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Published on: August 7, 2017
Management of Prematurity-Associated Wheeze and Its Association with Atopy
Martin O Edwards1, Sarah J Kotecha1, John Lowe1
1Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom.
Insights
Preterm birth increases childhood respiratory symptoms like wheezing, independent of family history of atopy. Bronchodilator use was higher in preterm infants, warranting further evaluation of treatment efficacy.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Neonatology
Background:
- Preterm birth is a known risk factor for childhood respiratory morbidity.
- The influence of genetic predisposition (family history of atopy) and treatment interventions on respiratory outcomes in preterm infants remains unclear.
Purpose of the Study:
- To assess the prevalence of respiratory symptoms, particularly wheezing, in children born preterm compared to those born at term.
- To evaluate the role of family history of atopy and mode of delivery in preterm infants' respiratory health.
- To document drug usage patterns in preterm-born children.
Main Methods:
- A cross-sectional, population-based questionnaire study involving 13,361 preterm infants and 13,361 matched term-born controls, aged 1-10 years.
- Data analysis was stratified by gestational age groups (24-32, 33-34, 35-36, and 37-43 weeks) and age (<5 years and ≥5 years).
Main Results:
- Children born preterm, especially those born earliest (24-32 weeks gestation), exhibited significantly higher rates of wheezing at both <5 and ≥5 years of age compared to term-born controls.
- The increased risk of wheezing associated with prematurity was independent of a family history of atopy.
- Inhaler and bronchodilator usage was greater in preterm groups, particularly the most premature, though efficacy requires further study.
Conclusions:
- Increasing degrees of prematurity are directly associated with a higher incidence of respiratory symptoms in childhood.
- Respiratory symptoms in preterm infants are not influenced by a family history of atopy.
- While bronchodilator use is more frequent in preterm populations, its effectiveness warrants careful evaluation.
Introduction:
Although preterm birth is associated with respiratory morbidity in childhood, the role of family history of atopy and whether appropriate treatment has been instituted is unclear. Thus we assessed (i) the prevalence of respiratory symptoms, particularly wheezing, in childhood; (ii) evaluated the role of family history of atopy and mode of delivery, and (iii) documented the drug usage, all in preterm-born children compared to term-born control children.
Methods:
We conducted a cross-sectional population-based questionnaire study of 1-10 year-old preterm-born children (n = 13,361) and matched term-born controls (13,361). Data (n = 7,149) was analysed by gestational groups (24-32 weeks, 33-34 weeks, 35-36 weeks and 37-43 weeks) and by age, <5 years old or ≥ 5 years.
Main Results:
Preterm born children aged <5 years (n = 2,111, term n = 1,402) had higher rates of wheeze-ever [odds ratio: 2.7 (95% confidence intervals 2.2, 3.3); 1.8 (1.5, 2.2); 1.5 (1.3, 1.8) respectively for the 24-32 weeks, 33-34 weeks, 35-36 weeks groups compared to term]. Similarly for the ≥5 year age group (n = 2,083, term n = 1,456) wheezing increased with increasing prematurity [odds ratios 3.3 (2.7, 4.1), 1.8 (1.5, 2.3) and 1.6 (1.3, 1.9) for the three preterm groups compared to term]. At both age groups, inhaler usage was greater in the lowest preterm group but prematurity-associated wheeze was independent of a family history of atopy.
Conclusions:
Increasing prematurity was associated with increased respiratory symptoms, which were independent of a family history of atopy. Use of bronchodilators was also increased in the preterm groups but its efficacy needs careful evaluation.
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