildred Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University, Nashville, TN, United States
| | - Lena Haist
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center With the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Center for Comprehensive Developmental Care (CDeCLMU), University Hospital Ludwig-Maximilian University, Munich, Germany
| | - Charlotte E Bolton
- Division of Respiratory Medicine, NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, City Hospital NUH Campus, Nottingham, United Kingdom
| | - Anne Hilgendorff
- Institute for Lung Biology and Disease and Comprehensive Pneumology Center With the CPC-M bioArchive, Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Center for Comprehensive Developmental Care (CDeCLMU), University Hospital Ludwig-Maximilian University, Munich, Germany
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11
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Pérez-Tarazona S, Rueda Esteban S, García-García ML, Arroyas Sanchez M, de Mir Messa I, Acevedo Valarezo T, Mesa Medina O, Callejón Callejón A, Canino Calderín EM, Albi Rodriguez S, Ayats Vidal R, Salcedo Posadas A, Costa Colomer J, Domingo Miró X, Berrocal Castañeda M, Villares Porto-Dominguez A. Respiratory outcomes of "new" bronchopulmonary dysplasia in adolescents: A multicenter study. Pediatr Pulmonol 2021; 56:1205-1214. [PMID: 33314679 PMCID: PMC8246560 DOI: 10.1002/ppul.25226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Long-term respiratory consequences of bronchopulmonary dysplasia (BPD) in preterm infants born in the post-surfactant era ("new" BPD) remain partially unknown. The present study aimed to evaluate the respiratory outcomes of "new" BPD in adolescents who were born preterm. METHODS This multicenter, cross-sectional study included 286 adolescents born between 2003 and 2005 (mean age: 14.2 years); among them, 184 and 102 were born extremely preterm (EP; <28 weeks' gestation) and moderate-late preterm (32 to <37 weeks' gestation), respectively. Among EP adolescents, 92 had BPD, and 92 did not. All participants underwent lung function tests, skin prick testing, and questionnaires on asthma symptoms and quality of life. RESULTS EP adolescents with BPD had significantly lower forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), FEV1 /FVC ratio, and forced expiratory flow between 25% and 75% of FVC than other included adolescents. FEV1 /FVC ratios were below the lower limit of normal (z-score <-1.645) in 30.4% of EP adolescents with BPD, 13.0% of EP adolescents without BPD, and 11.8% of adolescents who were born moderate-late preterm. Bronchodilator response and air-trapping were significantly higher in BPD adolescents than in other adolescents. Diffusion capacity was significantly lower in EP adolescents than in moderate-late preterm adolescents. Asthma symptoms and quality-of-life scores were similar among groups. CONCLUSION EP adolescents with "new" BPD had poorer pulmonary function than EP adolescents without BPD or moderate-late preterm adolescents. Further studies are needed to determine whether "new" BPD is associated with early-onset chronic obstructive pulmonary disease in adulthood.
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Affiliation(s)
| | | | - Maria L García-García
- Pediatric Pulmonology Unit, Severo Ochoa University Hospital, Leganés, Madrid, Spain
| | - Maria Arroyas Sanchez
- Pediatric Pulmonology Unit, Severo Ochoa University Hospital, Leganés, Madrid, Spain
| | - Inés de Mir Messa
- Pediatric Pulmonology and Cystic Fibrosis Unit, Vall d'Hebron Hospital, Barcelona, Spain
| | | | - Orlando Mesa Medina
- Pediatric Pulmonology Unit, Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Alicia Callejón Callejón
- Pediatric Pulmonology Unit, Nuestra Señora de la Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Elisa M Canino Calderín
- Pediatric Pulmonology Unit, Hospital Universitario Materno Infantil de Canarias, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Salome Albi Rodriguez
- Pediatric Pulmonology and Allergy Unit, 12th of October University Hospital, Madrid, Spain
| | - Roser Ayats Vidal
- Pediatric Pulmonology, Allergology and Immunology Unit, Cystic Fibrosis Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Jordi Costa Colomer
- Pediatric Pulmonology Unit, Sant Joan de Deu Hospital, Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Domingo Miró
- Pediatric Pulmonology, Allergology and Immunology Unit, Cystic Fibrosis Unit, Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
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12
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Gundogdu Z. Effect of sibship asthma on newborns with transient tachypnea of the newborn (TTN). CLINICAL RESPIRATORY JOURNAL 2020; 15:232-236. [PMID: 33058532 DOI: 10.1111/crj.13290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/01/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A number of studies have demonstrated that transient tachypnea of the newborn (TTN) is a risk factor for later asthma. The present study attempts to determine whether older sibling asthma is a risk factor for TTN. METHODS Medical records of 1318 newborns from neonatal intensive care and delivery units were studied. None of the subjects were first-born, and thus, all had older siblings. Clinical data of mothers and their children were obtained from medical records. Data items included date of birth, gestational age (GA) at birth, birth weight, gender, mode of delivery including Normal Spontaneous Delivery or caesarean section (CS) and whether pre-labour CS or not, reasons for CS, number of pregnancies, number of children, asthma of mothers and siblings, whether the newborn had TTN or not. Logistic regression analysis was used to assess the association between siblings' asthma and TTN. RESULTS Pre-labour CS, maternal asthma, GA, babies with large and small birth weight for GA, number of pregnancies and children (three and more) were found to be significantly associated with TTN. Siblings' asthma was found to be independently associated with a diagnosis of TTN. CONCLUSIONS Both pre-labour CS and mothers with asthma were common risk factors for the development of TTN. An association was present between TTN and siblings' asthma even in infants whose mothers did not have asthma.
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Affiliation(s)
- Zuhal Gundogdu
- Child Health and Diseases Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Stamenkovska M, Thaçi Q, Hadzi‐Petrushev N, Angelovski M, Bogdanov J, Reçica S, Kryeziu I, Gagov H, Mitrokhin V, Kamkin A, Schubert R, Mladenov M, Sopi RB. Curcumin analogs (B2BrBC and C66) supplementation attenuates airway hyperreactivity and promote airway relaxation in neonatal rats exposed to hyperoxia. Physiol Rep 2020; 8:e14555. [PMID: 32812392 PMCID: PMC7435033 DOI: 10.14814/phy2.14555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study was undertaken to test the hypothesis that the newly synthesized curcuminoids B2BrBC and C66 supplementation will overcome hyperoxia-induced tracheal hyperreactivity and impairment of relaxation of tracheal smooth muscle (TSM). MATERIALS AND METHODS Rat pups (P5) were exposed to hyperoxia (>95% O2 ) or normoxia for 7 days. At P12, tracheal cylinders were used to study in vitro contractile responses induced by methacholine (10-8 -10-4 M) or relaxation induced by electrical field stimulation (5-60 V) in the presence/absence of B2BrBC or C66, or to study the direct relaxant effects elicited by both analogs. RESULTS Hyperoxia significantly increased contraction and decreased relaxation of TSM compared to normoxia controls. Presence of B2BrBC or C66 normalized both contractile and relaxant responses altered by hyperoxia. Both, curcuminoids directly induced dose-dependent relaxation of preconstricted TSM. Supplementation of hyperoxic animals with B2BrBC or C66, significantly increased catalase activity. Lung TNF-α was significantly increased in hyperoxia-exposed animals. Both curcumin analogs attenuated increases in TNF-α in hyperoxic animals. CONCLUSION We show that B2BrBC and C66 provide protection against adverse contractility and relaxant effect of hyperoxia on TSM, and whole lung inflammation. Both analogs induced direct relaxation of TSM. Through restoration of catalase activity in hyperoxia, we speculate that analogs are protective against hyperoxia-induced tracheal hyperreactivity by augmenting H2 O2 catabolism. Neonatal hyperoxia induces increased tracheal contractility, attenuates tracheal relaxation, diminishes lung antioxidant capacity, and increases lung inflammation, while monocarbonyl CUR analogs were protective of these adverse effects of hyperoxia. Analogs may be promising new therapies for neonatal hyperoxic airway and lung disease.
