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Ginet V, Puyal J, Truttmann AC. Autophagy-related proteins measured in umbilical blood cord samples from human newborns: what can we learn from? Pediatr Res 2024:10.1038/s41390-024-03382-2. [PMID: 39014242 DOI: 10.1038/s41390-024-03382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Vanessa Ginet
- Department of Women, Mother and Child, Clinic of Neonatology, University Hospital Center of Vaud, Lausanne, Switzerland
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
| | - Julien Puyal
- Department of Fundamental Neurosciences, University of Lausanne, Lausanne, Switzerland
- CURML, University Center of Legal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Anita C Truttmann
- Department of Women, Mother and Child, Clinic of Neonatology, University Hospital Center of Vaud, Lausanne, Switzerland.
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Künstle N, Gorlanova O, Marten A, Müller L, Sharma P, Röösli M, Sinues P, Schär P, Schürmann D, Rüttimann C, Da Silva Sena CR, Nahum U, Usemann J, Steinberg R, Yammine S, Schulzke S, Latzin P, Frey U. Differences in autophagy marker levels at birth in preterm vs. term infants. Pediatr Res 2024:10.1038/s41390-024-03273-6. [PMID: 38811718 DOI: 10.1038/s41390-024-03273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/04/2024] [Accepted: 04/22/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Preterm infants are susceptible to oxidative stress and prone to respiratory diseases. Autophagy is an important defense mechanism against oxidative-stress-induced cell damage and involved in lung development and respiratory morbidity. We hypothesized that autophagy marker levels differ between preterm and term infants. METHODS In the prospective Basel-Bern Infant Lung Development (BILD) birth cohort we compared cord blood levels of macroautophagy (Beclin-1, LC3B), selective autophagy (p62) and regulation of autophagy (SIRT1) in 64 preterm and 453 term infants. RESULTS Beclin-1 and LC3B did not differ between preterm and term infants. However, p62 was higher (0.37, 95% confidence interval (CI) 0.05;0.69 in log2-transformed level, p = 0.025, padj = 0.050) and SIRT1 lower in preterm infants (-0.55, 95% CI -0.78;-0.31 in log2-transformed level, padj < 0.001). Furthermore, p62 decreased (padj-value for smoothing function was 0.018) and SIRT1 increased (0.10, 95% CI 0.07;0.13 in log2-transformed level, padj < 0.001) with increasing gestational age. CONCLUSION Our findings suggest differential levels of key autophagy markers between preterm and term infants. This adds to the knowledge of the sparsely studied field of autophagy mechanisms in preterm infants and might be linked to impaired oxidative stress response, preterm birth, impaired lung development and higher susceptibility to respiratory morbidity in preterm infants. IMPACT To the best of our knowledge, this is the first study to investigate autophagy marker levels between human preterm and term infants in a large population-based sample in cord blood plasma This study demonstrates differential levels of key autophagy markers in preterm compared to term infants and an association with gestational age This may be linked to impaired oxidative stress response or developmental aspects and provide bases for future studies investigating the association with respiratory morbidity.
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Affiliation(s)
- Noëmi Künstle
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Andrea Marten
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Loretta Müller
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pawan Sharma
- Center for Translational Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Jane & Leonard Korman Respiratory Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland and University of Basel, Basel, Switzerland
| | - Pablo Sinues
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Primo Schär
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - David Schürmann
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Céline Rüttimann
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carla Rebeca Da Silva Sena
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Priority Research Centre GrowUpWell® and Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Uri Nahum
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Institute for Medical Engineering and Medical Informatics, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Jakob Usemann
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ruth Steinberg
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Yammine
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Schulzke
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Frey
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
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Watkins WJ, Course CW, Cousins M, Hart K, Kotecha SJ, Kotecha S. Impact of ambient air pollution on lung function in preterm-born school-aged children. Thorax 2024; 79:553-563. [PMID: 38359924 PMCID: PMC11137460 DOI: 10.1136/thorax-2023-220233] [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: 03/10/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
RATIONALE Increased outdoor air pollution worsens lung function in children. However, these associations are less well studied in preterm-born individuals. OBJECTIVES We assessed associations between ambient air pollutants and spirometry measures in preterm-born children. METHODS The Respiratory Health Outcomes in Neonates study recruited preterm-born children aged 7-12 years who were born at ≤34 week's gestation. We associated four ambient air pollutants (particulate matter with aerodynamic diameter ≤2.5 µm (PM2.5), PM10, nitrogen dioxide (NO2) and sulfur dioxide) at time of birth and spirometry assessment and averaged exposure between these two time points with spirometry measures, using linear regression analyses. Gestational age was banded into 23-28, 29-31 and 32-34 week's. Regression models estimated spirometry values against pollutant levels at birth and at the time of spirometry. MEASUREMENTS AND MAIN RESULTS From 565 preterm-born children, 542 (96%) had satisfactory data. After adjustments for early and current life factors, significant detrimental associations were noted between PM10 at birth and per cent predicted forced vital capacity (%FVC) for the 23-28 and 29-31 week's gestation groups and between current PM2.5 and NO2 exposure and %FVC for the 23-28 week's gestation group. No associations with spirometry were noted for the averaged pollution exposure between birth and spirometry. Predictive models showed 5.9% and 7.4% differences in %FVC between the highest and lowest current pollution exposures for PM2.5 and NO2, respectively, in the 23-28 week group. CONCLUSIONS Birth and current exposures to road-traffic-associated pollutants detrimentally affected %FVC in preterm-born school-aged children, who already have compromised lung function.
