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Prematurity-associated wheeze: current knowledge and opportunities for further investigation. Pediatr Res 2022:10.1038/s41390-022-02404-1. [PMID: 36463364 PMCID: PMC10238677 DOI: 10.1038/s41390-022-02404-1] [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: 08/16/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 12/04/2022]
Abstract
Prematurity-associated wheeze is a common complication of preterm birth, with significant impact on the health and healthcare utilization of former preterm infants. This wheezing phenotype remains poorly understood and difficult to predict. This review will discuss the current state of the literature on prematurity-associated wheeze. We will discuss etiology and pathophysiology, and offer two conceptual models for the pathogenesis of this complex condition. This review will also identify current methods of ascertainment, and discuss the strengths and limitations of each. We will explore research-backed approaches to prevention and management, and finally suggest both pre-clinical and clinical avenues for investigation. An in-depth understanding of prematurity-associated wheeze will aid clinicians in its diagnosis and management, and inspire scientists to pursue much-needed further study into causes and prevention of this common and impactful condition. IMPACT: There is no recent, concise review on the current state of research on prematurity-associated wheeze, which is a rapidly evolving area of study. This article highlights causal models of wheeze, methods of ascertainment, management strategies for the clinician, and opportunities for further research for the physician scientist.
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Rudolph MW, Slager S, Burgerhof JGM, van Woensel JB, Alffenaar JWC, Wösten - van Asperen RM, de Hoog M, IJland MM, Kneyber MCJ. Paediatric Acute Respiratory Distress Syndrome Neuromuscular Blockade study (PAN-study): a phase IV randomised controlled trial of early neuromuscular blockade in moderate-to-severe paediatric acute respiratory distress syndrome. Trials 2022; 23:96. [PMID: 35101098 PMCID: PMC8802263 DOI: 10.1186/s13063-021-05927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/08/2021] [Indexed: 11/11/2022] Open
Abstract
Background Paediatric acute respiratory distress syndrome (PARDS) is a manifestation of severe, life-threatening lung injury necessitating mechanical ventilation with mortality rates ranging up to 40–50%. Neuromuscular blockade agents (NMBAs) may be considered to prevent patient self-inflicted lung injury in PARDS patients, but two trials in adults with severe ARDS yielded conflicting results. To date, randomised controlled trials (RCT) examining the effectiveness and efficacy of NMBAs for PARDS are lacking. We hypothesise that using NMBAs for 48 h in paediatric patients younger than 5 years of age with early moderate-to-severe PARDS will lead to at least a 20% reduction in cumulative respiratory morbidity score 12 months after discharge from the paediatric intensive care unit (PICU). Methods This is a phase IV, multicentre, randomised, double-blind, placebo-controlled trial performed in level-3 PICUs in the Netherlands. Eligible for inclusion are children younger than 5 years of age requiring invasive mechanical ventilation with positive end-expiratory pressure (PEEP) ≥ 5 cm H2O for moderate-to-severe PARDS occurring within the first 96 h of PICU admission. Patients are randomised to continuous infusion of rocuronium bromide or placebo for 48 h. The primary endpoint is the cumulative respiratory morbidity score 12 months after PICU discharge, adjusted for confounding by age, gestational age, family history of asthma and/or allergy, season in which questionnaire was filled out, day-care and parental smoking. Secondary outcomes include respiratory mechanics, oxygenation and ventilation metrics, pulmonary and systemic inflammation markers, prevalence of critical illness polyneuropathy and myopathy and metrics for patient outcome including ventilator free days at day 28, length of PICU and hospital stay, and mortality Discussion This is the first paediatric trial evaluating the effects of muscular paralysis in moderate-to-severe PARDS. The proposed study addresses a huge research gap identified by the Paediatric Acute Lung Injury Consensus Collaborative by evaluating practical needs regarding the treatment of PARDS. Paediatric critical care practitioners are inclined to use interventions such as NMBAs in the most critically ill. This liberal use must be weighed against potential side effects. The proposed study will provide much needed scientific support in the decision-making to start NMBAs in moderate-to-severe PARDS. Trial registration ClinicalTrials.govNCT02902055. Registered on September 15, 2016.