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Affiliation(s)
- Mimoza Stamenkovska
- Faculty of Natural Sciences and MathematicsInstitute of Biology“Sts, Cyril and Methodius” UniversitySkopjeMacedonia
| | - Qendrim Thaçi
- Department of Premedical Courses‐BiologyFaculty of MedicineUniversity of PrishtinaSt. Martyrs’ Boulevard n.n.PrishtinaKosovoSerbia
| | - Nikola Hadzi‐Petrushev
- Faculty of Natural Sciences and MathematicsInstitute of Biology“Sts, Cyril and Methodius” UniversitySkopjeMacedonia
| | - Marija Angelovski
- Faculty of Natural Sciences and MathematicsInstitute of Biology“Sts, Cyril and Methodius” UniversitySkopjeMacedonia
| | - Jane Bogdanov
- Faculty of Natural Sciences and MathematicsInstitute of Chemistry“Ss. Cyril and Methodius” UniversitySkopjeMacedonia
| | - Shkëlzen Reçica
- Department of Premedical Courses‐BiologyFaculty of MedicineUniversity of PrishtinaSt. Martyrs’ Boulevard n.n.PrishtinaKosovoSerbia
| | - Islam Kryeziu
- Department of Premedical Courses‐BiologyFaculty of MedicineUniversity of PrishtinaSt. Martyrs’ Boulevard n.n.PrishtinaKosovoSerbia
| | - Hristo Gagov
- Faculty of BiologySofia University St. Kliment OhridskiSofiaBulgaria
| | - Vadim Mitrokhin
- Department of Fundamental and Applied PhysiologyRussian National Research Medical UniversityMoscowRussia
| | - Andre Kamkin
- Department of Fundamental and Applied PhysiologyRussian National Research Medical UniversityMoscowRussia
| | - Rudolf Schubert
- PhysiologyInstitute of Theoretical MedicineMedical FacultyUniversity of AugsburgAugsburgGermany
| | - Mitko Mladenov
- Faculty of Natural Sciences and MathematicsInstitute of Biology“Sts, Cyril and Methodius” UniversitySkopjeMacedonia
| | - Ramadan B. Sopi
- Department of Premedical Courses‐BiologyFaculty of MedicineUniversity of PrishtinaSt. Martyrs’ Boulevard n.n.PrishtinaKosovoSerbia
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14
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Gundogdu Z. New Risk Factors for Transient Tachypnea of the Newborn and Childhood Asthma: A Study of Clinical Data and a Survey of Parents. Cureus 2019; 11:e6388. [PMID: 31938665 PMCID: PMC6957045 DOI: 10.7759/cureus.6388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: It is established that transient tachypnea of the newborn (TTN) is associated with an increased risk of early childhood asthma. However, the question remains whether both asthma and TTN have common risk factors as well as the same underlying etiology. This study aims to determine possible risk factors for TTN as well as early childhood asthma. Methods: This study was carried out in two phases. While the first phase included medical records of 1318 newborns, the second phase consisted of a phone survey. Results: Elective cesarean section (ECS), maternal asthma, gestational age (GA), babies with large and small birth weight, number of pregnancies, and number of children were found to be significantly associated with TTN. ECS, maternal asthma, length of the hospital stay due to TTN, and O2 treatment were statistically significant for asthma. TTN was found to be associated with a subsequent diagnosis of childhood asthma after adjusting for ECS and maternal asthma. Conclusions: Both ECS and maternal asthma are the common risk factors for the development of both TTN and childhood asthma as previously reported. In order to uncover this association, when ECS is taken out, it is seen that the association between TTN and asthma is stronger. Furthermore, O2 treatment and duration of hospital stay due to TTN were also found to be associated with childhood asthma. Association of maternal allergic rhinitis and eczema with TTN was investigated and there was no relationship between maternal allergic rhinitis or maternal eczema and the subsequent diagnosis of TTN.
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Abstract
The rate of bronchopulmonary dysplasia (BPD) in preterm infants is increasing; this trend reflects, in part, improved survival among extremely premature infants. BPD is associated with adverse developmental and medical outcomes in early childhood and at least through school age. Therefore, BPD imposes a significant burden on infants and children, their families, and society. Many interventions to decrease BPD and the sequelae of BPD have been studied; few to date have been proved to decrease both BPD and later disability.
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Affiliation(s)
- Sara B DeMauro
- Division of Neonatology, The Children's Hospital of Philadelphia, 2nd Floor Main Building, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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16
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Abstract
Being born preterm often adversely affects later lung function. Airway obstruction and bronchial hyperresponsiveness (BHR) are common findings. Respiratory symptoms in asthma and in lung disease after preterm birth might appear similar, but clinical experience and studies indicate that symptoms secondary to preterm birth reflect a separate disease entity. BHR is a defining feature of asthma, but can also be found in other lung disorders and in subjects without respiratory symptoms. We review different methods to assess BHR, and findings reported from studies that have investigated BHR after preterm birth. The area appeared understudied with relatively few and heterogeneous articles identified, and lack of a pervasive understanding. BHR seemed related to low gestational age at delivery and a neonatal history of bronchopulmonary dysplasia. No studies reported associations between BHR after preterm birth and the markers of eosinophilic inflammatory airway responses typically found in asthma. This should be borne in mind when treating preterm born individuals with BHR and airway symptoms.
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Malleske DT, Chorna O, Maitre NL. Pulmonary sequelae and functional limitations in children and adults with bronchopulmonary dysplasia. Paediatr Respir Rev 2018; 26:55-59. [PMID: 29031795 DOI: 10.1016/j.prrv.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Abstract
Preterm infants with bronchopulmonary dysplasia (BPD) often suffer from life-long pulmonary impairments in pulmonary physical function. This review summarizes our current understanding of the chronic pulmonary impairments and physical functional limitations associated with BPD from preterm birth to adulthood. It also identifies opportunities for intervention in children and adults living with chronic lung disease (CLD) after preterm birth.
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Affiliation(s)
- Daniel T Malleske
- Division of Neonatology, Nationwide Children's Hospital/The Ohio State University College of Medicine, United States.
| | - Olena Chorna
- Center for Perinatal Research, Nationwide Children's Hospital, United States
| | - Nathalie L Maitre
- Division of Neonatology, Nationwide Children's Hospital/The Ohio State University College of Medicine, United States; Center for Perinatal Research, Nationwide Children's Hospital, United States
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18
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Abstract
The onset of chronic obstructive pulmonary disease (COPD) can arise either from failure to attain the normal spirometric plateau or from an accelerated decline in lung function. Despite reports from numerous big cohorts, no single adult life factor, including smoking, accounts for this accelerated decline. By contrast, five childhood risk factors (maternal and paternal asthma, maternal smoking, childhood asthma and respiratory infections) are strongly associated with an accelerated rate of lung function decline and COPD. Among adverse effects on lung development are transgenerational (grandmaternal smoking), antenatal (exposure to tobacco and pollution), and early childhood (exposure to tobacco and pollution including pesticides) factors. Antenatal adverse events can operate by causing structural changes in the developing lung, causing low birth weight and prematurity and altered immunological responses. Also important are mode of delivery, early microbiological exposures, and multiple early atopic sensitizations. Early bronchial hyperresponsiveness, before any evidence of airway inflammation, is associated with adverse respiratory outcomes. Overlapping cohort studies established that spirometry tracks from the preschool years to late middle age, and those with COPD in the sixth decade already had the worst spirometry at age 10 years. Alveolar development is now believed to continue throughout somatic growth and is adversely impacted by early tobacco smoke exposure. Genetic factors are also important, with genes important in lung development and early wheezing also being implicated in COPD. The inescapable conclusion is that the roots of COPD are in early life, and COPD is a disease of childhood adverse factors interacting with genetic factors.