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Affiliation(s)
| | | | - Michael Cousins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
- Department of Paediatrics, Cardiff & Vale University Health Board, Cardiff, UK
| | - Kylie Hart
- Department of Paediatrics, Cardiff & Vale University Health Board, Cardiff, UK
| | - Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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Salem Y, Jakob J, Steinberg R, Gorlanova O, Fuchs O, Müller L, Usemann J, Frey U, Latzin P, Yammine S. Cohort Profile Update: The Bern Basel Infant Lung Development Cohort. Int J Epidemiol 2024; 53:dyad164. [PMID: 38061036 DOI: 10.1093/ije/dyad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/05/2023] [Indexed: 02/12/2024] Open
Affiliation(s)
- Yasmin Salem
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Julian Jakob
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ruth Steinberg
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Biomedical Science, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Oliver Fuchs
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Allergology, Department of Medicine, Lucerne Cantonal Hospital and University of Lucerne, Lucerne, Switzerland
| | - Loretta Müller
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Jakob Usemann
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Urs Frey
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Yammine
- Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Percival E, Collison AM, da Silva Sena CR, De Queiroz Andrade E, De Gouveia Belinelo P, Gomes GMC, Oldmeadow C, Murphy VE, Gibson PG, Karmaus W, Mattes J. The association of exhaled nitric oxide with air pollutants in young infants of asthmatic mothers. Environ Health 2023; 22:84. [PMID: 38049853 PMCID: PMC10696885 DOI: 10.1186/s12940-023-01030-6] [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: 05/03/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Exhaled nitric oxide is a marker of airway inflammation. Air pollution induces airway inflammation and oxidative stress. Little is known about the impact of air pollution on exhaled nitric oxide in young infants. METHODS The Breathing for Life Trial recruited pregnant women with asthma into a randomised controlled trial comparing usual clinical care versus inflammometry-guided asthma management in pregnancy. Four hundred fifty-seven infants from the Breathing for Life Trial birth cohort were assessed at six weeks of age. Exhaled nitric oxide was measured in unsedated, sleeping infants. Its association with local mean 24-h and mean seven-day concentrations of ozone, nitric oxide, nitrogen dioxide, carbon monoxide, sulfur dioxide, ammonia, particulate matter less than 10 μm (PM10) and less than 2.5 μm (PM2.5) in diameter was investigated. The air pollutant data were sourced from local monitoring sites of the New South Wales Air Quality Monitoring Network. The association was assessed using a 'least absolute shrinkage and selection operator' (LASSO) approach, multivariable regression and Spearman's rank correlation. RESULTS A seasonal variation was evident with higher median exhaled nitric oxide levels (13.6 ppb) in warmer months and lower median exhaled nitric oxide levels (11.0 ppb) in cooler months, P = 0.008. LASSO identified positive associations for exhaled nitric oxide with 24-h mean ammonia, seven-day mean ammonia, seven-day mean PM10, seven-day mean PM2.5, and seven-day mean ozone; and negative associations for eNO with seven-day mean carbon monoxide, 24-h mean nitric oxide and 24-h mean sulfur dioxide, with an R-square of 0.25 for the penalized coefficients. These coefficients selected by LASSO (and confounders) were entered in multivariable regression. The achieved R-square was 0.27. CONCLUSION In this cohort of young infants of asthmatic mothers, exhaled nitric oxide showed seasonal variation and an association with local air pollution concentrations.
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Affiliation(s)
- Elizabeth Percival
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Adam M Collison
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Carla Rebeca da Silva Sena
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Ediane De Queiroz Andrade
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Patricia De Gouveia Belinelo
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Gabriela Martins Costa Gomes
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vanessa E Murphy
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Wilfried Karmaus
- Division of Epidemiology, School of Public Health, and Environmental Health Science, University of Memphis, BiostatisticsMemphis, TN, 38152, USA
| | - Joerg Mattes
- Asthma & Breathing Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
- Department of Paediatric Respiratory & Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia.
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Pandipati S, Leong M, Basu R, Abel D, Hayer S, Conry J. Climate change: Overview of risks to pregnant persons and their offspring. Semin Perinatol 2023; 47:151836. [PMID: 37863676 DOI: 10.1016/j.semperi.2023.151836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Climate change is one of the greatest challenges confronting humanity. Pregnant persons, their unborn children, and offspring are particularly vulnerable, as evidenced by adverse perinatal outcomes and increased rates of childhood illnesses. Environmental inequities compound the problem of maternal health inequities, and have given rise to the environmental justice movement. The International Federation of Gynecology and Obstetrics and other major medical societies have worked to heighten awareness and address the deleterious health effects of climate change and toxic environmental exposures. As part of routine prenatal, neonatal, and pediatric care, neonatal-perinatal care providers should incorporate discussions with their patients and families on potential harms and also identify actions to mitigate climate change effects on their health. This article provides clinicians with an overview of how climate change affects their patients, practical guidance in caring for them, and a frame setting of the articles to follow. Clinicians have a critical role to play, and the time to act is now.
