Variation in childhood asthma among former preterm infants.
OBJECTIVE
The role of in utero and perinatal exposures in modifying asthma risk among children born prematurely was assessed. Study design Former preterm children (n=251) were identified from a birth cohort. Examinations, including lung function testing, were performed at ages 8 to 11 years. Perinatal exposures were ascertained from neonatal medical records.


RESULTS
Univariate predictors of asthma included male gender, African American ethnicity, maternal asthma, and birth weight. Asthmatics were less likely to have been small for gestational age (SGA) than nonasthmatics (12.4% vs 22.7%, P=.04) and had more neonatal pulmonary disease. After adjusting for maternal asthma and demographic factors, asthma was associated with chronic lung disease of infancy, neonatal mechanical ventilation and corticosteroid use, and a higher childhood body mass index. Children who were septic postbirth and girls who were SGA were less likely to have asthma (OR for sepsis, 0.2; 95% CI, 0.1-0.6; OR for girls who were SGA compared with girls who were not SGA, 0.05; CI, 0.01-0.34).


CONCLUSIONS
Among premature children, female SGA status and neonatal sepsis appear protective relative to the development of childhood asthma. Differential susceptibility to asthma among preterm children may relate to exposures that operate in the in utero and early postnatal environment to accelerate lung development, alter innate immunity, or both.
Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
Jonathan
J
Grischkan
Amy
A
Storfer-Isser
Carol L
CL
Rosen
Emma K
EK
Larkin
H Lester
HL
Kirchner
Andrew
A
South
Deanne C
DC
Wilson-Costello
Richard J
RJ
Martin
Susan
S
Redline
D001249:Asthma / Q000453:epidemiology* / Q000503:physiopathology; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D015995:Prevalence; D012121:Respiration, Artificial; D012307:Risk Factors
D005938:Glucocorticoids