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Edwards MO, Kotecha SJ, Lowe J, Richards L, Watkins WJ, Kotecha S. Management of Prematurity-Associated Wheeze and Its Association with Atopy. PLoS One 2016; 11:e0155695. [PMID: 27203564 PMCID: PMC4874578 DOI: 10.1371/journal.pone.0155695] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 05/03/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Although preterm birth is associated with respiratory morbidity in childhood, the role of family history of atopy and whether appropriate treatment has been instituted is unclear. Thus we assessed (i) the prevalence of respiratory symptoms, particularly wheezing, in childhood; (ii) evaluated the role of family history of atopy and mode of delivery, and (iii) documented the drug usage, all in preterm-born children compared to term-born control children. Methods We conducted a cross-sectional population-based questionnaire study of 1–10 year-old preterm-born children (n = 13,361) and matched term-born controls (13,361). Data (n = 7,149) was analysed by gestational groups (24–32 weeks, 33–34 weeks, 35–36 weeks and 37–43 weeks) and by age, <5 years old or ≥ 5 years. Main Results Preterm born children aged <5 years (n = 2,111, term n = 1,402) had higher rates of wheeze-ever [odds ratio: 2.7 (95% confidence intervals 2.2, 3.3); 1.8 (1.5, 2.2); 1.5 (1.3, 1.8) respectively for the 24–32 weeks, 33–34 weeks, 35–36 weeks groups compared to term]. Similarly for the ≥5 year age group (n = 2,083, term n = 1,456) wheezing increased with increasing prematurity [odds ratios 3.3 (2.7, 4.1), 1.8 (1.5, 2.3) and 1.6 (1.3, 1.9) for the three preterm groups compared to term]. At both age groups, inhaler usage was greater in the lowest preterm group but prematurity-associated wheeze was independent of a family history of atopy. Conclusions Increasing prematurity was associated with increased respiratory symptoms, which were independent of a family history of atopy. Use of bronchodilators was also increased in the preterm groups but its efficacy needs careful evaluation.
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Affiliation(s)
- Martin O. Edwards
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sarah J. Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - John Lowe
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Louise Richards
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - W. John Watkins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
- * E-mail:
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21
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Resch B, Kurath-Koller S, Eibisberger M, Zenz W. Prematurity and the burden of influenza and respiratory syncytial virus disease. World J Pediatr 2016; 12:8-18. [PMID: 26582294 DOI: 10.1007/s12519-015-0055-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Respiratory morbidity of former preterm infants and especially those with bronchopulmonary dysplasia (BPD) is high during infancy and early childhood. DATA SOURCES We performed a review based on a literature search including EMBASE, MEDLINE, and CINAHL databases to identify all relevant papers published in the English and German literature on influenza and respiratory syncytial virus infection associated with preterm infant, prematurity, and BPD between 1980 and 2014. RESULTS Recurrent respiratory symptoms remain common at preschool age, school age and even into young adulthood. Acute viral respiratory tract infections due to different pathogens cause significant morbidity and necessitate rehospitalizations during the first years of life. Influenza virus infection plays a minor role compared to respiratory syncytial virus (RSV) associated respiratory tract infection during infancy and early childhood. Nevertheless, particular morbidity to both viruses is high. CONCLUSIONS The particular burden of both viral diseases in preterm infants is dominated by RSV and its associated rehospitalizations during the first two years of life. Prophylactic measures include vaccination against influenza virus of family members and caregivers and active immunization starting at the age of 6 months, and monthly injections of palivizumab during the cold season to avoid severe RSV disease and its sequelae.
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Affiliation(s)
- Bernhard Resch
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
| | - Stefan Kurath-Koller
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Monika Eibisberger
- Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria
| | - Werner Zenz
- Research Unit for Infectious Diseases and Vaccinology, Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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Islam JY, Keller RL, Aschner JL, Hartert TV, Moore PE. Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia. Am J Respir Crit Care Med 2015; 192:134-56. [PMID: 26038806 DOI: 10.1164/rccm.201412-2142pp] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease associated with premature birth that primarily affects infants born at less than 28 weeks' gestational age. BPD is the most common serious complication experienced by premature infants, with more than 8,000 newly diagnosed infants annually in the United States alone. In light of the increasing numbers of preterm survivors with BPD, improving the current state of knowledge of long-term respiratory morbidity for infants with BPD is a priority. We undertook a comprehensive review of the published literature to analyze and consolidate current knowledge of the effects of BPD that are recognized at specific stages of life, including infancy, childhood, and adulthood. In this review, we discuss both the short-term and long-term respiratory outcomes of individuals diagnosed as infants with the disease and highlight the gaps in knowledge needed to improve early and lifelong management of these patients.
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Affiliation(s)
- Jessica Y Islam
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Roberta L Keller
- 2 Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, California; and
| | - Judy L Aschner
- 3 Department of Pediatrics and.,4 Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, New York
| | - Tina V Hartert
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Paul E Moore
- 1 Center for Asthma Research, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and.,5 Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
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23
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Suursalmi P, Kopeli T, Korhonen P, Lehtimäki L, Nieminen R, Luukkaala T, Moilanen E, Korppi M, Paassilta M, Tammela O. Very low birthweight bronchopulmonary dysplasia survivors show no substantial association between lung function and current inflammatory markers. Acta Paediatr 2015; 104:264-8. [PMID: 25348705 DOI: 10.1111/apa.12837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/08/2014] [Accepted: 10/22/2014] [Indexed: 01/17/2023]
Abstract
AIM The role of inflammation in the bronchopulmonary dysplasia (BPD) survivors is indistinct. We evaluated lung function in relation to inflammatory markers in plasma, exhaled breath condensate and exhaled air in school-aged very low birthweight (VLBW) survivors with and without radiographic BPD. METHODS Pre- and postbronchodilator impulse oscillometry were performed by 21 six to 14-year-old VLBW children with radiographic BPD, 19 VLBW children without radiographic BPD and 19 age-matched nonasthmatic term controls. Eosinophilic cationic protein, interleukins 6 and 8, adiponectin, adipsin, leptin and resistin in plasma, leukotriene B4 and 8-isoprostane in exhaled breath condensate, and bronchial and alveolar nitric oxide output were measured. RESULTS Abnormal lung function was found in 12.5% of the former VLBW children. Airway resistance at 5 Hz was highest in the radiographic BPD, but bronchodilator responses were most prominent in the non-BPD group. Plasma adiponectin had a modest positive correlation with obstruction and with bronchodilator responses, and alveolar nitric oxide and plasma interleukin 6 with bronchodilator responses. CONCLUSION Very low birthweight children with radiographic BPD had poorest lung function. The most pronounced bronchodilator responses were found in VLBW children without radiographic BPD. Current detected inflammatory markers had only a minor association with lung function in school-aged BPD survivors.
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Affiliation(s)
- Piia Suursalmi
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Tarja Kopeli
- Department of Pediatrics; Päijät-Häme Central Hospital; Lahti Finland
| | - Päivi Korhonen
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | - Lauri Lehtimäki
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
- Allergy Centre; Tampere University Hospital; Tampere Finland
| | - Riina Nieminen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - Tiina Luukkaala
- Science Center; Pirkanmaa Hospital District and School of Health Sciences; University of Tampere; Tampere Finland
| | - Eeva Moilanen
- The Immunopharmacology Research Group; University of Tampere School of Medicine and Tampere University Hospital; Tampere Finland
| | - Matti Korppi
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
| | | | - Outi Tammela
- Department of Pediatrics; Tampere University Hospital; Tampere Finland
- Tampere Center for Child Health Research; Tampere University Hospital and University of Tampere; Tampere Finland
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Hilgendorff A, O'Reilly MA. Bronchopulmonary dysplasia early changes leading to long-term consequences. Front Med (Lausanne) 2015; 2:2. [PMID: 25729750 PMCID: PMC4325927 DOI: 10.3389/fmed.2015.00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/05/2015] [Indexed: 12/05/2022] Open
Abstract
Neonatal chronic lung disease, i.e., bronchopulmonary dysplasia, is characterized by impaired pulmonary development resulting from the impact of different risk factors including infections, hyperoxia, and mechanical ventilation on the immature lung. Remodeling of the extracellular matrix, apoptosis as well as altered growth factor signaling characterize the disease. The immediate consequences of these early insults have been studied in different animal models supported by results from in vitro approaches leading to the successful application of some findings to the clinical setting in the past. Nonetheless, existing information about long-term consequences of the identified early and most likely sustained changes to the developing lung is limited. Interesting results point towards a tremendous impact of these early injuries on the pulmonary repair capacity as well as aging related processes in the adult lung.