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Affiliation(s)
- Santosh Pandipati
- Maternal-Fetal Medicine, Obstetrix of San Jose, e-Lōvu Health, United States.
| | - Melanie Leong
- Attending Neonatologist, Neonatal ECMO Services, The Regional Neonatal Center of Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, United States; Assistant Professor of Pediatrics, New York Medical College, United States
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California EPA, United States
| | - David Abel
- Maternal-Fetal Medicine, Oregon Health Sciences University, United States
| | - Sarena Hayer
- Obstetrics & Gynecology, Oregon Health Sciences University, United States
| | - Jeanne Conry
- International Federation of Gynecology and Obstetrics, United States
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Vilcins D, Lee WR, Pham C, Tanner S, Knibbs LD, Burgner D, Blake TL, Mansell T, Ponsonby AL, Sly PD. Association of maternal air pollution exposure and infant lung function is modified by genetic propensity to oxidative stress. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.13.23296994. [PMID: 37873073 PMCID: PMC10592989 DOI: 10.1101/2023.10.13.23296994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Introduction The association between air pollution and poor respiratory health outcomes is well established, however less is known about the biological mechanisms, especially in early life. Children are particularly at risk from air pollution, especially during the prenatal period as their organs and systems are still undergoing crucial development. Therefore, our study aims to investigate if maternal exposure to air pollution during pregnancy is associated with oxidative stress (OS) and inflammation in pregnancy or infant lung function at 4 weeks of age, and the extent to which the association is modified by an infant's genetic risk of OS. Methods The Barwon Infant Study (BIS) is a longitudinal study of Australian children from the region of Geelong, Victoria. A total of 314 infants had available lung function and maternal OS markers. Exposure to annual air pollutants (NO 2 and PM 2.5 ) were estimated using validated, satellite-based, land-use regression models. Infant lung function was measured by multiple-breath washout, and the ratio of peak tidal expiratory flow over expiratory time was calculated at 4 weeks of age. An inflammation biomarker, glycoprotein acetyls (GlycA), was measured in maternal (36 weeks) and cord blood, and oxidative stress (OS) biomarkers, 8-hydroxyguanine (8-OHGua) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured in maternal urine at 28 weeks. A genetic pathway score for OS (gPFS ox ) was calculated for each infant participant in the BIS cohort, and high risk defined as score >8. Linear regression was used to explore the association of maternal air pollution exposure with infant lung function, and potential modification by OS genotype was tested through use of interaction terms and other methods. Results There was no evidence of a relationship between maternal exposure to air pollution and infant lung function in the whole population. We did not find an association between air pollution and GlycA or OS during pregnancy. We found evidence of an association between NO 2 and lower in functional residual capacity (FRC) for children with a high genetic risk of OS (β=-5.3 mls, 95% CI (-9.3, -1.3), p=0.01). We also found that when NO 2 was considered in tertiles, the highest tertile of NO 2 was associated with increase in lung clearance index (LCI) (β=0.46 turnovers, (95% CI 0.10, 0.82), p=0.01) in children with a genetic propensity to OS. Conclusion Our study found that high prenatal levels of exposure to ambient NO 2 levels is associated with lower FRC and higher LCI in infants with a genetic propensity to oxidative stress. There was no relationship between maternal exposure to air pollution with maternal and cord blood inflammation or OS biomarkers.
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Leong M, Karr CJ, Shah SI, Brumberg HL. Before the first breath: why ambient air pollution and climate change should matter to neonatal-perinatal providers. J Perinatol 2023; 43:1059-1066. [PMID: 36038659 PMCID: PMC9421104 DOI: 10.1038/s41372-022-01479-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
Common outdoor air pollutants present threats to fetal and neonatal health, placing neonatal-perinatal clinical specialists in an important role for harm reduction through patient counseling and advocacy. Climate change is intertwined with air pollution and influences air quality. There is increasing evidence demonstrating the unique vulnerability in the development of adverse health consequences from exposures during the preconception, prenatal, and early postnatal periods, as well as promising indications that policies aimed at addressing these toxicants have improved birth outcomes. Advocacy by neonatal-perinatal providers articulating the potential impact of pollutants on newborns and mothers is essential to promoting improvements in air quality and reducing exposures. The goal of this review is to update neonatal-perinatal clinical specialists on the key ambient air pollutants of concern, their sources and health effects, and to outline strategies for protecting patients and communities from documented adverse health consequences.
