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Supplementary oxygen and risk of childhood lymphatic leukaemia
E Naumburg1, R Bellocco, S Cnattingius
1Department of Women 's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden. estelle.naumburg@kbh.uu.se
Insights
Newborn resuscitation with 100% oxygen immediately after birth is linked to a higher risk of childhood lymphatic leukaemia. This risk increases with longer ventilation durations, warranting further investigation.
Area of Science:
- Pediatric Oncology
- Neonatology
- Epidemiology
Background:
- Childhood leukaemia risk is associated with birth-related factors like asphyxia and birthweight.
- Newborn resuscitation practices may influence these risks.
- Previous studies suggest a potential link, necessitating further investigation.
Purpose of the Study:
- To investigate the association between childhood leukaemia and exposure to supplementary oxygen during birth.
- To examine the relationship between other birth-related factors and childhood leukaemia risk.
Main Methods:
- Population-based case-control study in Sweden (1973-1989).
- Matched 578 children with lymphatic leukaemia to controls, excluding those with Down's syndrome.
- Analyzed medical records for exposure data and used conditional logistic regression.
Main Results:
- Resuscitation with 100% oxygen via facemask and bag immediately postpartum showed a significant association with increased childhood lymphatic leukaemia risk (OR=2.57).
- Risk increased further with ventilation lasting 3 minutes or more (OR=3.54).
- Low Apgar scores showed a non-significant increased risk; no associations found with later neonatal oxygen or other birth factors.
Conclusions:
- Immediate postpartum resuscitation with 100% oxygen is associated with childhood lymphatic leukaemia.
- Further research is required to validate these findings and understand the underlying mechanisms.
Aim:
Childhood leukaemia has been linked to several factors, such as asphyxia and birthweight, which in turn are related to newborn resuscitation. Based on the findings from a previous study a population-based case-control study was performed to investigate the association between childhood leukaemia and exposure to supplementary oxygen and other birth-related factors.
Methods:
Children born in Sweden and diagnosed with lymphatic leukaemia between 1973 and 1989 (578 cases) were individually matched by gender and date of birth to a randomly selected control. Children with Down's syndrome were excluded. Exposure data were blindly gathered from antenatal, obstetric and other standardized medical records. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by conditional logistic regression.
Results:
Resuscitation with 100% oxygen with a facemask and bag immediately postpartum was significantly associated with an increased risk of childhood lymphatic leukaemia (OR = 2.57, 95% Cl 1.21-6.82). The oxygen-related risk further increased if the manual ventilation lasted for 3 min or more (OR = 3.54, 95% CI 1.16-10.80). Low Apgar scores at 1 and 5 min were associated with a non-significantly increased risk of lymphatic leukaemia. There were no associations between lymphatic leukaemia and supplementary oxygen later in the neonatal period or other birth-related factors.
Conclusion:
Resuscitation with 100% oxygen immediately postpartum is associated with childhood lymphatic leukaemia, but further studies are warranted to confirm the findings.