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Published on: August 7, 2017
Very low birth weight and respiratory outcome: association between airway inflammation and hyperresponsiveness
L Pekka Malmberg1, Anna S Pelkonen, Kristiina Malmström
1Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland. pekka.malmberg@hus.fi
Insights
Airway hyperresponsiveness (AHR) in very low birth weight (VLBW) children is linked to fractional exhaled nitric oxide (FeNO), but only in those with atopy. This association involves bronchial nitric oxide flux, not alveolar concentration.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Neonatology
Background:
- Respiratory outcomes in preterm infants have evolved.
- The relationship between childhood airway hyperresponsiveness (AHR) and airway inflammation remains unclear.
Purpose of the Study:
- To investigate the association between AHR and fractional exhaled nitric oxide (FeNO), including alveolar nitric oxide concentration, in school-age children with very low birth weight (VLBW).
Main Methods:
- Compared 29 VLBW children, 33 with early wheeze history, and 60 controls.
- Assessed FeNO, histamine bronchial challenge, and atopy via skin prick tests.
Main Results:
- VLBW children showed increased AHR but similar FeNO levels to controls.
- AHR correlated with FeNO in VLBW and early wheeze groups, specifically in atopic individuals.
- Bronchial nitric oxide flux, not alveolar concentration, associated with AHR in VLBW and early wheeze groups.
Conclusions:
- In VLBW children, AHR is linked to FeNO, but only in atopic subjects.
- The association between AHR and FeNO is driven by bronchial flux, similar to early wheeze patients.
- Atopic inflammation, rather than prematurity-related inflammation, likely modifies AHR in VLBW children.
Background:
The respiratory outcomes after preterm birth have changed, and it is unclear whether increased airway hyperresponsiveness (AHR) later in childhood is associated with airway inflammation.
Objective:
To investigate the association between AHR and fractional exhaled nitric oxide (FeNO), including the alveolar concentration of nitric oxide, in school-age children with very low birth weight (VLBW).
Methods:
Twenty-nine children with VLBW, 33 children with a history of early wheeze, and 60 healthy controls underwent a FeNO measurement and bronchial challenge test with histamine. Atopy was assessed with skin prick tests.
Results:
Children with VLBW had well-preserved baseline lung function but significantly increased AHR, expressed as the dose response slope (P < .001). Geometric mean FeNO levels were similar between VLBW children and healthy controls, and a history of bronchopulmonary dysplasia had no effect. In the VLBW and early wheeze groups, AHR was associated with FeNO (r = 0.47, P = .01, and r = 0.43, P = .013, respectively), but in a stratified analysis, this association was significant only in atopic individuals. By using the multiple flow FeNO technique, the bronchial nitric oxide flux rather than alveolar nitric oxide concentrations were associated with AHR in both children with early wheeze and VLBW.
Conclusion:
We conclude that in VLBW children AHR is related to FeNO but only in atopic individuals. Similar to children with early wheeze, this association is dependent on bronchial flux rather than alveolar nitric oxide concentration. It is likely that AHR is modified by atopic inflammation rather than by inflammatory process due to prematurity.
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