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Neonatal chronic lung disease, oxygen dependency, and a family history of asthma
R Hagan1, C Minutillo, N French
1Department of Newborn Services, King Edward Memorial Hospital for Women, Perth, Australia.
Insights
Infants with a family history of asthma (FHA) face a higher risk of needing oxygen at term. This family history, along with prematurity and severe hyaline membrane disease, increases oxygen dependency in neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Genetics
Background:
- Respiratory morbidity is a significant concern in preterm infants.
- Chronic lung disease (CLD) and oxygen dependency are common complications.
Purpose of the Study:
- To investigate the association between family history of asthma (FHA), neonatal chronic lung disease (CLD), and oxygen dependency in very preterm infants.
- To identify risk factors for prolonged oxygen use in this vulnerable population.
Main Methods:
- Inception cohort study of infants born between 24 and 30 weeks gestation.
- Data analysis included 116 infants, with 112 surviving to discharge.
- Logistic regression was used to identify factors associated with oxygen dependency at term.
Main Results:
- CLD affected 53% of infants, with 14% oxygen dependent at term.
- Infants with an FHA had a 4.4 times higher risk of being oxygen dependent at term.
- Gestational age <28 weeks, severe hyaline membrane disease (HMD), and FHA were significant predictors of term oxygen dependency.
Conclusions:
- Family history of asthma is a significant risk factor for increased oxygen dependency at term in very preterm infants.
- While not causal, FHA can exacerbate CLD and prolong oxygen supplementation needs.
- Clinicians should consider FHA when counseling parents about the prognosis and management of oxygen therapy in preterm neonates.
Abstract:
We examined the relationship between a family history of asthma (FHA), neonatal chronic lung disease (CLD), and oxygen dependency in an inception cohort study of all 24- to 30-week gestation infants admitted to the sole tertiary perinatal center in Western Australia. One hundred and forty-four infants were admitted during the study period; 116 had data analyzed, 112 of whom survived to discharge. Respiratory morbidity was common and the prevalence increased with decreasing gestation. Hyaline membrane disease (HMD) occurred in 92 (79%) and CLD (oxygen dependency at 28 days) in 62 (53%); 35 (30%) were oxygen dependent at 36 weeks corrected age, and 16 (14%) were oxygen dependent at term. Thirty-two infants had an FHA which was equally distributed between those infants with and without CLD. Infants with an FHA were more likely to be oxygen dependent at term (relative risk 4.4; 95% Cl 1.7,11.1). Thirty-eight percent of mothers smoked; 68% of their infants developed HMD compared to 89% of those whose mothers did not smoke. Logistic regression identified GA<28 weeks (OR 7.3; 95% Cl 1.4,39), severe HMD (OR 4.8; 95% Cl 1.1,22), and FHA (OR 11.0; 95% Cl 2.3,53) as the only factors associated with an increased risk of being oxygen dependent at term. The duration of supplemental oxygen in infants with CLD was significantly related to decreasing gestation, greater degree of barotrauma, presence of HMD, pregnancy-induced hypertension in the mother, duration of patent ductus arteriosus, and an FHA. An FHA may worsen chronic lung disease in the neonate, but is not involved as a causal factor. Clinicians should be aware of its influence on duration of oxygen supplementation when counselling parents of very preterm infants.