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Hussein H, Shamsipour M, Yunesian M, Hasanvand MS, Mahamudu T, Fotouhi A. Fuel type use and risk of respiratory symptoms: A cohort study of infants in the Northern region of Ghana. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:142501. [PMID: 33038841 DOI: 10.1016/j.scitotenv.2020.142501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
Little evidence exists about the association between fuel type use and risk of respiratory symptoms among infants; we aimed to evaluate this hypothesis through a cohort study in the Northern Region of Ghana. The study was carried out from April 2018 to May 2019. We recruited 28 weeks old pregnant women at selected hospitals and prospectively followed them at birth in the hospital ward to register their newborns and at homes when the baby had attained 3 to 7 months to collect data on respiratory symptoms of infants. A logistic regression model was used to investigate the odds of respiratory symptoms in infants. Exactly 1270 infants completed the study; the average age of women was 27.1 years and standard deviation of 5.1. The study found that infants of mothers who cooked with charcoal and those with firewood had increased odds of having cough with cold 4.10 (95% CI, 2.21-7.61) and 3.95 (95% CI, 2.06-7.58), increased odds of congestion, phlegm with cold by 3.89 (95% CI, 1.73-8.79) and 3.45 (95% CI, 1.44-8.26), increased odds of wheezing 4-14 days or nights by 1.68 (95% CI, 0.72-3.91) and 3.37 (95% CI, 1.41-8.04) and increased odds of seeking medical treatments in a health facility for chest illness by 3.97 (95% CI, 1.31-12.02) and 6.67 (95% CI, 2.14-20.77) in comparison with liquid petroleum gas respectively. Some significant predictors of respiratory infections were maternal malaria, hospitalisations of an infant after birth, residence, cooking location, composite breastfeeding, sharing of a bedroom with infant and air-conditioner or fan in the living room. Our findings indicate increased odds of infant respiratory symptoms in households using solid fuel in Ghana. Although our observational design precludes ascribing any causal relationships, our results are consistent with other studies suggesting clean fuel use during pregnancy and infancy may benefit this vulnerable age group.
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Affiliation(s)
- Hawawu Hussein
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; African Union Scientific Technical and Research Commission, Abuja, Nigeria; Tamale Teaching Hospital, Research Department, Tamale, Ghana
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad S Hasanvand
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ledingham L, Tatsuoka C, Minich N, Ross KR, Kerns LA, Wagner CL, Fuloria M, Groh-Wargo S, Zimmerman T, Hibbs AM. Burden of prematurity-associated recurrent wheezing: caregiver missed work in the D-Wheeze trial. J Perinatol 2021; 41:69-76. [PMID: 32694857 PMCID: PMC7855497 DOI: 10.1038/s41372-020-0729-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/31/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study describes the burden of prematurity-associated wheezing in black infants with respect to caregiver missed work. STUDY DESIGN We analyzed data from the D-Wheeze trial (ClinicalTrials.gov identifier NCT01601847). Black infants between 28-0/7 to 36-6/7 weeks' gestational age at birth receiving <28 days of supplemental oxygen were enrolled. The primary outcome was missed work to care for the infant in the first year. RESULTS 147/277 (53.1%) infants had caregivers who reported time off. In an adjusted model, vitamin D supplementation (OR 0.52 [95% CI 0.30-0.89]; P = 0.018), recurrent wheeze (OR 2.26 [95% CI, 1.15-4.44]; P = 0.018), and other children in the household <5 years old (OR 0.45 [95% CI 0.26-0.78]; P = 0.004) were significantly associated with caregiver missed work. CONCLUSIONS Black premature infants had a significant burden of caregiver missed work, emphasizing the impact of prematurity-associated wheezing.