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Affiliation(s)
- Melanie Leong
- Division of Neonatology, Maria Fareri Children's Hospital, Westchester Medical Center and Department of Pediatrics, New York Medical College, Valhalla, NY, USA.
| | - Catherine J Karr
- Departments of Pediatrics and Environmental and Occupational Health Sciences and Northwest Pediatric Environmental Health Specialty Unit, University of Washington, Seattle, WA, USA
| | - Shetal I Shah
- Division of Neonatology, Maria Fareri Children's Hospital, Westchester Medical Center and Department of Pediatrics, New York Medical College, Valhalla, NY, USA
| | - Heather L Brumberg
- Division of Neonatology, Maria Fareri Children's Hospital, Westchester Medical Center and Department of Pediatrics, New York Medical College, Valhalla, NY, USA
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Yadav A, Pacheco SE. Prebirth effects of climate change on children's respiratory health. Curr Opin Pediatr 2023; 35:344-349. [PMID: 36974440 DOI: 10.1097/mop.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW To date, there is no evidence that humanity will implement appropriate mitigation measures to avoid the catastrophic impact of climate change on the planet and human health. Vulnerable populations such as pregnant women and children will be the most affected. This review highlights epidemiologic data on climate change-related prenatal environmental exposures affecting the fetus and children's respiratory health. RECENT FINDINGS Research on outcomes of prenatal exposure to climate change-related environmental changes and pediatric pulmonary health is limited. In addition to adverse pregnancy outcomes known to affect lung development, changes in lung function, increased prevalence of wheezing, atopy, and respiratory infections have been associated with prenatal exposure to increased temperatures, air pollution, and maternal stress. The mechanisms behind these changes are ill-defined, although oxidative stress, impaired placental functioning, and epigenetic modifications have been observed. However, the long-term impact of these changes remains unknown. SUMMARY The detrimental impact of the climate crisis on pediatric respiratory health begins before birth, highlighting the inherent vulnerability of pregnant women and children. Research and advocacy, along with mitigation and adaptation measures, must be implemented to protect pregnant women and children, the most affected but the least responsible for the climate crisis.
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Affiliation(s)
- Aravind Yadav
- Division of Pulmonary Medicine, Department of Pediatrics, The University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA
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Lee KS, Min WK, Choi YJ, Jin S, Park KH, Kim S. The Effect of Maternal Exposure to Air Pollutants and Heavy Metals during Pregnancy on the Risk of Neurological Disorders Using the National Health Insurance Claims Data of South Korea. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050951. [PMID: 37241184 DOI: 10.3390/medicina59050951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/15/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The objective of this study was to evaluate the effects of high levels of maternal exposure to ambient air pollution and heavy metals on risks of autism spectrum disorder (ASD) and epilepsy using the National Health Insurance claims data of South Korea. The data of mothers and their newborns from 2016 to 2018 provided by the National Health Insurance Service were used (n = 843,134). Data on exposure to ambient air pollutants (PM2.5, CO, SO2, NO2, and O3) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during pregnancy were matched based on the mother's National Health Insurance registration area. SO2 (OR: 2.723, 95% CI: 1.971-3.761) and Pb (OR: 1.063, 95% CI: 1.019-1.11) were more closely associated with the incidence of ASD when infants were exposed to them in the third trimester of pregnancy. Pb (OR: 1.109, 95% CI: 1.043-1.179) in the first trimester of pregnancy and Cd (OR: 2.193, 95% CI: 1.074-4.477) in the third trimester of pregnancy were associated with the incidence of epilepsy. Thus, exposure to SO2, NO2, and Pb during pregnancy could affect the development of a neurologic disorder based on the timing of exposure, suggesting a relationship with fetal development. However, further research is needed.
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Affiliation(s)
- Kuen Su Lee
- Department of Anesthesiology and Pain Medicine, Eulji University Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu 11759, Republic of Korea
| | - Won Kee Min
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea
| | - Sejong Jin
- Department of Neuroscience, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Kyu Hee Park
- Department of Pediatrics, Korea University Ansan Hospital, Ansan 15355, Republic of Korea
| | - Suhyun Kim
- Department of Biomedical Sciences, College of Medicine, Korea University, Seoul 02841, Republic of Korea
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Lin LZ, Chen JH, Yu YJ, Dong GH. Ambient air pollution and infant health: a narrative review. EBioMedicine 2023:104609. [PMID: 37169689 PMCID: PMC10363448 DOI: 10.1016/j.ebiom.2023.104609] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/26/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023] Open
Abstract
The extensive evidence regarding the effects of ambient air pollution on child health is well documented, but limited review summarized their health effects during infancy. Symptoms or health conditions attributed to ambient air pollution in infancy could result in the progression of severe diseases during childhood. Here, we reviewed previous empirical epidemiological studies and/or reviews for evaluating the linkages between ambient air pollution and various infant outcomes including adverse birth outcomes, infant morbidity and mortality, early respiratory health, early allergic symptoms, early neurodevelopment, early infant growth and other relevant outcomes. Patterns of the associations varied by different pollutants (i.e., particles and gaseous pollutants), exposure periods (i.e., pregnancy and postpartum) and exposure lengths (i.e., long-term and short-term). Protection of infant health requires that paediatricians, researchers, and policy makers understand to what extent infants are affected by ambient air pollution, and a call for action is still necessary to reduce ambient air pollution.
