Prematurity, chorioamnionitis, and the development of recurrent wheezing: A prospective birth cohort study

Kumar, Rajesh; Yu, Yunxian; Story, Rachel E.; Pongracic, Jacqueline A.; Gupta, Ruchi S.; Pearson, Colleen; Ortiz, Katherin; Bauchner, Howard; Wang, Xiaobin

doi:10.1016/j.jaci.2008.01.030

Cited by 128 publications

(89 citation statements)

References 42 publications

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“…[16][17][18][19][20][21][22] Mechanistically, it has been proposed that chorioamnionitis, because of the associated proinflammatory state and heightened immune response, might play a role in asthma development for infants born preterm. 20,29 The few studies of late prematurity and the development of asthma showed mixed results. Using survey data from a nationally representative sample, Abe et al 24 did not find an association with late-preterm birth when asthma was assessed on the basis of caregiver reports.…”

Section: Discussionmentioning

confidence: 99%

“…An association between extreme preterm birth and chronic respiratory morbidity, including asthma, has been established. [16][17][18][19][20][21][22] However, most studies of late prematurity and respiratory morbidity have focused on short-term outcomes, such as respiratory distress syndrome, transient tachypnea of the newborn, and transfer to the NICU for mechanical ventilation. 3,4,10,23 Few studies have focused on the impact of late prematurity on longterm respiratory outcomes, such as the development of asthma.…”

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confidence: 99%

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Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

2011

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OBJECTIVE: To evaluate the association of late-preterm birth with asthma severity among young children. METHODS: A retrospective cohort study was performed with electronic health record data from 31 practices affiliated with an academic medical center. Participants included children born in 2007 at 34 to 42 weeks of gestation and monitored from birth to 18 months. We used multivariate logistic or Poisson models to assess the impact of late-preterm (34–36 weeks) and low-normal (37–38 weeks) compared with term (39–42 weeks) gestation on diagnoses of asthma and persistent asthma, inhaled corticosteroid use, and numbers of acute respiratory visits. RESULTS: Our population included 7925 infants (7% late-preterm and 21% low-normal gestation). Overall, 8.3% had been diagnosed with asthma by 18 months. Compared with term gestation, late-preterm gestation was associated with significant increases in persistent asthma diagnoses (adjusted odds ratio [aOR]: 1.68), inhaled corticosteroid use (aOR: 1.66), and numbers of acute respiratory visits (incidence rate ratio: 1.44). Low-normal gestation was associated with increases in asthma diagnoses (aOR: 1.34) and inhaled corticosteroid use (aOR: 1.39). CONCLUSION: Birth at late-preterm and low-normal gestational ages might be an important risk factor for the development of asthma and for increased health service use in early childhood.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

2011

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“…54,55 In a trial of postnatal hydrocortisone, chorioamnionitis was not associated with changes in the use of supplemental oxygen, bronchodilators or steroids at 18 to 22 months. 54 However, Kumar et al 55 recently reported an association between chorioamnionitis and both recurrent wheezing and physician-diagnosed asthma. This suggests that intrauterine exposure to inflammation may indeed have long-term adverse respiratory effects.…”

Section: Lungsmentioning

confidence: 99%

Chorioamnionitis: a multiorgan disease of the fetus?

et al. 2010

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The bacterial infection of chorion and amnion is a common finding in premature delivery and is referred to as chorioamnionitis. As the mother rarely shows symptoms of a systemic inflammation, the course of chorioamnionitis is frequently asymptomatic and chronic. In contrast, the fetal inflammatory response syndrome represents a separate phenomenon, including umbilical inflammation and increased serum levels of proinflammatory cytokines in the fetus. Ascending maternal infections frequently lead to systemic fetal inflammatory reaction. Clinical studies have shown that antenatal exposure to inflammation puts the extremely immature neonates at a high risk for worsening pulmonary, neurological and other organ development. Interestingly, the presence of chorioamnionitis is associated with a lower rate of neonatal mortality in extremely immature newborns. In the following review, the pathogeneses of inflammation-associated perinatal morbidity are outlined. The concept of fetal multiorganic disease during intrauterine infection is introduced and discussed.

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“…Mast cells in the lower airways contribute to the development of asthma and allergic diseases (26). Mast cells are of interest because of a possible relation between chorioamnionitis, preterm birth, and the development of asthma later in life (27,28). Mast cell activation results in degranulation, leading to the rapid release of inflammatory mediators, such as histamine, proteoglycans, and cytokines, which stimulate the recruitment of other inflammatory cells (29).…”

Section: Effects Of Lps As Gestation Advancesmentioning

confidence: 99%

Effects of intra-amniotic lipopolysaccharide exposure on the fetal lamb lung as gestation advances

et al. 2014

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Background: Intra-amniotic lipopolysaccharide (LPS) exposure may affect neonatal outcome by altering fetal lung and immune system development. We hypothesized that intra-amniotic LPS exposure would cause persistent fetal pulmonary responses as the lungs develop in utero. Methods: Fetal lambs were exposed to intra-amniotic LPS at 118 or at 118 and 123 d of gestational age (GA) with delivery at 125, 133, or 140 d (term = 147 d). Immune responses, PU.1 expression, toll-like receptor (tLR)-1,2,4,6 mRNA levels, mast cell levels, and pulmonary elastin deposition were evaluated. results: After a single dose of LPS, pulmonary inflammatory responses were observed with increases of (i) PU.1 and tLR1 at 125 d GA and (ii) monocytes, lymphocytes, tLR2, and tLR6 at 133 d GA. Repetitive LPS exposure resulted in (i) increases of neutrophils, monocytes, PU.1, and tLR1 at 125 d GA; (ii) increases of neutrophils, PU.1, and tLR2 at 133 d GA; and (iii) decreases of mast cells, elastin foci, tLR4, and tLR6 at early gestation. At 140 d GA, only PU.1 was increased after repetitive LPS exposure. conclusion: The preterm fetal lung can respond to a single exposure or repeated exposures from intra-amniotic LPS in multiple ways, but the absence of inflammatory and structural changes in LPS-exposed fetuses delivered near term suggest that the fetus can resolve an inflammatory stimulus in utero with time.

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Prematurity, chorioamnionitis, and the development of recurrent wheezing: A prospective birth cohort study

Abstract: We found a strong joint effect of prematurity and chorioamnionitis on early childhood wheezing. This effect was stronger in African American subjects.

Cited by 128 publications

References 42 publications

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

Chorioamnionitis: a multiorgan disease of the fetus?

Effects of intra-amniotic lipopolysaccharide exposure on the fetal lamb lung as gestation advances

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