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Affiliation(s)
- Anne Hilgendorff
- Comprehensive Pneumology Center, Helmholtz Zentrum München, Member of the German Center for Lung Research (DZL) , Munich , Germany ; Neonatology, Perinatal Center Grosshadern, Dr. von Hauner Children's Hospital, Ludwig-Maximilians University , Munich , Germany
| | - Michael A O'Reilly
- Department of Pediatrics, School of Medicine and Dentistry, The University of Rochester , Rochester, NY , USA
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Damgaard AL, Hansen BM, Mathiasen R, Buchvald F, Lange T, Greisen G. Prematurity and prescription asthma medication from childhood to young adulthood: a Danish national cohort study. PLoS One 2015; 10:e0117253. [PMID: 25651521 PMCID: PMC4317188 DOI: 10.1371/journal.pone.0117253] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/22/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Preterm birth is associated with increased risk of asthma-like symptoms and purchase of prescription asthma medication in childhood. We investigated whether this association persists into adulthood and whether it is affected by accounting for neonatal respiratory morbidity (acute respiratory disease and bronchopulmonary dysplasia). METHODS A national cohort of all infants born in Denmark in the period 1980-2009 was included in this register study. Data on purchase of asthma medication (combination of inhaled β-2 agonists and other drugs for obstructive airway disease) in 2010-2011 were obtained from the Danish National Prescription Registry. Associations between gestational age (GA), neonatal respiratory morbidity and a cross-sectional evaluation of asthma medication purchase were explored by multivariate logistic regressions. RESULTS A full dataset was obtained on 1,790,241 individuals, 84.6% of all infants born in the period. Odds-ratios (95% CI) for the association between GA and purchase of asthma medication during infancy were: 3.86 (2.46-6.04) in GA 23-27 weeks, 2.37 (1.84-3.04) in GA 28-31 weeks and 1.59 (1.43-1.77) in GA 32-36 weeks compared to term infants with GA 37-42 weeks. Associations weakened in older age groups and became insignificant in young adults born extremely and very preterm with odds-ratios: 1.41 (0.63-3.19) and 1.15 (0.83-1.60) in GA 23-27 and 28-31 respectively. When adjusting for neonatal respiratory morbidity, the associations weakened but persisted both in childhood and adolescence. CONCLUSION There was a strong dose-response association between gestational age and the purchase of prescription asthma medication in infancy and childhood. This association weakened during adolescence and was mostly non-significant in young adulthood. The increased risk of prescription asthma medication purchase in ex-preterm children could only partly be explained by neonatal respiratory morbidity.
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Affiliation(s)
- Anne Louise Damgaard
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - Bo Mølholm Hansen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatric and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Frederik Buchvald
- Dept. of Pediatric and Adolescent Medicine, Pulmonary Service, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Theis Lange
- Dept. of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Kotecha SJ, Edwards MO, Watkins WJ, Lowe J, Henderson AJ, Kotecha S. Effect of bronchodilators on forced expiratory volume in 1 s in preterm-born participants aged 5 and over: a systematic review. Neonatology 2015; 107:231-240. [PMID: 25721674 DOI: 10.1159/000371539] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/15/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Preterm-born participants are at risk of long-term deficits in percentage predicted forced expiratory volume in 1 s (%FEV1). Since it is unclear if these deficits respond to bronchodilators, we systematically reviewed the evidence for reversibility of deficits in %FEV1 by bronchodilators in preterm-born participants. DESIGN Studies reporting a change in %FEV1 in response to bronchodilator treatment in preterm-born participants at ≥5 years of age, with or without a term-born control group, were identified. The quality of studies was assessed by adapted tools. Due to considerable heterogeneity between studies, formal meta-analysis was not possible. RESULTS From 8,839 titles, 22 studies were identified after an updated search in May 2013. Twenty-one studies assessed the response to a single inhaled dose of a bronchodilator, and 1 study assessed longer-term effects. Most studies observed decreased %FEV1 in preterm-born participants compared with controls. Most studies observed improved %FEV1 after a single dose of bronchodilator, with the largest improvements noted in those with bronchopulmonary dysplasia, who had greater deficits of %FEV1 when compared with preterm and term controls. One long-term study investigated a 2-week terbutaline administration, but the initial FEV1 after a single dose did not show a change in %FEV1 of ≥15%, but 5/29 (17%) children had an increased %FEV1 of ≥10%. CONCLUSIONS In this systematic review, disparate studies were identified. Although single doses of bronchodilators appear to improve the FEV1 in the short term, further studies are required to assess their longer-term benefits not only on airway obstruction, but also their effect on respiratory symptoms.
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Lin SC, Lin HW. Urbanization factors associated with childhood asthma and prematurity: a population-based analysis aged from 0 to 5 years in Taiwan by using Cox regression within a hospital cluster model. J Asthma 2014; 52:273-8. [PMID: 25171433 DOI: 10.3109/02770903.2014.958854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Childhood asthma and premature birth are both common; however, no studies have reported urbanization association between asthma and prematurity and the duration of prematurity affect asthma development. We use Taiwan Longitudinal Health Insurance Database (LHID) to explore association between asthma and prematurity among children by using a population-based analysis. METHODS This is a retrospective cohort study with registration data derived from Taiwan LHID. We evaluated prematurely born infants and children aged <5 years (n = 532) and age-matched control patients (n = 60505) using Cox proportional hazard regression analysis within a hospital cluster model. Of the 61 037 examinees, 14 012 experienced asthma during the 5-year follow-up, including 161 (72.26 per 1000 person-years) infants and children born prematurely and 13 851 (40.27 per 1000 person-years) controls. RESULTS The hazard ratio for asthma during 5-year follow-up period was 1.95 (95% confidence interval = 1.67-2.28) among children born prematurely. Boys born prematurely aged 0-2 years were associated with higher asthma rates compared with girls in non-premature and premature groups. Living in urban areas, those born prematurely were associated with higher rates of asthma compared with non-prematurity. Those born prematurely lived in northern region had higher asthma hazard ratio than other regions. CONCLUSION Our analyses indicated that sex, age, urbanization level, and geographic region are significantly associated with prematurity and asthma. Based on cumulative asthma-free survival curve generated using the Kaplan-Meier method, infants born prematurely should be closely monitored to see if they would develop asthma until the age of 6 years.
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Affiliation(s)
- Sheng-Chieh Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University , Taipei , Taiwan
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Schmalisch G, Wilitzki S, Fischer HS, Bührer C. Effect of intubation and mechanical ventilation on exhaled nitric oxide in preterm infants with and without bronchopulmonary dysplasia measured at a median postmenstrual age of 49 weeks. BMC Res Notes 2014; 7:389. [PMID: 24957096 PMCID: PMC4102333 DOI: 10.1186/1756-0500-7-389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background Exhaled nitric oxide (eNO) is a marker of established airway inflammation in adults and children, but conflicting results have been reported in preterm infants when postnatal eNO is measured during tidal breathing. This study investigated the extent to which intubation and mechanical ventilation (MV) affect eNO and NO production (V’NO) in preterm infants with and without bronchopulmonary dysplasia (BPD). Patients and methods A total of 176 very low birth weight (VLBW) infants (birth weight <1500 g), including 74 (42%) with and 102 (58%) without BPD, were examined at a median postmenstrual age of 49 weeks. Of the 176 infants, 84 (48%) did not require MV, 47 (27%) required MV for <7 days and 45 (26%) required MV for ≥7 days. Exhaled NO and tidal breathing parameters were measured in sleeping infants during tidal breathing, respiratory mechanics were assessed by occlusion tests, and arterialized capillary blood gas was analyzed. Results eNO was significantly correlated with tidal breathing parameters, while V’NO was correlated with growth parameters, including age and body length (p < 0.001 each). Infants who were intubated and received MV for <7 days had significantly lower eNO (p < 0.01) and V’NO (p < 0.01) than non-ventilated infants. In contrast, eNO and V’NO did not differ significantly in non-ventilated infants and those receiving MV for ≥7 days. Multivariate analysis showed that independent on the duration of MV eNO (p = 0.003) and V’NO (p = 0.018) were significantly increased in BPD infants comparable with the effects of intubation and MV on eNO (p = 0.002) and V’NO (p = 0.017). Conclusions Preterm infants with BPD show only weak postnatal increases in eNO and V’NO, but these changes may be obscured by the distinct influences of breathing pattern and invasive respiratory support. This limits the diagnostic value of postnatal eNO measurements in the follow-up of BPD infants.
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Affiliation(s)
- Gerd Schmalisch
- Department of Neonatology, Charité University Medicine, Charitéplatz 1, D - 10117 Berlin, Germany.