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Affiliation(s)
- Lauren Ledingham
- Case Western Reserve University, Cleveland, OH, USA. .,UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | - Curtis Tatsuoka
- Case Western Reserve University, Cleveland, OH,University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Nori Minich
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Kristie R. Ross
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Leigh Ann Kerns
- Case Western Reserve University, Cleveland, OH,Cleveland Clinic Foundation, Cleveland, OH
| | - Carol L. Wagner
- Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, South Carolina
| | - Mamta Fuloria
- The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Sharon Groh-Wargo
- Case Western Reserve University, Cleveland, OH,MetroHealth Medical Center, Cleveland, Ohio
| | - Teresa Zimmerman
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
| | - Anna Maria Hibbs
- Case Western Reserve University, Cleveland, OH,UH Rainbow Babies and Children’s Hospital, Cleveland, OH
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Glenn T, Ross KR, Trembath A, Tatsuoka C, Minich N, Hibbs AM. Correlations between oxygen and positive pressure exposure in the neonatal intensive care unit and wheezing in preterm infants without bronchopulmonary dysplasia. J Neonatal Perinatal Med 2020; 13:189-195. [PMID: 31771079 PMCID: PMC8216657 DOI: 10.3233/npm-190217] [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] [Indexed: 06/10/2023]
Abstract
BACKGROUND Oxygen exposure has been associated with increased wheezing and respiratory morbidity after discharge in extremely preterm infants and those with bronchopulmonary dysplasia. More mature preterm infants with less severe disease are also at risk for pulmonary complications, including rehospitalization for respiratory illnesses and wheezing disorders. Our aim was to evaluate associations between respiratory support and morbidity in preterm infants without bronchopulmonary dysplasia. METHODS A secondary analysis was performed on 300 infants born at 28-34 weeks gestation without bronchopulmonary dysplasia. Exposure included oxygen or positive pressure, (continuous positive airway pressure or mechanical ventilation). The primary outcome was recurrent wheezing. Secondary outcomes were respiratory medications, emergency room visits, and hospitalizations. RESULTS 50% of infants who received oxygen experienced recurrent wheezing compared to 42.4% of infants who did not (OR 1.15 CI 0.72-1.85 adjusted OR 1.15 CI 0.67-1.98). 51.1% of infants who received positive pressure experienced recurrent wheezing compared to 38.1% who did not (OR 1.57 CI 0.97-2.53 adjusted OR 1.58 CI 0.90-2.77). There were no significant associations between oxygen and positive pressure exposure and any primary or secondary outcomes in the adjusted analyses. CONCLUSIONS After adjustment for known risk factors the analyses showed no significant associations between oxygen and positive pressure with respiratory morbidity in this population. Further study of infants with mild disease is needed.
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Affiliation(s)
- Tara Glenn
- Department of Pediatrics, UH Rainbow Babies and Children’s Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Kristie R. Ross
- Department of Pediatrics, UH Rainbow Babies and Children’s Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Andrea Trembath
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
| | - Nori Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Anna Maria Hibbs
- Department of Pediatrics, UH Rainbow Babies and Children’s Hospital, Cleveland, OH
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
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Di Fiore JM, Dylag AM, Honomichl RD, Hibbs AM, Martin RJ, Tatsuoka C, Raffay TM. Early inspired oxygen and intermittent hypoxemic events in extremely premature infants are associated with asthma medication use at 2 years of age. J Perinatol 2019; 39:203-211. [PMID: 30367103 PMCID: PMC6351157 DOI: 10.1038/s41372-018-0264-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/07/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Extremely premature infants are at risk for childhood wheezing. Early respiratory support and intermittent hypoxemia (IH) events may be associated with adverse breathing outcomes. STUDY DESIGN A single-center retrospective cohort study of 137 premature infants <28 weeks gestational age characterized the associations of cumulative oxygen, cumulative mean airway pressure, IH, and oxygen saturation (SpO2) on the primary outcome of prescription asthma medication use at 2-year follow-up. Relative risk was calculated by generalized estimating equations. RESULTS Reported asthma medication use was 46%. At 1-3 days of age, elevated cumulative oxygen exposure, increased daily IH, and lower mean SpO2 (adjusted for gestational age and sex) and increased cumulative mean airway pressure exposure (unadjusted) were associated with asthma medication use. CONCLUSION Increased oxygen and frequent IH events during just the first 3 days of age may help identify extremely premature newborns at risk for symptomatic childhood wheezing requiring prescription asthma medications.
