Aspberg Sara, Dahlquist Gisela, Kahan Thomas, Källén Bengt
Division of Internal Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Pediatr Allergy Immunol. 2007 Jun;18(4):313-9. doi: 10.1111/j.1399-3038.2006.00518.x. Epub 2007 Mar 7.
This population-based register study examined if factors during the fetal and neonatal period influence the risk for the child to develop bronchial asthma (asthma). From the Swedish Hospital Discharge Register we identified children, born between 1987 and 1999, who had been hospitalized for asthma up to 2001. Thus, the outcome measure contains only hospitalized cases, not all children with asthma. Children younger than 2 yr at admission were excluded because of the uncertainty about the diagnosis of asthma in younger children. The remaining 14,803 children were compared with all children born the same years, recorded in the Swedish Medical Birth Registry, for information on pre- and perinatal characteristics. Odds ratios (ORs) were calculated with Mantel-Haenszel technique and 95% confidence intervals (CIs) with Miettinen's test-based method. The presence of various maternal and neonatal confounders were identified and adjusted for in the analyses. The association between some known factors and childhood asthma were confirmed: young maternal age, maternal smoking, period of unwanted childlessness, low maternal level of education, maternal diabetes, preterm birth, low birth weight, small-for-gestational age, caesarean section, and instrumental vaginal delivery. A number of neonatal characteristics were shown to be independent risk factors: sepsis or pneumonia, neonatal respiratory problems and treatments, neonatal icterus, and/or neonatal phototherapy. The association with icterus and phototherapy remained after exclusion of cases showing other neonatal risk factors and after adjustment for maternal factors (OR 1.27, 95% CI: 1.08-1.50), and increased to 1.5 if the children had been hospitalized for asthma more than once. In conclusion, our results suggest an association between neonatal icterus and/or treatment with neonatal phototherapy and hospitalized childhood asthma. This association needs further exploration.
这项基于人群的登记研究调查了胎儿期和新生儿期的因素是否会影响儿童患支气管哮喘（哮喘）的风险。我们从瑞典医院出院登记处确定了1987年至1999年出生、截至2001年因哮喘住院的儿童。因此，结果指标仅包括住院病例，而非所有哮喘儿童。入院时年龄小于2岁的儿童因幼儿哮喘诊断的不确定性而被排除。将其余14803名儿童与瑞典医学出生登记处记录的同年出生的所有儿童进行比较，以获取围产期和出生前特征的信息。采用Mantel-Haenszel技术计算比值比（OR），采用基于Miettinen检验的方法计算95%置信区间（CI）。在分析中识别并调整了各种母亲和新生儿混杂因素。一些已知因素与儿童哮喘之间的关联得到了证实：母亲年龄小、母亲吸烟、意外无子女期、母亲教育水平低、母亲糖尿病、早产、低出生体重、小于胎龄儿、剖宫产和器械助产阴道分娩。一些新生儿特征被证明是独立的危险因素：败血症或肺炎、新生儿呼吸问题及治疗、新生儿黄疸和/或新生儿光疗。排除显示其他新生儿危险因素的病例并调整母亲因素后，黄疸和光疗的关联仍然存在（OR 1.27，95%CI：1.08-1.50），如果儿童因哮喘住院不止一次，该关联增加至1.5。总之，我们的结果表明新生儿黄疸和/或新生儿光疗与儿童哮喘住院之间存在关联。这种关联需要进一步探究。