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Affiliation(s)
- Li-Zi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jin-Hui Chen
- School of Public Policy and Management, Tsinghua University, Beijing, 100084, China; High-Tech Research and Development Center, Ministry of Science and Technology, Beijing, 100044, China
| | - Yun-Jiang Yu
- State Environmental Protection Key Laboratory of Environmental Pollution Health Risk Assessment, South China Institute of Environmental Sciences, Ministry of Environmental Protection, Guangzhou, 510655, China.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
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12
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Teyton A, Baer RJ, Benmarhnia T, Bandoli G. Exposure to Air Pollution and Emergency Department Visits During the First Year of Life Among Preterm and Full-term Infants. JAMA Netw Open 2023; 6:e230262. [PMID: 36811862 PMCID: PMC9947725 DOI: 10.1001/jamanetworkopen.2023.0262] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
IMPORTANCE Previous studies have focused on exposure to fine particulate matter 2.5 μm or less in diameter (PM2.5) and on birth outcome risks; however, few studies have evaluated the health consequences of PM2.5 exposure on infants during their first year of life and whether prematurity could exacerbate such risks. OBJECTIVE To assess the association of PM2.5 exposure with emergency department (ED) visits during the first year of life and determine whether preterm birth status modifies the association. DESIGN, SETTING, AND PARTICIPANTS This individual-level cohort study used data from the Study of Outcomes in Mothers and Infants cohort, which includes all live-born, singleton deliveries in California. Data from infants' health records through their first birthday were included. Participants included 2 175 180 infants born between 2014 and 2018, and complete data were included for an analytic sample of 1 983 700 (91.2%). Analysis was conducted from October 2021 to September 2022. EXPOSURES Weekly PM2.5 exposure at the residential ZIP code at birth was estimated from an ensemble model combining multiple machine learning algorithms and several potentially associated variables. MAIN OUTCOMES AND MEASURES Main outcomes included the first all-cause ED visit and the first infection- and respiratory-related visits separately. Hypotheses were generated after data collection and prior to analysis. Pooled logistic regression models with a discrete time approach assessed PM2.5 exposure and time to ED visits during each week of the first year of life and across the entire year. Preterm birth status, sex, and payment type for delivery were assessed as effect modifiers. RESULTS Of the 1 983 700 infants, 979 038 (49.4%) were female, 966 349 (48.7%) were Hispanic, and 142 081 (7.2%) were preterm. Across the first year of life, the odds of an ED visit for any cause were greater among both preterm (AOR, 1.056; 95% CI, 1.048-1.064) and full-term (AOR, 1.051; 95% CI, 1.049-1.053) infants for each 5-μg/m3 increase in exposure to PM2.5. Elevated odds were also observed for infection-related ED visit (preterm: AOR, 1.035; 95% CI, 1.001-1.069; full-term: AOR, 1.053; 95% CI, 1.044-1.062) and first respiratory-related ED visit (preterm: AOR, 1.080; 95% CI, 1.067-1.093; full-term: AOR,1.065; 95% CI, 1.061-1.069). For both preterm and full-term infants, ages 18 to 23 weeks were associated with the greatest odds of all-cause ED visits (AORs ranged from 1.034; 95% CI, 0.976-1.094 to 1.077; 95% CI, 1.022-1.135). CONCLUSIONS AND RELEVANCE Increasing PM2.5 exposure was associated with an increased ED visit risk for both preterm and full-term infants during the first year of life, which may have implications for interventions aimed at minimizing air pollution.