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Affiliation(s)
- Juliann M. Di Fiore
- Division of Neonatology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Andrew M. Dylag
- Division of Neonatology, Golisano Children’s Hospital, University of Rochester, Rochester, NY
| | - Ryan D. Honomichl
- Division of Neurology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Anna Maria Hibbs
- Division of Neonatology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Richard J. Martin
- Division of Neonatology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Curtis Tatsuoka
- Division of Neurology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH
| | - Thomas M. Raffay
- Division of Neonatology, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
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Wai KC, Hibbs AM, Steurer MA, Black DM, Asselin JM, Eichenwald EC, Ballard PL, Ballard RA, Keller RL. Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns: Secondary Analysis of a Randomized Trial. J Pediatr 2018; 198:201-208.e3. [PMID: 29627188 PMCID: PMC6019148 DOI: 10.1016/j.jpeds.2018.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/20/2017] [Accepted: 02/13/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. STUDY DESIGN We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. RESULTS Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. CONCLUSIONS Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. TRIAL REGISTRATION ClinicalTrials.gov: NCT01022580.
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Affiliation(s)
- Katherine C. Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco CA
| | - Anna M. Hibbs
- Department of Pediatrics, Rainbow Babies and Children’s Hospital, Cleveland OH
| | - Martina A. Steurer
- Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco CA,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA
| | - Dennis M. Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA
| | | | - Eric C. Eichenwald
- Department of Pediatrics, The University of Pennsylvania, Philadelphia PA
| | - Philip L. Ballard
- Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco CA
| | - Roberta A. Ballard
- Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco CA
| | - Roberta L. Keller
- Department of Pediatrics, UCSF Benioff Children’s Hospital, San Francisco CA
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Hibbs AM, Ross K, Kerns LA, Wagner C, Fuloria M, Groh-Wargo S, Zimmerman T, Minich N, Tatsuoka C. Effect of Vitamin D Supplementation on Recurrent Wheezing in Black Infants Who Were Born Preterm: The D-Wheeze Randomized Clinical Trial. JAMA 2018; 319:2086-2094. [PMID: 29800180 PMCID: PMC6583240 DOI: 10.1001/jama.2018.5729] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Black infants born preterm face high rates of recurrent wheezing throughout infancy. Vitamin D supplementation has the potential to positively or negatively affect wheezing through modulation of the pulmonary and immune systems. OBJECTIVE To assess the effectiveness of 2 vitamin D dosing strategies in preventing recurrent wheezing. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial enrolled 300 black infants born at 28 to 36 weeks' gestation between January 2013 and January 2016 at 4 sites in the United States, and followed them up through March 2017. Randomization was stratified by site and maternal milk exposure. INTERVENTIONS Patients were enrolled prior to discharge from the neonatal intensive care unit or newborn nursery and received open-label multivitamin until they were consuming 200 IU/d of cholecalciferol from formula or fortifier added to human milk, after which they received either 400 IU/d of cholecalciferol until 6 months of age adjusted for prematurity (sustained supplementation) or placebo (diet-limited supplementation). One-hundred fifty three infants were randomized to the sustained group, and 147 were randomized to the diet-limited group. MAIN OUTCOMES AND MEASURES Recurrent wheezing by 12 months' adjusted age was the primary