We assessed the relationship between very low birth weight (VLBW) (<or=1500 g) and the development of asthma, lung function and atopy. The study groups comprised 74 of all 86 (86%) VLBW and 64 of all 86 (74%) matched term children who were prospectively followed for 12 years. A questionnaire on asthmatic and allergic symptoms was completed and skin prick tests, spirometry and hypertonic saline provocation tests were performed at 12 years of age. Cytokine secretion was analysed in stimulated blood leukocyte cultures in 28 VLBW and 23 term children. A history of asthma was more frequent among the VLBW children, as compared with the term children at age 12 (22% vs. 9%, p = 0.046). Among the VLBW children, very preterm birth (gestational age: week 25 to 29) (RR 2.5, 95%CI 1.1-5.8), neonatal mechanical ventilation (RR 2.8, 95%CI 1.2-6.4) and neonatal oxygen supplementation (RR 4.3, 95%CI 1.3-14.0) were significantly associated with a history of asthma by the age of 12 years in univariate analyses. In multivariate logistic regression, neonatal oxygen supplementation >or= 9 days was the only remaining significant risk factor for a history of asthma (adjusted OR 6.7, 95%CI 1.0-44). The VLBW children who required mechanical ventilation during the neonatal period were more likely to have bronchial hyperresponsiveness than those not requiring mechanical ventilation (60% vs. 28%, p = 0.050). The spirometric values were similar among the VLBW and the term children at 12 years. Very low birth weight was not significantly related to allergic rhinoconjunctivitis, eczema or positive skin prick tests. Furthermore, the levels of IL-4, IL-5 and IFN-gamma in stimulated cell cultures were similar in the VLBW and the term children. A history of asthma by 12 years of age was twice as common among the VLBW as the term children, and neonatal oxygen supplementation seemed to be associated with the increased risk. Furthermore, mechanical ventilation during the neonatal period was associated with bronchial hyperresponsiveness at age 12. Very low birth weight per se was not, however, related to atopy.
"Baraldi and colleagues  recently showed that nitric oxide fraction in exhaled air (FeNO) values which are an indirect marker of eosinophilic airway inflammation were lower in preterm children than in those with asthma and even as much as four times lower in children with BPD. There are also investigations proving that prematurity reduces the long-term risk of atopy [8-10], and the occurrence of diseases such as allergic rhinitis, eczema and atopic asthma. We will try to cover these and many other issues in this study which deals with the the respiratory and allergic outcomes of babies born with a gestational age <30 weeks and birth weight <1000 g (ELBW) compared to term-born children at the age of 6–7 years. "
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Children who were <1000g (ELBW extremely low birth weight) at birth more frequently present with wheezing which is the most common reason that pediatric consultation is sought. Therefore asthma is diagnosed very often. However is the asthma that is diagnosed in ELBW subjects atopic in origin, or is there a different etiology?Aim: To determine if ELBW infants are at higher risk for the development of allergic and respiratory symptoms and to establish if there were any specific risk factors for these symptoms. METHODS: 81 children born with a mean birthweight of 845g (91% of available cohort) were evaluated at the mean age 6.7 years. The control group included 40 full-term children. The children were examined for clinical signs of allergy, and were subjected to the following tests: serum total IgE, skin prick tests (SPT), exhaled nitric oxide measurement (FeNO) and spirometry. RESULTS: ELBW children had wheezing episodes more often (64% vs. 25%; OR (odds ratio): 5.38; 95%CI (confidence interval): 2.14-13.8) and were diagnosed more frequently with asthma (32% vs. 7.5%; OR: 5.83, 95%CI: 1.52-26) than their term born peers. The most important risk factors for wheezing persistence were hospitalization and wheezing episodes in first 24 months of life. Mean serum tIgE level (geometric mean: 32+/-4 vs. 56+/-4 kU/L; p=0.002) was higher and the number of children with positive results of tIgE level (12% vs. 32%; p=0.02) were more frequent in the control group. Children from the control group also more frequently had SPT, however this data was not statistically significant (11% vs. 24%; p=0.09). All of the ELBW had normal FeNO level (<=20 ppb), but 5 children from the control group had abnormal results (p=0.02). There was no difference between the groups in the occurrence of allergic symptoms. CONCLUSION: ELBW children have more frequent respiratory, but not allergic problems at the age of 6--7 years compared to children born at term. The need for rehospitalization in the first 2 years of life, was a more important risk factor of future respiratory problems at the age of 7 than perinatal factors, the diagnosis of bronchopulmonary dysplasia or allergy.
Italian Journal of Pediatrics 01/2013; 39(1):4. DOI:10.1186/1824-7288-39-4 · 1.52 Impact Factor
"In response to maximal exercise tests, exercise performances of prematurely born children were indicative of reduced aerobic power, as shown by a significantly lower maximal heart rate [13, 25], faster breathing frequency [22, 24], smaller VT , reduced maximal oxygen consumption (VO2max) [21–23, 25], reduced maximal minute ventilation (VEmax) , and shorter exercise time  and distance [21, 25]; these functional differences are consistent with long-term alterations in cardiopulmonary development. Interestingly, oxygen supplementation during the neonatal period in very low birth weight infants has been identified as an independent risk factor for asthma in childhood . "
[Show abstract][Hide abstract] ABSTRACT: Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity that affects very preterm infants. Although advances in perinatal care have changed the course of lung injury and enabled the survival of infants born as early as 23-24 weeks of gestation, BPD still remains a common complication of extreme prematurity, and there is no specific treatment for it. Furthermore, children, adolescents, and adults who were born very preterm and developed BPD have an increased risk of persistent lung dysfunction, including early-onset emphysema. Therefore, it is possible that early-life pulmonary insults, such as extreme prematurity and BPD, may increase the risk of COPD later in life, especially if exposed to secondary challenges such as respiratory infections and/or smoking. Recent advances in our understanding of stem/progenitor cells and their potential to repair damaged organs offer the possibility of cell-based treatments for neonatal and adult lung injuries. This paper summarizes the long-term pulmonary outcomes of preterm birth and BPD and discusses the recent advances of cell-based therapies for lung diseases, with a particular focus on BPD and COPD.
Pulmonary Medicine 01/2013; 2013:874161. DOI:10.1155/2013/874161
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