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Kalliola S, Malmberg LP, Kajosaari M, Mattila PS, Pelkonen AS, Mäkelä MJ. Assessing direct and indirect airway hyperresponsiveness in children using impulse oscillometry. Ann Allergy Asthma Immunol 2014; 113:166-72. [PMID: 24882741 DOI: 10.1016/j.anai.2014.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/15/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Airway hyperresponsiveness (AHR) is a hallmark of asthma but its assessment is usually restricted to older children who are capable of performing the maneuvers involved in spirometry. In younger children, a feasible option to perform the lung function measurement is impulse oscillometry (IOS), which requires less cooperation. OBJECTIVE To evaluate whether assessment of AHR by IOS could differentiate children with various obstructive symptoms from one another. METHODS One hundred twenty-one children (median age 6.0 years, range 3.7-8.1 years) were examined: 31 with probable asthma characterized by current troublesome lung symptoms, 61 with a history of early wheezing disorder (recurrent wheezing ≤24 months of age), 15 with a history of bronchopulmonary dysplasia, and 14 healthy controls. Indirect AHR was assessed by exercise and mannitol challenge tests, and direct AHR was assessed with methacholine using IOS. AHR to exercise was defined as an increase of at least 40% in respiratory resistance at 5 Hz. In the mannitol and methacholine challenges, the dose causing an increase of 40% in respiratory resistance at 5 Hz was calculated. RESULTS AHR to exercise was good at differentiating children with current troublesome lung symptoms from those in the other groups (P < .001). AHR to methacholine separated children with current troublesome lung symptoms, early wheezing disorder, and bronchopulmonary dysplasia from the controls (P < .001), whereas the mannitol test did not distinguish among the study groups (P = .209). CONCLUSION The methacholine and exercise challenge tests with IOS identify children with probable asthma characterized by troublesome lung symptoms and therefore may represent a practical aid in the evaluation of AHR in young children.
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Affiliation(s)
- Satu Kalliola
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
| | - L Pekka Malmberg
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Merja Kajosaari
- Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Petri S Mattila
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland
| | - Anna S Pelkonen
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika J Mäkelä
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Gibson AM, Doyle LW. Respiratory outcomes for the tiniest or most immature infants. Semin Fetal Neonatal Med 2014; 19:105-11. [PMID: 24239022 DOI: 10.1016/j.siny.2013.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extremely low birth weight (<1000 g birth weight) or extremely preterm (<28 weeks of gestation) infants are surviving in greater numbers as neonatal care advances. Many of these survivors, especially those who develop bronchopulmonary dysplasia, have more respiratory ill health in the first years after discharge home, reduced respiratory function and impaired exercise capacity throughout childhood and into adulthood compared with term-born controls. It is important to establish the long-term respiratory outcomes for the tiniest or most immature survivors as they grow older, since they may contribute disproportionately to rates of chronic obstructive pulmonary disease and respiratory ill-health in adulthood.
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Affiliation(s)
- Anne-Marie Gibson
- Respiratory Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Lex W Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Lista G, Castoldi F, Bianchi S, Lupo E, Cavigioli F, Farolfi A, Bersanini C, Ferrerio E. Lung function and respiratory health at school age in ventilated very low birth weight infants. Indian J Pediatr 2014; 81:275-8. [PMID: 23868538 DOI: 10.1007/s12098-013-1129-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 06/06/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate respiratory health and lung function in school-aged children without broncho-pulmonary dysplasia (BPD), who were very low birth weight (VLBWi) and randomized at birth to high frequency oscillatory ventilation (HFOV) or volume guarantee (VG) ventilation for severe respiratory distress syndrome (RDS). METHODS In this observational study, 7-y-old ex-preterm infants with severe RDS, randomly assigned at birth to receive assisted/control ventilation + VG (Vt = 5 mL/kg, PEEP = 5 cmH2O)(VG group; mean GA 27 ± 2 wk; mean BW 1086 ± 158 g) or HFOV (HFOV group; mean GA: 27 ± 2; mean BW: 1090 ± 139 g) (both groups were ventilated with Drager Babylog 8000 plus) were recalled. Neonatal clinical data and outcome were known. Actual outcomes were investigated with an interview; lung function was measured by whole-body plethysmography. RESULTS Twenty five children were studied (VG group, n = 13 vs. HFOV group, n = 12). There were no differences in anthropometric data, drugs (steroids/bronchodilators and antibiotics) or hospital readmission for respiratory disorders. Compliance to the test was adequate. The authors found a similar obstructive deficit (elevated values: airway resistance (RAW), residual volume (RV), total lung capacity (TLC) with near-normal spirometry) in both groups suggesting a persistent airflow limitation even in absence of BPD. CONCLUSIONS VLBW infants even in absence of BPD, need long term respiratory follow-up, because they frequently show an impairment of lung function, independent from initial respiratory support, even if at birth the choice is a lung protective approach (e.g., HFOV or VG ventilation).
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Affiliation(s)
- Gianluca Lista
- Department of NICU, V.Buzzi Children's Hospital ICP, Via Castelvetro 32, 20154, Milan, Italy,
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Abstract
Chronic respiratory morbidity is a common adverse outcome of very premature birth, particularly in infants who had developed bronchopulmonary dysplasia (BPD). Prematurely born infants who had BPD may require supplementary oxygen at home for many months and affected infants have increased healthcare utilisation until school age. Chest radiograph abnormalities are common; computed tomography of the chest gives predictive information in children with ongoing respiratory problems. Readmission to hospital is common, particularly for those who have BPD and suffer respiratory syncytial virus lower respiratory infections (RSV LRTIs). Recurrent respiratory symptoms requiring treatment are common and are associated with evidence of airways obstruction and gas trapping. Pulmonary function improves with increasing age, but children with BPD may have ongoing airflow limitation. Lung function abnormalities may be more severe in those who had RSV LRTIs, although this may partly be explained by worse premorbid lung function. Worryingly, lung function may deteriorate during the first year. Longitudinal studies are required to determine if there is catch up growth.
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Cazzato S, Ridolfi L, Bernardi F, Faldella G, Bertelli L. Lung function outcome at school age in very low birth weight children. Pediatr Pulmonol 2013; 48:830-7. [PMID: 23129340 DOI: 10.1002/ppul.22676] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 07/31/2012] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to assess pulmonary function and its predictors in very low birth weight (birth weight ≤1,500 g) children (VLBWc) with or without bronchopulmonary dysplasia (BPD), born at gestational age ≤32 weeks at a single tertiary center during 1996-1999, after the introduction of surfactant therapy. METHODS Of the 120 surviving VLBW children, 48 (40%) VLBWc (22 with prior-BPD) at age 8.5 ± 1.0 years and 46 age-matched controls (8.8 ± 1.4 years) born at term, underwent lung function study. RESULTS Adjusted values (z-score) of forced vital capacity (z-FVC), forced expiratory volume in 1 sec (z-FEV1), forced expiratory flow 25-75% (z-FEF25-75), carbon monoxide lung diffusion capacity (z-DLCO), and DLCO/alveolar volume (z-DLCO/VA) were significantly lower than controls (mean difference, 95% CI: -1.35, -1.81 to -0.90, P < 0.001; -1.31, -1.73 to -0.90, P < 0.001; -0.87, -1.29 to -0.46, P < 0.001; -0.98, -1.72 to -0.23, P < 0.001; -0.70, -1.22 to -0.18, P < 0.05; respectively). Residual volume (z-RV) and RV/total lung capacity (RV/TLC) ratio (%) were significantly higher in VLBWc than controls (mean difference, 95% CI: 1.06, 0.44 to 1.68, P < 0.001; 9.54%, 5.73 to 13.3%, P < 0.001; respectively). No differences were found in lung function between VLBWc (no-BPD vs. BPD) with the exception of a significant higher RV/TLC ratio in the BPD-subgroup (mean difference, 95% CI: 7.0%, 0.4 to 13%, P = 0.03). Lung function abnormalities were found in 30 (63%) VLBWc with evidence of airway obstruction and diffusing capacity impairment. A weak relationship was observed between gestational age with z-FVC (r = 0.30, P = 0.04), birth weight with z-FEV1 (r = 0.30, P = 0.04) and RV/TLC ratio (r = -0.49, P = 0.001). The duration of oxygen treatment correlated negatively with the z-DLCO/Va (r = -0.5, P = 0.02). No differences were found in FeNO levels between VLBWc and controls. CONCLUSION VLBWc at school age showed lung function abnormalities characterized by airway obstruction, hyperinflation, and diffusion impairment. Neonatal lung damage together with preterm birth may play a role in worsening the functional respiratory outcome.