outcome. RESULTS Among 300 patients who were randomized (mean gestational age, 33 weeks; median birth weight, 1.9 kg), 277 (92.3%) completed the trial. Recurrent wheezing was experienced by 31.1% of infants in the sustained supplementation group and 41.8% of infants in the diet-limited supplementation group (difference, -10.7% [95% CI, -27.4% to -2.9%]; relative risk, 0.66 [95% CI, 0.47 to 0.94]). Upper and lower respiratory tract infections were among the most commonly reported adverse events. Upper respiratory infections were experienced by 84 of 153 infants (54.9%) in the sustained group and 83 of 147 infants (56.5%) in the diet-limited group (difference, -1.6% [95% CI, -17.1% to 7.0%]). Lower respiratory infections were experienced by 33 of 153 infants (21.6%) in the sustained group and 37 of 147 infants (25.2%) in the diet-limited group (difference, -3.6% [95% CI, -16.4% to 4.4%]). CONCLUSIONS AND RELEVANCE Among black infants born preterm, sustained supplementation with vitamin D, compared with diet-limited supplementation, resulted in a reduced risk of recurrent wheezing by 12 months' adjusted age. Future research is needed to better understand the mechanisms and longer-term effects of vitamin D supplementation on wheezing in children born preterm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01601847.
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Affiliation(s)
- Anna Maria Hibbs
- Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kristie Ross
- Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Leigh Ann Kerns
- Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Carol Wagner
- Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston
| | - Mamta Fuloria
- The Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Sharon Groh-Wargo
- Case Western Reserve University, Cleveland, Ohio
- MetroHealth Medical Center, Cleveland, Ohio
| | - Teresa Zimmerman
- Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nori Minich
- Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Curtis Tatsuoka
- Case Western Reserve University, Cleveland, Ohio
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Corwin BK, Trembath AN, Hibbs AM. Bronchopulmonary dysplasia appropriateness as a surrogate marker for long-term pulmonary outcomes: A Systematic review. J Neonatal Perinatal Med 2018; 11:121-130. [PMID: 29843269 DOI: 10.3233/npm-181756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is used to clinically describe the severity of lung disease and to serve as a common surrogate endpoint for long-term pulmonary morbidity in clinical trials, but its performance as a surrogate end-point warrants evaluation. Our objective was to assess real-world performance of BPD as a surrogate marker for long-term pulmonary outcomes. METHODS We performed a systematic review of large, multi-centered, blinded, randomized control trials to evaluate the use of BPD as a surrogate marker for long-term pulmonary outcomes. Long-term pulmonary outcomes occurred within two years and included measures of hospital utilization, respiratory illness, respiratory medication, and mortality. Direction and magnitude of effect were evaluated using number needed to treat analysis. RESULTS Five studies were included in our review. Studies varied in definition of BPD and in long-term outcomes measured. Only one study found a significant, consistent risk reduction in both BPD and any long-term pulmonary outcome. Two studies found significant reductions in long-term pulmonary outcomes with a non-significant reduction in BPD. CONCLUSIONS BPD is an imperfect surrogate marker for long-term pulmonary outcomes. It did not consistently predict the magnitude or direction of the effect of an intervention on longer-term pulmonary outcomes. Furthermore, there was significant variation in the definitions of BPD and in the long-term pulmonary outcomes used. There is a need for future work to identify more predictive surrogate markers and a need for better standardization of assessments of long-term pulmonary outcomes.