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Affiliation(s)
- Anaïs Teyton
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- School of Public Health, San Diego State University, San Diego
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla
| | - Rebecca J. Baer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco
- Department of Pediatrics, University of California, San Diego, La Jolla
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla
| | - Gretchen Bandoli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Department of Pediatrics, University of California, San Diego, La Jolla
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13
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Gorlanova O, Oller H, Marten A, Müller L, Laine-Carmelli J, Decrue F, Salem Y, Vienneau D, Hoogh KD, Gisler A, Usemann J, Korten I, Yammine S, Nahum U, Künstle N, Sinues P, Schulzke S, Latzin P, Fuchs O, Röösli M, Schaub B, Frey U. Ambient prenatal air pollution exposure is associated with low cord blood IL-17a in infants. Pediatr Allergy Immunol 2023; 34:e13902. [PMID: 36705042 DOI: 10.1111/pai.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Olga Gorlanova
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heide Oller
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Andrea Marten
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Loretta Müller
- Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Fabienne Decrue
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Yasmin Salem
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Amanda Gisler
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Jakob Usemann
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Insa Korten
- Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sophie Yammine
- Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uri Nahum
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Noemi Künstle
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Pablo Sinues
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Sven Schulzke
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
| | - Philipp Latzin
- Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oliver Fuchs
- Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Bianca Schaub
- Department of Pulmonary and Allergy, Dr. von Hauner Children's Hospital, LMU, University of Munich, Munich, Germany
| | - Urs Frey
- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
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- University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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14
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Du Berry C, Nesci C, Cheong JL, FitzGerald T, Mainzer R, Ranganathan S, Doyle LW, Vrijlandt EJ, Welsh L. Long-term expiratory airflow of infants born moderate-late preterm: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101597. [PMID: 35923430 PMCID: PMC9340512 DOI: 10.1016/j.eclinm.2022.101597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Moderate-late preterm (MLP; 32 to <37 weeks' gestation) birth is associated with reduced expiratory airflow during child, adolescent and adult years. However, some studies have reported only minimal airflow limitation and hence it is unclear if clinical assessment in later life is warranted. Our aim was to compare maximal expiratory airflow in children and adults born MLP with term-born controls, and with expected norms. METHODS We systematically reviewed studies reporting z-scores for spirometric indices (forced expired volume in 1 second [FEV1], forced vital capacity [FVC], FEV1/FVC ratio and forced expiratory flow at 25-75% of FVC [FEF25-75%]) from participants born MLP aged five years or older, with or without a term-born control group from 4 databases (MEDLINE, CINAHL, Embase, Emcare). Publications were searched for between the 22nd of September 2021 to the 29th of September 2021. A meta-analysis of eligible studies was conducted using a random effects model. The study protocol was published in PROSPERO (CRD #42021281518). FINDINGS We screened 4970 articles and identified 18 relevant studies, 15 of which were eligible for meta-analysis (8 with term-born controls and 7 without). Compared with controls, MLP participants had lower z-scores (mean difference [95% confidence interval] I2) for FEV1: -0.22 [-0.35, -0.09] 49.3%, FVC: -0.23 [-0.4, -0.06] 71.8%, FEV1/FVC: -0.11 [-0.20 to -0.03] 9.3% and FEF25-75%: -0.27 [-0.41 to -0.12] 21.9%. Participants born MLP also had lower z-scores, on average, when compared with a z-score of 0 (mean [95% CI] I2) for FEV1: -0.26 [-0.40 to -0.11] 85.2%, FVC: -0.18 [-0.34 to -0.02] 88.3%, FEV1/FVC: -0.24 [-0.43 to -0.05] 90.5% and FEF25-75%: -0.33 [-0.54 to -0.20] 94.7%. INTERPRETATION Those born MLP had worse expiratory airflows than those born at term, and compared with norms, although reductions were modest. Clinicians should be aware that children and adults born MLP may be at higher risk of obstructive lung disease compared with term-born peers. FUNDING This work is supported by grants from the National Health and Medical Research Council (Centre of Research Excellence #1153176, Project grant #1161304); Medical Research Future Fund (Career Development Fellowship to J.L.Y Cheong #1141354) and from the Victorian Government's Operational Infrastructure Support Programme. C. Du Berry's PhD candidature is supported by the Melbourne Research Scholarship and the Centre of Research Excellence in Newborn Medicine.
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Affiliation(s)
- Cassidy Du Berry
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
- Corresponding author at: Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia.
| | - Christopher Nesci
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
| | - Jeanie L.Y. Cheong
- Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
- Victorian Infant Brain Studies Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- Newborn Research, The Royal Women's Hospital Melbourne, Australia
| | - Tara FitzGerald
- Department of Physiotherapy, The University of Melbourne, Australia
- Victorian Infant Brain Studies Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
| | - Rheanna Mainzer
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Clinical Epidemiology and Biostatistics Unit, Population Health, Murdoch Children's Research Institute, Australia
| | - Sarath Ranganathan
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
| | - Lex W. Doyle
- Department of Paediatrics, The University of Melbourne, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
- Victorian Infant Brain Studies Group, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Australia
- Newborn Research, The Royal Women's Hospital Melbourne, Australia
| | - Elianne J.L.E. Vrijlandt
- Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, and the Groningen Research Institute for Asthma and COPD, the Netherlands
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liam Welsh
- Department of Paediatrics, The University of Melbourne, Australia
- Respiratory Group, Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia
- Department of Respiratory Medicine, The Royal Children's Hospital Melbourne, Australia
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15
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Muttoo S, Jeena PM, Röösli M, de Hoogh K, Meliefste K, Tularam H, Olin AC, Carlsen HK, Mentz G, Asharam K, Naidoo RN. Effect of short-term exposure to ambient nitrogen dioxide and particulate matter on repeated lung function measures in infancy: A South African birth cohort. ENVIRONMENTAL RESEARCH 2022; 213:113645. [PMID: 35700764 DOI: 10.1016/j.envres.2022.113645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The developing lung is highly susceptible to environmental toxicants, with both short- and long-term exposure to ambient air pollutants linked to early childhood effects. This study assessed the short-term exposure effects of nitrogen dioxide (NO2) and particulate matter (PM10) on lung function in infants aged 6 weeks, 6, 12 and 24 months, the early developmental phase of child growth. METHODS Lung function was determined by multiple breath washout and tidal breathing measurement in non-sedated infants. Individual exposure to NO2 and PM10 was determined by hybrid land use regression and dispersion modelling, with two-week average estimates (preceding the test date). Linear mixed models were used to adjust for the repeated measures design and an age*exposure interaction was introduced to obtain effect estimates for each age group. RESULTS There were 165 infants that had lung function testing, with 82 of them having more than one test occasion. Exposure to PM10 (μg/m3) resulted in a decline in tidal volume at 6 weeks [-0.4 ml (-0.9; 0.0), p = 0.065], 6 months [-0.5 ml (-1.0; 0.0), p = 0.046] and 12 months [-0.3 ml (-0.7; 0.0), p = 0.045]. PM10 was related to an increase in respiratory rate and minute ventilation, while a decline was observed for functional residual capacity for the same age groups, though not statistically significant for these outcomes. Such associations were however less evident for exposure to NO2, with inconsistent changes observed across measurement parameters and age groups. CONCLUSION Our study suggests that PM10 results in acute lung function impairments among infants from a low-socioeconomic setting, while the association with NO2 is less convincing.