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Affiliation(s)
- Salvatore Cazzato
- Department of Pediatrics, University of Bologna, S. Orsola-Malpighi Hospital Bologna, Italy.
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Malmberg LP, Pelkonen AS, Malmström K, Saarinen KM, Kajosaari M, Hakulinen A, Mäkelä MJ. Very low birth weight and respiratory outcome: association between airway inflammation and hyperresponsiveness. Ann Allergy Asthma Immunol 2013; 111:96-101. [PMID: 23886226 DOI: 10.1016/j.anai.2013.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/29/2013] [Accepted: 06/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The respiratory outcomes after preterm birth have changed, and it is unclear whether increased airway hyperresponsiveness (AHR) later in childhood is associated with airway inflammation. OBJECTIVE To investigate the association between AHR and fractional exhaled nitric oxide (FeNO), including the alveolar concentration of nitric oxide, in school-age children with very low birth weight (VLBW). METHODS Twenty-nine children with VLBW, 33 children with a history of early wheeze, and 60 healthy controls underwent a FeNO measurement and bronchial challenge test with histamine. Atopy was assessed with skin prick tests. RESULTS Children with VLBW had well-preserved baseline lung function but significantly increased AHR, expressed as the dose response slope (P < .001). Geometric mean FeNO levels were similar between VLBW children and healthy controls, and a history of bronchopulmonary dysplasia had no effect. In the VLBW and early wheeze groups, AHR was associated with FeNO (r = 0.47, P = .01, and r = 0.43, P = .013, respectively), but in a stratified analysis, this association was significant only in atopic individuals. By using the multiple flow FeNO technique, the bronchial nitric oxide flux rather than alveolar nitric oxide concentrations were associated with AHR in both children with early wheeze and VLBW. CONCLUSION We conclude that in VLBW children AHR is related to FeNO but only in atopic individuals. Similar to children with early wheeze, this association is dependent on bronchial flux rather than alveolar nitric oxide concentration. It is likely that AHR is modified by atopic inflammation rather than by inflammatory process due to prematurity.
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Affiliation(s)
- L Pekka Malmberg
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
BACKGROUND School children born preterm often show airway hyperresponsiveness to methacholine or histamine. Less attention has been paid to their airway response to exercise, an important point because of the role of exercise in the child's daily life. The aim of this study was to describe the characteristics of, and potential determinants to, the airway response to exercise in children born extremely preterm. METHODS Forty-two nonasthmatic nonatopic children born before 32 wk gestation were compared with 27 healthy nonasthmatic nonatopic term children at age 7. Spirometry and respiratory impedance were measured at baseline and repeated after a single-step 6-min treadmill exercise in a climate-controlled room. RESULTS The preterm group showed significant broncho-constriction induced by exercise. Prematurity, but not low baseline lung function, neonatal oxygen supplementation, mechanical ventilation, chronic lung disease, or maternal smoking, was a determinant of exercise-induced bronchoconstriction. CONCLUSION Children born extremely preterm present significant exercise-induced airway obstruction at age 7. The response has different characteristics from that occurring in asthmatics and is likely to express airway noneosinophilic inflammation.
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Sopi RB, Zaidi SIA, Mladenov M, Sahiti H, Istrefi Z, Gjorgoski I, Lajçi A, Jakupaj M. L-citrulline supplementation reverses the impaired airway relaxation in neonatal rats exposed to hyperoxia. Respir Res 2012; 13:68. [PMID: 22870905 PMCID: PMC3487946 DOI: 10.1186/1465-9921-13-68] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 07/27/2012] [Indexed: 11/21/2022] Open
Abstract
Background Hyperoxia is shown to impair airway relaxation via limiting L-arginine bioavailability to nitric oxide synthase (NOS) and reducing NO production as a consequence. L-arginine can also be synthesized by L-citrulline recycling. The role of L-citrulline supplementation was investigated in the reversing of hyperoxia-induced impaired relaxation of rat tracheal smooth muscle (TSM). Methods Electrical field stimulation (EFS, 2–20 V)-induced relaxation was measured under in vitro conditions in preconstricted tracheal preparations obtained from 12 day old rat pups exposed to room air or hyperoxia (>95% oxygen) for 7 days supplemented with L-citrulline or saline (in vitro or in vivo). The role of the L-citrulline/L-arginine cycle under basal conditions was studied by incubation of preparations in the presence of argininosuccinate synthase (ASS) inhibitor [α-methyl-D, L-aspartate, 1 mM] or argininosuccinate lyase inhibitor (ASL) succinate (1 mM) and/or NOS inhibitor [Nω-nitro-L-arginine methyl ester; 100 μM] with respect to the presence or absence of L-citrulline (2 mM). Results Hyperoxia impaired the EFS-induced relaxation of TSM as compared to room air control (p < 0.001; 0.5 ± 0.1% at 2 V to 50.6 ± 5.7% at 20 V in hyperoxic group: 0.7 ± 0.2 at 2 V to 80.0 ± 5.6% at 20 V in room air group). Inhibition of ASS or ASL, and L-citrulline supplementation did not affect relaxation responses under basal conditions. However, inhibition of NOS significantly reduced relaxation responses (p < 0.001), which were restored to control level by L-citrulline. L-citrulline supplementation in vivo and in vitro also reversed the hyperoxia-impaired relaxation. The differences were significant (p <0.001; 0.8 ± 0.3% at 2 V to 47.1 ± 4.1% at 20 V without L-citrulline; 0.9 ± 0.3% at 2 V to 68.2 ± 4.8% at 20 V with L-citrulline). Inhibition of ASS or ASL prevented this effect of L-citrulline. Conclusion The results indicate the presence of an L-citrulline/L-arginine cycle in the airways of rat pups. L-citrulline recycling does not play a major role under basal conditions in airways, but it has an important role under conditions of substrate limitations to NOS as a source of L-arginine, and L-citrulline supplementation reverses the impaired relaxation of airways under hyperoxic conditions.
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Affiliation(s)
- Ramadan B Sopi
- Department of Pharmacy-Biology, Faculty of Medicine, University of Prishtina, St, Martyrs' Boulevard n,n,, Prishtina, 10000, Kosovo, Macedonia.
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Greenough A. Long term respiratory outcomes of very premature birth (<32 weeks). Semin Fetal Neonatal Med 2012; 17:73-6. [PMID: 22300711 DOI: 10.1016/j.siny.2012.01.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Many very prematurely born infants develop bronchopulmonary dysplasia (BPD), remaining oxygen dependent for many months and requiring frequent rehospitalisations. Troublesome, recurrent respiratory symptoms requiring treatment and lung function abnormalities at follow-up are common. The most severely affected may remain symptomatic with evidence of airways obstruction even as adults. Data from adolescents and adults on the respiratory outcome of extreme prematurity, however, are usually from patients who have had 'classical' BPD with severe respiratory failure in the neonatal period. Nowadays, infants have 'new' BPD developing chronic oxygen dependence despite initially minimal or even no respiratory distress. Affected patients do suffer chronic respiratory morbidity and their lung function may deteriorate during the first year after birth. Infants who suffer respiratory syncytial virus lower respiratory tract infections are most likely to require rehospitalisation and suffer chronic respiratory morbidity, but this may reflect greater abnormal premorbid lung function.