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Affiliation(s)
- B K Corwin
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Medicine, Summa Health System, Akron OH, USA
| | - A N Trembath
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - A M Hibbs
- Case Western Reserve School of Medicine, Cleveland, OH, USA
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
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10
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Keller RL, Eichenwald EC, Hibbs AM, Rogers EE, Wai KC, Black DM, Ballard PL, Asselin JM, Truog WE, Merrill JD, Mammel MC, Steinhorn RH, Ryan RM, Durand DJ, Bendel CM, Bendel-Stenzel EM, Courtney SE, Dhanireddy R, Hudak ML, Koch FR, Mayock DE, McKay VJ, Helderman J, Porta NF, Wadhawan R, Palermo L, Ballard RA. The Randomized, Controlled Trial of Late Surfactant: Effects on Respiratory Outcomes at 1-Year Corrected Age. J Pediatr 2017; 183:19-25.e2. [PMID: 28100402 PMCID: PMC5367937 DOI: 10.1016/j.jpeds.2016.12.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/31/2016] [Accepted: 12/19/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine the effects of late surfactant on respiratory outcomes determined at 1-year corrected age in the Trial of Late Surfactant (TOLSURF), which randomized newborns of extremely low gestational age (≤28 weeks' gestational age) ventilated at 7-14 days to late surfactant and inhaled nitric oxide vs inhaled nitric oxide-alone (control). STUDY DESIGN Caregivers were surveyed in a double-blinded manner at 3, 6, 9, and 12 months' corrected age to collect information on respiratory resource use (infant medication use, home support, and hospitalization). Infants were classified for composite outcomes of pulmonary morbidity (no PM, determined in infants with no reported respiratory resource use) and persistent PM (determined in infants with any resource use in ≥3 surveys). RESULTS Infants (n = 450, late surfactant n = 217, control n = 233) were 25.3 ± 1.2 weeks' gestation and 713 ± 164 g at birth. In the late surfactant group, fewer infants received home respiratory support than in the control group (35.8% vs 52.9%, relative benefit [RB] 1.28 [95% CI 1.07-1.55]). There was no benefit of late surfactant for No PM vs PM (RB 1.27; 95% CI 0.89-1.81) or no persistent PM vs persistent PM (RB 1.01; 95% CI 0.87-1.17). After adjustment for imbalances in baseline characteristics, relative benefit of late surfactant treatment increased: RB 1.40 (95% CI 0.89-1.80) for no PM and RB 1.24 (95% CI 1.08-1.42) for no persistent PM. CONCLUSION Treatment of newborns of extremely low gestational age with late surfactant in combination with inhaled nitric oxide decreased use of home respiratory support and may decrease persistent pulmonary morbidity. TRIAL REGISTRATION ClinicalTrials.gov: NCT01022580.
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Affiliation(s)
- Roberta L. Keller
- Department of Pediatrics, University of California San Francisco, San Francisco CA
| | | | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University, Cleveland OH
| | - Elizabeth E. Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco CA
| | | | - Dennis M. Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA
| | - Philip L. Ballard
- Department of Pediatrics, University of California San Francisco, San Francisco CA
| | | | - William E. Truog
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City MO
| | | | - Mark C. Mammel
- Department of Pediatrics, Children’s Hospital and Clinics of Minnesota, St. Paul and Minneapolis MN
| | - Robin H. Steinhorn
- Department of Pediatrics, Children’s National Medical Center, Washington DC
| | - Rita M. Ryan
- Department of Pediatrics, Medical University of South Carolina, Charleston SC
| | | | | | - Ellen M. Bendel-Stenzel
- Department of Pediatrics, Children’s Hospital and Clinics of Minnesota, St. Paul and Minneapolis MN
| | - Sherry E. Courtney
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock AR
| | | | - Mark L. Hudak
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville FL
| | - Frances R. Koch
- Department of Pediatrics, Medical University of South Carolina, Charleston SC
| | | | - Victor J. McKay
- Department of Pediatrics, All Children’s Hospital, St. Petersburg FL
| | - Jennifer Helderman
- Department of Pediatrics, Wake Forest School of Medicine/Forsyth Medical Center, Winston-Salem NC
| | - Nicolas F. Porta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago IL
| | - Rajan Wadhawan