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Affiliation(s)
- S Muttoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - P M Jeena
- Discipline of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa.
| | - M Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - K de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | - K Meliefste
- Institute for Risk Assessment Sciences, Utrecht, the Netherlands.
| | - H Tularam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - A C Olin
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - H K Carlsen
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - G Mentz
- University Michigan, Ann Arbor, MI, USA.
| | - K Asharam
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
| | - R N Naidoo
- Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa.
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16
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 PMCID: PMC11260396 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 182] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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17
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Gheissari R, Liao J, Garcia E, Pavlovic N, Gilliland FD, Xiang AH, Chen Z. Health Outcomes in Children Associated with Prenatal and Early-Life Exposures to Air Pollution: A Narrative Review. TOXICS 2022; 10:toxics10080458. [PMID: 36006137 PMCID: PMC9415268 DOI: 10.3390/toxics10080458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 06/04/2023]
Abstract
(1) Background: The developmental origins of health and disease (DOHaD) hypothesis links adverse fetal exposures with developmental mal-adaptations and morbidity later in life. Short- and long-term exposures to air pollutants are known contributors to health outcomes; however, the potential for developmental health effects of air pollution exposures during gestation or early-childhood have yet to be reviewed and synthesized from a DOHaD lens. The objective of this study is to summarize the literature on cardiovascular and metabolic, respiratory, allergic, and neuropsychological health outcomes, from prenatal development through early childhood, associated with early-life exposures to outdoor air pollutants, including traffic-related and wildfire-generated air pollutants. (2) Methods: We conducted a search using PubMed and the references of articles previously known to the authors. We selected papers that investigated health outcomes during fetal or childhood development in association with early-life ambient or source-specific air pollution exposure. (3) Results: The current literature reports that prenatal and early-childhood exposures to ambient and traffic-related air pollutants are associated with a range of adverse outcomes in early life, including cardiovascular and metabolic, respiratory and allergic, and neurodevelopmental outcomes. Very few studies have investigated associations between wildfire-related air pollution exposure and health outcomes during prenatal, postnatal, or childhood development. (4) Conclusion: Evidence from January 2000 to January 2022 supports a role for prenatal and early-childhood air pollution exposures adversely affecting health outcomes during development. Future studies are needed to identify both detrimental air pollutants from the exposure mixture and critical exposure time periods, investigate emerging exposure sources such as wildfire, and develop feasible interventional tools.
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Affiliation(s)
- Roya Gheissari
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Jiawen Liao
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Erika Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Nathan Pavlovic
- Sonoma Technology Inc., 1450 N. McDowell Blvd., Suite 200, Petaluma, CA 94954, USA
| | - Frank D. Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91107, USA
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
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18
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Lundberg B, Gruzieva O, Eneroth K, Melén E, Persson Å, Hallberg J, Pershagen G. Air pollution exposure impairs lung function in infants. Acta Paediatr 2022; 111:1788-1794. [PMID: 35582781 PMCID: PMC9543871 DOI: 10.1111/apa.16412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 12/23/2022]
Abstract
Aim To assess associations between air pollution exposure and infant lung function. Methods Healthy infants from Stockholm were recruited to two cohorts (n = 99 and n = 78). Infant spirometry included plethysmography and raised volume forced expiratory flows. In pooled analyses, lung function at ~6 months of age was related to time‐weighted average air pollution levels at residential addresses from birth until the lung function test. The pollutants included particulate matter with an aerodynamic diameter < 10 μm (PM10) or <2.5 μm and nitrogen dioxide. Results There were significant inverse relations between air pollution exposure during infancy and forced expiratory volume at 0.5 s (FEV0.5) as well as forced vital capacity (FVC) for all pollutants. For example, the decline was 10.1 ml (95% confidence interval 1.3–18.8) and 10.3 ml (0.5–20.1) in FEV0.5 and FVC, respectively, for an interquartile increment of 5.3 μg/m3 in PM10. Corresponding associations for minute ventilation and functional residual capacity were 43.3 ml/min (−9.75–96.3) and 0.84 ml (−4.14–5.82). Conclusions Air pollution exposure was associated with impaired infant lung function measures related to airway calibre and lung volume, suggesting that comparatively low levels of air pollution negatively affect lung function in early life.