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Affiliation(s)
- Anne Greenough
- Division of Asthma, Allergy and Lung Biology, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London, UK
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Ali NKM, Jafri A, Sopi RB, Prakash YS, Martin RJ, Zaidi SIA. Role of arginase in impairing relaxation of lung parenchyma of hyperoxia-exposed neonatal rats. Neonatology 2012; 101:106-15. [PMID: 21952491 PMCID: PMC3223066 DOI: 10.1159/000329540] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/18/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND Prolonged exposure of immature lungs to hyperoxia contributes to neonatal lung injury and airway hyperreactivity. We have previously demonstrated that neonatal exposure of rat pups to ≥95% O2 impairs airway relaxation due to disruption of nitric oxide (NO)-cyclic guanosine monophosphate (cGMP) signaling. OBJECTIVE We now hypothesize that these impaired relaxation responses are secondary to hyperoxia-induced upregulation of arginase, which competes with NO synthase for L-arginine. METHODS Rat pups were exposed to moderate neonatal hyperoxia (50% O2) or room air for 7 days from birth. In additional hyperoxic and room air groups, exogenous L-arginine (300 mg/kg/day i.p.) or arginase inhibitor (Nω-hydroxy-nor-arginine, 30 mg/kg/day i.p.) were administered daily. After 7 days, animals were anesthetized and sacrificed either for preparation of lung parenchymal strips or lung perfusion. RESULTS In response to electrical field stimulation (EFS), bethanechol-preconstricted lung parenchymal strips from hyperoxic pups exhibited significantly reduced relaxation compared to room air controls. Supplementation of L-arginine or arginase blockade restored hyperoxia-induced impairment of relaxation. Expression of arginase I in airway epithelium was increased in response to hyperoxia but reduced by arginase blockade. Arginase activity was also significantly increased in hyperoxic lungs as compared to room air controls and reduced following arginase blockade. EFS-induced production of NO was decreased in hyperoxia-exposed airway smooth muscle and restored by arginase blockade. CONCLUSION These data suggest that NO-cGMP signaling is disrupted in neonatal rat pups exposed to even moderate hyperoxia due to increased arginase activity and consequent decreased bioavailability of the substrate L-arginine. We speculate that supplementation of arginine and/or inhibition of arginase may be a useful therapeutic tool to prevent or treat neonatal lung injury.
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Affiliation(s)
- Nuzhat K M Ali
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106-6009, USA
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Gasior N, David M, Millet V, Reynaud-Gaubert M, Dubus JC. [Adult respiratory sequelae of premature birth]. Rev Mal Respir 2011; 28:1329-39. [PMID: 22152940 DOI: 10.1016/j.rmr.2011.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 05/19/2011] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Between 5 and 7% of babies are born prematurely. In the paediatric age group, the respiratory morbidity of these patients is well known, particularly in cases of bronchopulmonary dysplasia (BPD). On the other hand, very few data are available concerning their adult respiratory status. BACKGROUND There are currently three different groups of ex-premature babies: (1) those with no BPD who are usually not considered as respiratory high-risk adults but have not been well studied; (2) ex-premature babies with BPD who have an increased risk of asthma, respiratory infections, bronchial obstruction aggravated by smoking, and non-atopic bronchial hyperreactivity; this group has been well studied but not beyond 30 years of age; (3) the babies born very prematurely and affected with a new form of BPD due to neonatal intensive care at a very immature stage of pulmonary development, and for whom the future in adult life is unknown but worrying because of reduced lung volumes since birth. VIEWPOINTS AND CONCLUSIONS The respiratory physician must be aware of these groups of adults who he may encounter and who may develop, sooner or later, a certain type of chronic obstructive pulmonary disease.
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Affiliation(s)
- N Gasior
- Service de pneumologie, CHU Nord, Marseille, France
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Greenough A, Alexander J, Boorman J, Chetcuti PAJ, Cliff I, Lenney W, Morgan C, Shaw NJ, Sylvester KP, Turner J. Respiratory morbidity, healthcare utilisation and cost of care at school age related to home oxygen status. Eur J Pediatr 2011; 170:969-75. [PMID: 21225284 DOI: 10.1007/s00431-010-1381-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED The aim of the study was to determine whether respiratory morbidity, lung function, healthcare utilisation and cost of care at school age in prematurely born children who had bronchopulmonary dysplasia (BPD) were influenced by use of supplementary oxygen at home after neonatal intensive care unit discharge. Healthcare utilisation and cost of care in years 5 to 7 and respiratory morbidity (parent-completed respiratory questionnaire) and lung function measurements at least at age 8 years were assessed in 160 children. Their median gestational age was 27 (range 22-31) weeks and 65 of them had received supplementary oxygen when discharged home (home oxygen group). The home oxygen group had more outpatient attendances (p = 0.0168) and respiratory-related outpatient attendances (p = 0.0032) with greater related cost of care (p = 0.0186 and p = 0.0030, respectively), their cost of care for prescriptions (p = 0.0409) and total respiratory related cost of care (p = 0.0354) were significantly greater. There were, however, no significant differences in cough, wheeze or lung function results between the two groups. CONCLUSION Prematurely born children who had BPD and supplementary oxygen at home after discharge had increased healthcare utilisation at school age. Whether such children require greater follow, in the absence of excess respiratory morbidity, merits investigation.
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Affiliation(s)
- Anne Greenough
- Division of Asthma, Allergy and Lung Biology, MRC Asthma Centre for Allergic Mechanisms of Asthma, King's College London, London, UK.
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Lum S, Bush A, Stocks J. Clinical Pulmonary Function Testing for Children with Bronchopulmonary Dysplasia. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2011; 24:77-88. [DOI: 10.1089/ped.2010.0059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sooky Lum
- Portex Respiratory Unit, UCL, Institute of Child Health, London, United Kingdom
| | - Andrew Bush
- Department of Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Janet Stocks
- Portex Respiratory Unit, UCL, Institute of Child Health, London, United Kingdom
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43
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Delacourt C. Faut-il maintenir une surveillance respiratoire chez les grands prématurés ? Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McGrath-Morrow S. The Transition from Bronchopulmonary Dysplasia to Childhood Chronic Lung Disease. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2011; 24:27-32. [PMID: 35927857 DOI: 10.1089/ped.2011.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The impact of a preterm birth on lung function in later life is not always predictable and the variability of lung phenotype in these children can be striking even among children of the same gestational age. Although many children with a history of bronchopulmonary dysplasia (BPD) improve with age, others continue to manifest significant pulmonary abnormalities. Several different lung phenotypes have been described in older children with a history of BPD. These descriptions have been based in part on chronic respiratory symptoms, pulmonary function abnormalities, and response to respiratory illnesses. These lung phenotypes include large and/or small airway dysfunction, impaired alveolar growth characterized by decreased pulmonary reserve, and pulmonary hypertension found primarily in children with severe chronic lung disease. Children with a history of BPD can manifest 1 or more of these lung phenotypes with varying degrees of severity. Currently, treatment of respiratory symptoms is primarily supportive and symptom based. Although many children improve with age, others continue to have chronic respiratory symptoms into adult life. The development of standardized guidelines for the care of children after discharge from the neonatal intensive care unit may help direct appropriate therapy, limit lung injury, and maximize lung growth potential in this vulnerable group of children.
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Affiliation(s)
- Sharon McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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45
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Kwinta P, Pietrzyk JJ. Preterm birth and respiratory disease in later life. Expert Rev Respir Med 2011; 4:593-604. [PMID: 20923339 DOI: 10.1586/ers.10.59] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic respiratory diseases are a common complication of preterm birth, particularly among very immature infants or those suffering from bronchopulmonary dysplasia. Major progress in the treatment of preterm newborns has changed the pattern of late respiratory complications. The major respiratory problem in infancy and early childhood is respiratory exacerbations caused by infections (particularly viral ones), which need hospitalization. The symptoms become mild in school-age children; however, a group of children still present with chronic airway obstruction defined by recurrent episodes of wheezing and decreased lung function tests (decreased forced expiratory volume). For some preterm infants, particularly those with bronchopulmonary dysplasia, obstructive lung disease persists into adulthood. They are very likely to develop chronic obstructive pulmonary disease or similar disease later in life. In these patients, a program of lung function monitoring and pulmonary prophylaxis by means of elimination of specific risk factors in adulthood is advisable.
