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Food and drug reactions, wheezing, and eczema in preterm infants
A Lucas1, O G Brooke, T J Cole
1MRC Dunn Nutrition Unit, Cambridge.
Insights
Preterm infants show high rates of asthma and eczema, linked to factors like maternal smoking and multiple births. Caesarean birth unexpectedly reduced asthma risk in this vulnerable group.
Area of Science:
- Neonatal Medicine
- Pediatric Allergy
- Epidemiology
Background:
- Preterm infants may have increased risk for allergic diseases.
- Understanding risk factors for allergic reactions in preterm infants is crucial.
Purpose of the Study:
- To investigate the incidence and risk factors of allergic reactions in preterm infants.
- To explore associations between prematurity, diet, and allergic outcomes.
Main Methods:
- Prospective study of 777 preterm infants followed to 18 months corrected age.
- Randomized assignment to early diet and data collection on wheezing, asthma, eczema, and reactions to foods and drugs.
Main Results:
- Wheezing/asthma incidence was 23%, associated with neonatal ventilation, maternal smoking, and family atopy; reduced in caesarean-born infants.
- Eczema occurred in 19%, strongly linked to multiple pregnancies.
- Cow's milk, food, and drug reactions were observed, with some associated with multiple births and family atopy.
Conclusions:
- Preterm infants represent a high-risk group for developing asthma and eczema.
- Findings suggest potential links between prematurity, atopy, and specific environmental/obstetric factors.
- Neonatal ventilation and multiple medications may influence drug tolerance in preterm infants.
Abstract:
Allergic reactions were investigated in 777 preterm infants who were randomly assigned to early diet and followed up to 18 months post term. Wheezing or asthma was common (incidence 23%); it was associated with neonatal ventilation, maternal smoking, and a family history of atopy and was unexpectedly reduced in babies born by caesarean section. Even in non-ventilated infants, the incidence of subsequent wheezing was 18%, rising to an estimated 44% (using logistic regression) when the foregoing risk factors (excluding ventilation) were present. Eczema occurred in 151 infants (19%) and was strongly associated with multiple pregnancy (30% incidence in twins or triplets). Reactions to cows' milk (incidence: 4.4% from detailed history; 0.8% confirmed by challenge), other foods (10%), and drugs (5%) were within the range reported in full term infants. Milk and food reactions were associated with multiple pregnancy (19%) and a family history of atopy. Reactions to drugs were least likely to occur in infants who had been ventilated and were on multiple medications in the neonatal period, suggesting that drug tolerance may have developed. We speculate that preterm infants may be a high risk group for asthma and eczema, which could imply an association between atopy and prematurity.