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Characteristics of asthma and airway hyper-responsiveness after premature birth

Thomas Halvorsen1, Britt Torunn Skadberg, Geir Egil Eide

  • 1Department of Clinical Medicine, Section of Pediatrics, University of Bergen, Bergen, Norway. thomas.halvorsen@pedi.uib.no

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|September 24, 2005
PubMed

Insights

Children born extremely prematurely often develop asthma-like symptoms and airway hyper-responsiveness (AHR). These conditions in pre-term infants are linked to neonatal factors, not typical asthma triggers like allergies.

Area of Science:

  • Pediatric Pulmonology
  • Neonatology
  • Allergy and Immunology

Background:

  • Premature birth and bronchopulmonary dysplasia (BPD) are associated with asthma-like symptoms and airway hyper-responsiveness (AHR) in children.
  • Mechanisms underlying these respiratory issues in pre-term infants are not well understood.
  • Typical childhood asthma is linked to genetics, allergies, inflammation, and smoking.

Purpose of the Study:

  • To investigate the factors associated with current asthma and AHR in extremely pre-term children.
  • To compare these factors with those in a matched term-born control population.
  • To explore the relationship between neonatal respiratory morbidity and asthma/AHR in pre-term infants.

Main Methods:

  • A population-based cohort study of 81 extremely pre-term infants (gestational age ≤28 wk or birth weight ≤1000 g) and matched term-born controls.
  • Assessment of current asthma and AHR at follow-up.
  • Analysis of factors including inheritance, allergy, airway inflammation, smoking, and neonatal respiratory morbidity (e.g., BPD, oxygen requirement).
  • Measurement of urinary leukotriene metabolite E4 (U-LTE4) and forced expiratory volume in the first second (FEV1).

Main Results:

  • Pre-term children had higher rates of asthma and significantly increased AHR compared to controls.
  • Pre-term infants showed reduced FEV1 and elevated U-LTE4 levels.
  • In controls, asthma and AHR were linked to typical factors (genetics, allergy, inflammation, smoking).
  • In pre-terms, asthma and AHR were less related to these typical factors.
  • Neonatal history of BPD and prolonged oxygen treatment strongly correlated with AHR in pre-term infants.

Conclusions:

  • Asthma and AHR in extremely pre-term children present differently from typical childhood asthma.
  • Neonatal variables, particularly BPD and oxygen dependency, are key determinants of AHR in this population.
  • These respiratory manifestations in pre-term infants may represent a distinct clinical entity.

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