Prenatal determinants of neonatal lung function in high-risk newborns

Bisgaard, Hans; Loland, Lotte; Holst, Klaus K.; Pipper, Christian Bressen

doi:10.1016/j.jaci.2008.11.036

Cited by 68 publications

(69 citation statements)

References 42 publications

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“…Each factor was added separately to the model to investigate its influence on the association. We made a distinction between possible confounding factors (sex, season of birth, siblings, breast feeding, daycare, maternal allergy, ethnicity, educational level and study year, as strains of RSV may differ in virulence between years [18][19][20]) and factors that may be in the causal chain, for example birth weight and maternal smoking [21]. We studied the effect of those intermediates in order to understand whether they explain the association between neonatal lung function and RSV hospitalisation for preventive purposes.…”

Section: Discussionmentioning

confidence: 99%

Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

Zomer-Kooijker

Uiterwaal

Gugten

et al. 2014

European Respiratory Journal

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It is unknown why respiratory syncytial virus (RSV) causes mild disease in some children and severe disease, requiring hospitalisation, in others. We aimed to assess whether diminished premorbid lung function in healthy term infants predisposes to hospitalisation during RSV bronchiolitis, and to post-RSV wheeze.In a prospective birth cohort study of unselected term healthy children, neonatal lung function was measured before the age of 2 months (n52133). From birth through the first year of life, respiratory symptoms were recorded in a diary, and general practitioner consultations and hospitalisations were documented. In a subgroup (n5417) repeated nose and throat swabs were collected for PCR to detect RSV infections.Median neonatal respiratory system compliance (Crs) was significantly lower (41.2 versus 47.4 mL?kPa -1 , p50.03) and resistance (Rrs) was higher (8.2 versus 6.3 kPa?s?L -1 , p50.10) in hospitalised RSV patients (n518) compared with nonhospitalised RSV-positive infants (n584). Every 10 mL?kPa -1 increase in Crs was associated with 55% less post-RSV wheeze (OR 0.56, 95% CI 0.35-0.90), and each kPa?s?L -1 increase in Rrs was associated with 42% more post-RSV wheeze, which was only marginally explained by pre-RSV wheeze or severity of the RSV disease.This unselected birth cohort study shows for the first time that decreased lung function at birth predisposes to severe RSV disease, and to post-RSV wheeze. @ERSpublications Impaired neonatal lung function precedes a severe course of RSV infection in unselected children

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Section: Discussionmentioning

confidence: 99%

Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

Zomer-Kooijker

Uiterwaal

Gugten

et al. 2014

European Respiratory Journal

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“…The best studies in the context of asthma and allergic disease focus on cigarette smoke and other respiratory pollutants such as diesel exhaust. Cigarette smoke has recognised adverse effects in pregnancy, including effects on fetal lung growth [77] and immune development [23], with increased risk of early-onset wheezing and reduced lung function in childhood [78,79]. New studies indicate that children exposed to maternal tobacco smoke in utero may have epigenetic effects, modifying fetal gene expression (through aberrant DNA methylation) [34].…”

Section: Pathways and Target Candidates For Prevention Strategiesmentioning

confidence: 99%

Strategies to Prevent or Reduce Allergic Disease

Prescott

Nowak‐Węgrzyn

2011

Ann Nutr Metab

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The need for allergy prevention strategies has never been greater. Surging rates of food allergy and eczema are now adding to the already substantial burden of asthma and respiratory allergic diseases. The parallel rise in many other immune diseases suggests that the developing immune system is highly vulnerable to modern environmental changes. These strong environmental pressures may be one reason why simple allergen avoidance strategies have not been successful. Another more recent strategy to curtail the allergy epidemic has been to identify factors associated with modern lifestyle that may be causally linked with allergic disease, in an attempt to restore more favourable conditions for immune tolerance during early development. More hygienic conditions and disruption of microbial exposure have prompted strategies to restore this balance using probiotic and prebiotic supplements. Modern dietary changes linked with allergic diseases have prompted supplementation studies to assess the preventive merits of specific immunomodulatory dietary nutrients such as polyunsaturated fatty acids. Other nutrients such as antioxidants, folate, and vitamin D are also currently under investigation. Modern environmental pollutants have also been associated with adverse effects on immune development and the risk of disease. While many of these avenues have provided some promise, they have not yet translated into specific recommendations. Current evidence-based guidelines for allergy prevention remain limited to avoidance of cigarette smoke, promotion of breastfeeding and the use of hydrolysed formula when breastfeeding is not possible. Allergen avoidance strategies have been largely removed from most guidelines. It is hoped that a number of ongoing studies will help provide clearer recommendations around the use of probiotics, prebiotics, specific dietary nutrients and the role of early introduction of allergenic foods for the promotion of tolerance. Despite the current uncertainties, prevention remains the best long-term strategy to reduce the growing burden of allergic disease.

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“…19,[24][25][26] A total of 356 (183 girls and 173 boys) had complete clinical follow-up for the first 3 years of life. Reasons for withdrawal included death from sudden infant death syndrome (1 infant), family moved, refusal by parents to continue in the study, or missing a scheduled visit.…”

Section: Descriptive Statisticsmentioning

confidence: 99%