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The initial care of newborn infants and subsequent hay fever
S M Montgomery1, A J Wakefield, D L Morris
1Department of Medicine, Royal Free and University College Medical School, London, UK.
Insights
Infants spending their first night away from their mother in a communal nursery had a higher risk of developing hay fever later in life. Early life microbial exposure may influence immune system development and allergy risk.
Area of Science:
- Immunology
- Epidemiology
- Developmental Pediatrics
Background:
- Neonatal microbial exposure patterns have shifted over the past century, potentially impacting immune-mediated disease risk.
- Investigating early-life handling of newborns as a factor influencing subsequent atopy development, specifically hay fever.
- Utilizing a proxy measure to assess the relationship between initial microbial exposure and allergy risk.
Purpose of the Study:
- To test the hypothesis that neonatal handling, affecting microbial exposure, alters the risk of developing hay fever.
- To examine the association between early infant separation from the mother and the incidence of atopy.
- To understand the long-term implications of early-life microbial exposure on immune development.
Main Methods:
- Analysis of 5,519 members of the 1970 British Cohort Study, a nationally representative birth cohort.
- Identification of hay fever cases up to age 26, with prospective recording of neonatal care and childhood circumstances.
- Comparison of infants spending the first night in a communal nursery (atypical exposure) versus those remaining with their mother, using multiple logistic regression analysis adjusted for confounders.
Main Results:
- Infants spending the first night in a communal nursery showed unadjusted relative odds of 1.48 (95% CI: 1.23-1.77) for developing hay fever.
- Adjusted relative odds remained significant at 1.31 (95% CI: 1.08-1.59) after accounting for confounding factors like feeding practices and socioeconomic status.
- The association between early separation and increased hay fever risk persisted even after comprehensive adjustment for potential confounders.
Conclusions:
- The study's proxy measure indicates an association between early atypical microbial exposure and an increased risk of hay fever.
- Further research is needed to confirm the causal link between early-life infectious exposure patterns and atopy development.
- Findings support the hypothesis that initial microbial challenges are critical for the development of the newborn infant's immune system.
Background:
Patterns of neonatal exposure to microorganisms have changed substantially over the last 100 years, and it has been suggested that this has influenced the risk of immune-mediated disease. Using a proxy measure, we tested the hypothesis that the initial handling of newborn infants, which is known to affect the pattern of exposure to microorganisms, may alter the risk of developing subsequent atopy, as indicated by hay fever.
Methods:
Analysis was performed on 5,519 members of the 1970 British Cohort Study, a nationally representative birth cohort. Cohort members with hay fever were identified at intervals up to the age of 26 years. Details of neonatal care and childhood circumstances were recorded prospectively. Those who had spent their first night away from their mother in the communal infant nursery were selected as likely to have experienced atypical exposure compared with infants who remained with their mother. Adjustment was made for potential confounding factors in infancy and childhood by multiple logistic regression analysis.
Results:
Unadjusted relative odds (with 95% CI) for developing hay fever among those spending the first night in the communal nursery, when compared with other infants who remained with the mother, were 1.48 (1.23-1.77), P<0.001. Comprehensive adjustment for the potential confounding factors, including feeding practices on the first day of life, markers of social and material circumstances, and region, did not substantially alter this relationship, with adjusted relative odds of 1.31 (1.08-1.59), P=0.005.
Conclusions:
While our proxy measure is associated with an increased risk of hay fever, further research is required to confirm that this is due to the pattern of infectious exposure in very early life. The results are consistent with the hypothesis that the first challenges are particularly important in the development of the newborn infant's immune system.