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46
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Ahmed MN, Codipilly C, Hogg N, Auten RL. The protective effect of overexpression of extracellular superoxide dismutase on nitric oxide bioavailability in the lung after exposure to hyperoxia stress. Exp Lung Res 2010; 37:10-7. [PMID: 21077778 DOI: 10.3109/01902148.2010.497893] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The objective of this study was to determine whether overexpression of human extracellular superoxide dismutase (hEC-SOD) can preserve nitric oxide (NO) bioavailability. In vitro studies examined the transient expression of hEC-SOD in mouse epithelial (C10) cells and its effect on extracellular accumulation of NO, intracellular cyclic guanosine monophosphate (cGMP), and nuclear factor kappa B (NF-κB) activation under normal and oxidative stress conditions. In vivo, newborn rabbits were treated with a plasmid containing hEC-SOD cDNA or vehicle plasmid alone, followed by exposure to hyperoxia (Fio₂ = 95% for 7 days). A third group was raised under normoxic conditions. cGMP and NF-κB activation were studied. There was significantly higher NO accumulation in cells expressing hEC-SOD exposed to oxidative stress compared with nontransfected cells. Accumulation of cGMP was significantly higher in cells expressing hEC-SOD. Oxidative stress induced NF-κB activation, which was abrogated by hEC-SOD expression. In vivo, there was significantly higher cGMP accumulation in transfected neonatal rabbit lung tissue at 3 and 7 days of hyperoxic exposure. Immunostaining for NF-κB, showed a marked increase in NF-κB concentration in nontreated neonatal rabbit lung tissue compared to transfected neonatal lung with hEC-SOD and the control air group. These results show that transient EC-SOD overexpression maintains NO bioavailability, which directly leads to maintenance of cGMP activity and reduction of NF-κB activation under oxidative stress.
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Affiliation(s)
- Mohamed N Ahmed
- Division of Neonatal-Perinatal Medicine, Schneider Children's Hospital and Center for Heart and Lung Research, The Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, New York, USA.
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47
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Pérez Pérez G, Navarro Merino M. [Bronchopulmonary dysplasia and prematurity. Short-and long-term respiratory changes]. An Pediatr (Barc) 2009; 72:79.e1-16. [PMID: 20004153 DOI: 10.1016/j.anpedi.2009.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Revised: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 11/17/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is the most frequent chronic lung disease in premature children. With the inclusion of antenatal steroid therapy, surfactant use and novel mechanical ventilation strategies, survival of premature newborns has increased, whereupon the incidence of BPD has not only decreased but has also risen in extremely premature newborns. This has led to a high respiratory morbidity in the first 2-3 years of life, with numerous admissions to hospital and respiratory exacerbations mostly due to viral infections. Although there is a trend towards improvement, during school age and adolescence, respiratory symptoms may persist, due to changes in pulmonary function often showing a lower exercise capacity. Although BPD symptoms are similar to those of asthma, as there is limitation in airflow and bronchial hyperresponsiveness (BHR), pathophysiological mechanisms could be different in both diseases. On the other hand, isolated prematurity plays an important role in the child's respiratory pathology, proving that pulmonary function alterations in preterm children are present since the first months of life. A higher respiratory morbidity has also been observed in these children when compared to full-term newborns, not only during the first years of life but also subsequently. In this study, different aspects of chronic respiratory disease associated with prematurity will be analysed, drawing special attention to clinical symptoms, respiratory function changes, BHR and exercise capacity. All these aspects will be reviewed from early childhood until adolescence and young adult age. Similarities and differences between BPD and asthma will also be discussed.
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Affiliation(s)
- G Pérez Pérez
- Sección de Neumología Infantil, Hospital Universitario Virgen Macarena, Sevilla, España.
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Patelarou E, Chochlidaki M, Vivilaki V, Brokalaki H. Is there a link between wheezing in early childhood and adverse birth outcomes? A systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2752-61. [PMID: 20049220 PMCID: PMC2800059 DOI: 10.3390/ijerph6112752] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 10/29/2009] [Indexed: 11/29/2022]
Abstract
We aimed to provide a summary of the existing published knowledge on the association between adverse birth outcomes and the development of wheezing during the first two years of life. We carried out a systematic review of epidemiological studies within the MEDLINE database. Epidemiological studies on human subjects, published in English, were included in the review. A comprehensive literature search yielded 72 studies for further consideration. Following the application of the eligibility criteria we identified nine studies. A positive association and an excess risk of wheezing during the first two years of life were revealed for adverse birth outcomes.
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Affiliation(s)
- Evridiki Patelarou
- University Hospital of Heraklion, Crete, 71414 Greece
- Author to whom correspondence should be addressed; E-Mail:
; Tel.: +30-2810-392366; Fax: +30-2810-394671
| | | | - Victoria Vivilaki
- Department of Midwifery, Technological Educational Institution, Athens, 12210 Greece; E-Mail:
| | - Hero Brokalaki
- Faculty of Nursing, University of Athens, 11527 Greece; E-Mail:
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Xu X, Dailey AB, Freeman NC, Curbow BA, Talbott EO. The effects of birthweight and breastfeeding on asthma among children aged 1-5 years. J Paediatr Child Health 2009; 45:646-51. [PMID: 19845842 DOI: 10.1111/j.1440-1754.2009.01588.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Asthma is a major cause of morbidity and mortality among children and has steadily increased in prevalence. The combined effect of birthweight and breastfeeding on childhood asthma remains unclear. METHODS In this study, we analysed a nationally representative sample of children aged 1-5 years from the National Health and Nutrition Examination Survey 1999-2002. Logistic regression was performed to examine the hypothesis whether birthweight and breastfeeding are independently associated with the prevalence of asthma after accounting for the complex sampling design. In addition, we sought to describe the relationship between birthweight and childhood asthma and to assess the potentially combined effect between birthweight and breastfeeding on asthma among children aged 1-5 years after considering the possible effects of social and environmental factors. RESULTS We found that birthweight (measured continuously) was inversely and linearly associated with the prevalence of childhood asthma (odds ratio (OR) = 0.80 per 1 kg increase in birthweight, 95% confidence interval (CI): 0.65-0.98). Using a categorical variable, low birthweight (LBW) was positively associated with childhood asthma (OR = 1.28, 95% CI: 0.81-2.68). Furthermore, we detected an interaction between birthweight and breastfeeding on childhood asthma. Breastfeeding had a strong protective effect on asthma among children with high birthweight (OR = 0.14, 95% CI: 0.04-0.43) while it had no significant effect on asthma among children with normal birthweight or LBW. CONCLUSIONS The mechanisms underlying these relationships remain uncertain and warrant further explanation.
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Affiliation(s)
- Xiaohui Xu
- Department of Epidemiology and Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States.
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50
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De Matteo R, Snibson K, Thompson B, Koumoundouros E, Harding R. Lung function in developing lambs: is it affected by preterm birth? J Appl Physiol (1985) 2009; 107:1083-8. [DOI: 10.1152/japplphysiol.00129.2009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Children born before term often have reduced lung function, but the effects of preterm birth alone are difficult to determine owing to iatrogenic factors such as mechanical ventilation. Our objective was to determine the effects of preterm birth alone on airway resistance, airway reactivity, and ventilatory heterogeneity as an index of intrapulmonary gas mixing. Preterm birth was induced in sheep 12 days before term; controls were born at term (∼147 days). Lung function was assessed at 8 wk postterm. To assess medium-large airway function we measured airway resistance and reactivity to carbachol. Multiple breath N2 washout (MBW) was used to assess ventilatory heterogeneity in conducting (Scond) and acinar (Sacin) airways. Baseline airway resistance and responsiveness to carbachol were similar in preterm and term lambs. Airway responsiveness to carbachol was greater in females than males ( P < 0.05), and baseline airway resistance tended to be higher in females than males ( P = 0.06). There were no significant differences in ventilatory heterogeneity between preterm and term lambs; for all animals combined, mean Sacin was 0.29 ± 0.05 liter−1 and Scond was 0.26 ± 0.03 liter−1. Males had significantly higher Scond than females, indicating poorer gas mixing in small conducting airways; there was no sex difference in Sacin. We conclude that preterm birth per se in lambs does not affect baseline airway resistance, airway responsiveness, or ventilatory heterogeneity as measured by MBW. The observed sex-related differences in airway responsiveness and ventilatory heterogeneity in the conducting airways could help explain sex differences in lung function observed in humans.
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Affiliation(s)
| | - Ken Snibson
- Veterinary Science, University of Melbourne, Melbourne; and
| | - Bruce Thompson
- Allergy, Immunology, and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Richard Harding
- Anatomy and Developmental Biology, Monash University, Melbourne
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