Atopic Manifestations in Children Born Preterm: A Long-Term Observational Study
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Published on: August 7, 2017
Federica Pagano1, Maria Giulia Conti1,2, Giovanni Boscarino1
1Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy.
Insights
Gestational diabetes and antibiotic use increase atopy risk in preterm infants. Extreme prematurity may reduce atopic dermatitis risk, but preterm babies exhibit a distinct atopic march.
Area of Science:
- Neonatal care
- Pediatric allergy
- Public health
Background:
- Preterm birth is associated with increased risk of atopic diseases.
- Understanding neonatal risk factors for atopy in preterm infants is crucial for early intervention.
- Atopic manifestations and their progression (atopic march) in preschool children born preterm require detailed investigation.
Purpose of the Study:
- To identify neonatal risk factors for atopy in infants born preterm.
- To describe the clinical manifestations and progression of atopy in this cohort.
- To analyze the influence of specific conditions on the development of atopic diseases.
Main Methods:
- Enrollment of neonates with gestational age < 32 weeks or birth weight < 1500 g.
- Classification of participants into cases (at least one atopic manifestation) and controls.
- Multivariate analysis to determine risk factors for atopy, atopic dermatitis, and wheeze.
Main Results:
- Multiple antibiotic cycles and gestational diabetes were significant risk factors for atopy in preterm infants.
- Gestational age < 29 weeks and gestational diabetes influenced the risk of atopic dermatitis.
- Family history of asthma and multiple antibiotic cycles were associated with an increased risk of wheeze.
- A significant reduction in atopic manifestations was observed after two years of age.
Conclusions:
- Modifiable factors (gestational diabetes, antibiotic use) and unmodifiable factors (family history of asthma) impact atopy risk in preterm infants.
- Extreme prematurity appears to reduce the risk of atopic dermatitis.
- Preterm infants demonstrate a unique pattern in the progression of atopic diseases (atopic march).
Abstract:
(1) Background: Preterm birth exposes the infant to the known risk factors for atopic diseases. We aimed to study the neonatal risk factors and to describe the clinical manifestations of atopy, including the march of symptoms, in a cohort of preschool children born preterm. (2) Methods: We enrolled neonates with gestational age < 32 weeks or birth weight < 1500 g. We classified patients in cases and controls according to the presence of at least one atopic manifestation. (3) Results: We observed 72 cases and 93 controls. Multivariate models showed that the administration of more than one cycle of antibiotics (B 0.902, p = 0.026) and gestational diabetes (B 1.207, p = 0.035) influence the risk of atopy in babies born preterm. In addition, risk of atopic dermatitis was influenced by gestational age < 29 weeks (B -1.710, p = 0.025) and gestational diabetes (B 1.275, p = 0.027). The risk of wheeze was associated with familiarity for asthma (B 1.392, p = 0.022) and the administration of more than one cycle of antibiotics (B 0.969, p = 0.025). We observed a significant reduction in the rate of atopic manifestation after 2 years of life (33.9% vs. 23.8%, p < 0.05). (4) Conclusions: Modifiable (gestational diabetes, antibiotics use) and unmodifiable (familiarity for asthma) conditions influence the risk of atopy in babies born preterm. Extreme prematurity reduces the risk of atopic dermatitis. Preterm babies showed a peculiar atopic march.
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