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Affiliation(s)
- Björn Lundberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset Stockholm Sweden
| | - Olena Gruzieva
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm Stockholm Sweden
| | - Kristina Eneroth
- Environment and Health Administration, SLB‐analys Stockholm Sweden
| | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset Stockholm Sweden
| | - Åsa Persson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet Stockholm Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset Stockholm Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Centre for Occupational and Environmental Medicine, Region Stockholm Stockholm Sweden
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19
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Wright RJ. Preterm Birth Enhances Ambient Pollution Toxicity: Oxidative Stress and Placental Function. Am J Respir Crit Care Med 2022; 205:10-12. [PMID: 34793683 PMCID: PMC8865585 DOI: 10.1164/rccm.202110-2338ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Rosalind J Wright
- Department of Environmental Medicine and Public Health New York, New York
- Icahn School of Medicine at Mount Sinai New York, New York
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20
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Decrue F, Singh KD, Gisler A, Awchi M, Zeng J, Usemann J, Frey U, Sinues P. Combination of Exhaled Breath Analysis with Parallel Lung Function and FeNO Measurements in Infants. Anal Chem 2021; 93:15579-15583. [PMID: 34780695 DOI: 10.1021/acs.analchem.1c02036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Breath analysis by secondary electrospray ionization-high resolution mass spectrometry (SESI-HRMS) offers the possibility to measure comprehensive metabolic profiles. The technology is currently being deployed in several clinical settings in Switzerland and China. However, patients are required to exhale directly into the device located in a dedicated room. Consequently, clinical implementation in patients incapable of performing necessary exhalation maneuvers (e.g., infants) or immobile (e.g., too weak, elderly, or in intensive care) remains a challenge. The aim of this study was to develop a method to extend such breath analysis capabilities to this subpopulation of patients by collecting breath samples remotely (offline) and promptly (within 10 min) transfer them to SESI-HRMS for chemical analysis. We initially assessed the method in adults by comparing breath mass spectra collected offline with Nalophan bags against spectra of breath samples collected in real time. In total, 13 adults provided 176 pairs of real-time and offline measurements. Lin's concordance correlation coefficient (CCC) was used to estimate the agreement between offline and real-time analyses. Here, 1249 mass spectral features (55% of total detected) exhibited Lin's CCC > 0.6. Subsequently, the method was successfully deployed to analyze breath samples from infants (n = 16), obtaining as a result SESI-HRMS breath profiles. To demonstrate the clinical feasibility of the method, we measured in parallel other clinical variables: (i) lung function, which characterizes the breathing patterns, and (ii) nitric oxide, which is a surrogate marker of airway inflammation. As a showcase, we focused our analysis on the exhaled oxidative stress marker 4-hydroxynonenal and its association with nitric oxide and minute ventilation.
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Affiliation(s)
- Fabienne Decrue
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Kapil Dev Singh
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil 4123, Switzerland
| | - Amanda Gisler
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Mo Awchi
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil 4123, Switzerland
| | - Jiafa Zeng
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil 4123, Switzerland
| | - Jakob Usemann
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland
| | - Urs Frey
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil 4123, Switzerland
| | - Pablo Sinues
- University of Basel Children's Hospital (UKBB), Basel 4056, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil 4123, Switzerland
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21
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Pijnenburg MW, Frey U, De Jongste JC, Saglani S. Childhood asthma- pathogenesis and phenotypes. Eur Respir J 2021; 59:13993003.00731-2021. [PMID: 34711541 DOI: 10.1183/13993003.00731-2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022]
Abstract
In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections, atopy, genetic susceptibility, and environmental exposures (such as farmyard environment, air pollution, tobacco smoke exposure) influence the development of wheezing illness and the risk for progression to asthma. The immune system, lung function and the microbiome in gut and airways develop in parallel and dysbiosis of the microbiome may be a critical factor in asthma development. Increased infant weight gain and preterm birth are other risk factors for development of asthma and reduced lung function. The complex interplay between these factors explains the heterogeneity of asthma in children. Subgroups of patients can be identified as phenotypes based on clinical parameters, or endotypes, based on a specific pathophysiological mechanism. Paediatric asthma phenotypes and endotypes may ultimately help to improve diagnosis of asthma, prediction of asthma development and treatment of individual children, based on clinical, temporal, developmental or inflammatory characteristics. Unbiased, data-driven clustering, using a multidimensional or systems biology approach may be needed to better define phenotypes. The present knowledge on inflammatory phenotypes of childhood asthma has now been successfully applied in the treatment with biologicals of children with severe therapy resistant asthma, and it is to be expected that more personalized treatment options may become available.
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Affiliation(s)
- Mariëlle W Pijnenburg
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Urs Frey
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Johan C De Jongste
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College, London, UK
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