- Department of Pediatrics, Florida Hospital for Children, Orlando FL
| | - Lisa Palermo
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco CA
| | - Roberta A. Ballard
- Department of Pediatrics, University of California San Francisco, San Francisco CA
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Olicker A, Li H, Tatsuoka C, Ross K, Trembath A, Hibbs AM. Have Changing Palivizumab Administration Policies Led to More Respiratory Morbidity in Infants Born at 32-35 Weeks? J Pediatr 2016; 171:31-7. [PMID: 26724119 DOI: 10.1016/j.jpeds.2015.11.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/20/2015] [Accepted: 11/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine differences in the incidence of respiratory morbidity during the first year of life among infants born 32(0/7)-34(6/7) weeks' gestational age (GA) before and after the administration policy for palivizumab, as written by the American Academy of Pediatrics, was updated in 2009. STUDY DESIGN Secondary analysis of the dataset collected for the Gastrointestinal Risk Factors for Wheezing in Premature Infants study, which enrolled preterm infants without bronchopulmonary dysplasia and followed them by parental questionnaires at 3, 6, 9, and 12 months adjusted age for prematurity. Participants were included if they were enrolled in Gastrointestinal Risk Factors for Wheezing in Premature Infants, born 32(0/7)-34(6/7) weeks' GA, and completed the 12-month questionnaire. We compared rates of recurrent wheezing, respiratory medication use, and health care use before (Epoch 1) and after (Epoch 2) the 2009 administration policy change. RESULTS A total of 165 infants met inclusion criteria. There was a significant increase in recurrent wheezing in Epoch 2 (46.2%) vs Epoch 1 (28.8%) (OR 2.22 [95% CI 1.08-4.53], P = .03). There was a nonsignificant increase in visits to the emergency department in Epoch 2 (27.4%) vs Epoch 1 (15.3%) (OR 2.12 [95% CI 0.91-4.96], P = .08). There were no differences in hospital admissions or respiratory medication use. CONCLUSIONS Infants born 32(0/7)-34(6/7) weeks' GA treated after the American Academy of Pediatrics administration policy change in 2009 had a greater incidence of recurrent wheezing than those treated according to the previous policy. It will be important to track rates of recurrent wheezing after the 2014 administration policy, because it may be an important factor in future cost-effectiveness analyses.
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Affiliation(s)
- Arielle Olicker
- University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH.
| | - Hong Li
- Case Western Reserve University, Cleveland, OH
| | - Curtis Tatsuoka
- University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH
| | - Kristie Ross
- University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH
| | - Andrea Trembath
- University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH
| | - Anna Maria Hibbs
- University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH
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12
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Race differences in the association between multivitamin exposure and wheezing in preterm infants. J Perinatol 2015; 35:192-7. [PMID: 25275695 PMCID: PMC4342282 DOI: 10.1038/jp.2014.176] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/23/2014] [Accepted: 08/05/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We aimed to determine whether vitamin D exposure, as estimated by use of multivitamins, is positively or negatively associated with recurrent wheezing in infants born preterm. STUDY DESIGN This prospective cohort study enrolled 300 infants, born at 28(0/7) to 34(6/7) weeks gestational age, and conducted follow-up at 3-, 6-, 9- and 12-month adjusted age. RESULT Black (55.9%) and non-black (36.6%) infants experienced recurrent wheezing. Adjusted odds ratios (ORs) for the association between multivitamin exposure at 3 months and recurrent wheezing were 2.15 (95% confidence interval (CI): 0.97, 4.75) for black and 0.43 (95% CI: 0.19, 0.96) for non-black infants with an interaction by race (P=0.003). In lag-effect models, ORs were 2.69 (95% CI: 1.41, 5.14) for black and 0.50 (95% CI: 0.27, 0.92) for non-black infants. CONCLUSION Differences by race were seen in association between multivitamins and wheezing; population heterogeneity should be considered when evaluating vitamin supplementation.
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