Prematurity, chorioamnionitis, and the development of recurrent wheezing: A prospective birth cohort study
Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways. To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurr...
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| Published in | Journal of allergy and clinical immunology Vol. 121; no. 4; pp. 878 - 884.e6 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Mosby, Inc
01.04.2008
Elsevier Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways.
To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing.
The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 ± 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (≥2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (<33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis.
Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema.
We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects. |
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| AbstractList | Prematurity (< 37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways.BACKGROUNDPrematurity (< 37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways.To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing.OBJECTIVETo investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing.The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 +/- 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (> or =2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (< 33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis.METHODSThe Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 +/- 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (> or =2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (< 33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis.Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema.RESULTSPrematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema.We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects.CONCLUSIONWe found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects. Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways. To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing. The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 ± 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (≥2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (<33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis. Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema. We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects. Background: Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways. Objective: To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing. Methods: The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 - 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (?2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (<33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis. Results: Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema. Conclusion: We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects. Prematurity (< 37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways. To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing. The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 +/- 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (> or =2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (< 33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis. Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema. We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects. Background: Prematurity (<37 weeks) has been inconsistently Background Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in infants' airways. Objective To investigate the relationship of prematurity and chorioamnionitis with the development of early childhood recurrent wheezing. Methods The Boston Birth Cohort (n = 1096) were followed prospectively from birth to a mean age of 2.2 ± 2 years. Perinatal and postnatal clinical data and placental pathology were collected. The primary outcome was recurrent wheezing (≥2 physician documented episodes). Secondary outcomes included physician-diagnosed asthma, food allergy, and eczema. Preterm children were grouped by gestational age into moderately (33-36.9 weeks) and very preterm (<33 weeks) with and without chorioamnionitis, and compared with term children without chorioamnionitis (reference group). Chorioamnionitis was diagnosed either by intrapartum fever or by placental histology findings. Logistic regression models were performed to investigate the independent and joint associations of degree of prematurity and chorioamnionitis. Results Prematurity was associated with recurrent wheezing (odds ratio [OR], 1.7; 95% CI, 1.2-2.6). However, when subjects were grouped by degree of prematurity with or without chorioamnionitis, the highest risk of wheezing (OR, 4.0; 95% CI, 2.0-8.0) and physician-diagnosed asthma (OR, 4.4; 95% CI, 2.2-8.7) was present in the very preterm children with chorioamnionitis. The effect on both wheezing (OR, 5.4; 95% CI, 2.4-12.0) and asthma (OR, 5.2; 95% CI, 2.3-11.9) was greater in African Americans. Neither prematurity nor chorioamnionitis was associated with food allergy or eczema. Conclusion We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects. |
| Author | Yu, Yunxian Pearson, Colleen Kumar, Rajesh Story, Rachel E. Gupta, Ruchi Pongracic, Jacqueline A. Ortiz, Kathryn Wang, Xiaobin Bauchner, Howard C. |
| AuthorAffiliation | 2 The Mary Ann and J. Milburn Smith Child Health Research Program, Children’s Memorial Hospital and Children’s Memorial Research Center,Chicago, IL 3 Department of Pediatrics, Boston University School of Medicine, and Boston Medical Center 1 Division of Allergy, Children’s Memorial Hospital,Chicago, IL |
| AuthorAffiliation_xml | – name: 2 The Mary Ann and J. Milburn Smith Child Health Research Program, Children’s Memorial Hospital and Children’s Memorial Research Center,Chicago, IL – name: 3 Department of Pediatrics, Boston University School of Medicine, and Boston Medical Center – name: 1 Division of Allergy, Children’s Memorial Hospital,Chicago, IL |
| Author_xml | – sequence: 1 givenname: Rajesh surname: Kumar fullname: Kumar, Rajesh email: rkumar@childrensmemorial.org organization: Division of Allergy, Children's Memorial Hospital, Chicago, Ill – sequence: 2 givenname: Yunxian surname: Yu fullname: Yu, Yunxian organization: Mary Ann and J. Milburn Smith Child Health Research Program, Children's Memorial Hospital and Children's Memorial Research Center, Chicago, Ill – sequence: 3 givenname: Rachel E. surname: Story fullname: Story, Rachel E. organization: Division of Allergy, Children's Memorial Hospital, Chicago, Ill – sequence: 4 givenname: Jacqueline A. surname: Pongracic fullname: Pongracic, Jacqueline A. organization: Division of Allergy, Children's Memorial Hospital, Chicago, Ill – sequence: 5 givenname: Ruchi surname: Gupta fullname: Gupta, Ruchi organization: Mary Ann and J. Milburn Smith Child Health Research Program, Children's Memorial Hospital and Children's Memorial Research Center, Chicago, Ill – sequence: 6 givenname: Colleen surname: Pearson fullname: Pearson, Colleen organization: Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Mass – sequence: 7 givenname: Kathryn surname: Ortiz fullname: Ortiz, Kathryn organization: Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Mass – sequence: 8 givenname: Howard C. surname: Bauchner fullname: Bauchner, Howard C. organization: Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, Mass – sequence: 9 givenname: Xiaobin surname: Wang fullname: Wang, Xiaobin organization: Mary Ann and J. Milburn Smith Child Health Research Program, Children's Memorial Hospital and Children's Memorial Research Center, Chicago, Ill |
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| Copyright | 2008 American Academy of Allergy, Asthma & Immunology American Academy of Allergy, Asthma & Immunology 2008 INIST-CNRS Copyright Elsevier Limited Apr 2008 2009 Published by Mosby, Inc on behalf of American Academy of Allergy, Asthma and Immunology. 2009 |
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| Keywords | Chorioamnionitis prematurity OR IOM IRB BMC recurrent wheezing Odds ratio Boston Medical Center Institute of Medicine Institutional Review Board Immunopathology Relapse Pregnancy disorders Wheezing Placenta diseases Prospective Fetal diseases Immunology Prematurity Cohort study Delivery disorders Birth cohort |
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| Snippet | Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways in... Background Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory... Prematurity (< 37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory pathways... Background: Prematurity (<37 weeks) has been inconsistently associated with asthma and wheezing. Chorioamnionitis may promote both prematurity and inflammatory... Background: Prematurity (<37 weeks) has been inconsistently |
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| SubjectTerms | Age Allergy and Immunology Antibiotics Asthma Asthma - diagnosis Asthma - ethnology Asthma - etiology Biological and medical sciences Birth weight Black or African American Black People Blood Breastfeeding & lactation Child Child, Preschool Children & youth Chorioamnionitis Chorioamnionitis - diagnosis Chorioamnionitis - ethnology Chorioamnionitis - etiology Chorioamnionitis - pathology Cohort Studies Consent Diabetes Ethnicity Female Fever Follow-Up Studies Food allergies Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Immunopathology Infant Infant, Newborn Infant, Premature Inner city Male Medical sciences Pathology Pregnancy Premature birth prematurity Prospective Studies Recurrence recurrent wheezing Respiratory Sounds - diagnosis Respiratory Sounds - etiology Risk Assessment Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis Studies Ultrasonic imaging |
| Title | Prematurity, chorioamnionitis, and the development of recurrent wheezing: A prospective birth cohort study |
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