Neonatal chronic lung disease, oxygen dependency, and a family history of asthma

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.

Effects of birthweight and oxygen supplementation on lung function in late childhood in children of very low birth weight

“…To enable log transformation of zero days, one day was added to each of the scores for days on oxygen and IPPV. 27 The nonlinear relationship between FEV 1 and oxygen was modeled, using a power function of the form…”

“…Some studies have suggested that a family history of asthma predisposes to BPD 32 or that maternal bronchial hyperresponsiveness (BHR) predisposes to premature birth. 11 Hagan et al 27 recently reported that a family history of asthma increased the risk of, but did not directly cause, BPD. Wheezing itself did not contribute significantly to the variance of the expiratory flow measurements in this study, and this apparent dichotomy is probably due to the label of asthma being applied at the more symptomatic end of the wheezing range.…”

Recurrent wheezing in very preterm infants.

“…We also had clear evidence of an incremental increase in risk when both parents reported symptoms of bronchial hyperreactivity and this effect persisted after controlling for all confounding variables in our logistic regression analysis. Some authors have postulated that familial bronchial hyperresponsiveness might be a risk factor for idiopathic preterm labour and chronic lung disease postnatally.31 32 This correlation with neonatal chronic lung disease may relate to an increase in severity in the disease in those infants with a family history of bronchial hyperresponsiveness5 7 rather than an increase in the prevalence.…”

Neonatal epithelial hypoxia inducible factor-1α expression regulates the response of the lung to experimental asthma

“…In fact, small molecule-induced stimulation of the HIF-1 signaling cascade during hyperoxia can alleviate some of the structural deficits induced by neonatal hyperoxia exposure (2). Clinicians, therefore, might explore the relationship between oxygenation, HIF-1␣-mediated changes in inflammation, and susceptibility to chronic lung disease in preterm infants (15,33). It should be noted that the link between preterm birth and changes in allergeninduced inflammation might only be beneficial in certain conditions.…”