Paediatric Pneumology Unit, University Clinic Hospital, University of Valencia, Av Blasco Ibáñez, 17, 46010, Valencia, Spain.
, Valencia, Spain.
Eur J Pediatr. 2019 Jul;178(7):973-982. doi: 10.1007/s00431-019-03372-1. Epub 2019 Apr 18.
Little is known about respiratory morbidity and asthma risk in preterm infants (PTIs) with a gestational age (GA) over 32 weeks. This was a prospective study carried out from birth to 7-8 years, comparing two groups: (a) PTIs (GAs 32 weeks + 1 day to 35 weeks + 0 days, without comorbidities) and (b) full-term infants (FTIs; GA ≥ 37 weeks). Risk and protective factors for bronchiolitis and asthma were identified. A total of 232 children (116/group) were included. Sixty-six (56.9%) PTIs and 43 (37.1%) FTIs presented bronchiolitis (p = 0.002). Recurrent wheezing was 52 (44.8%) on PTIs versus 36 (31.0%) on FTIs (p = 0.03). Asthma at school aged was 27 (23.3%) on PTIs and 8 (6.9%) on FTIs (p = 0.020). Asthma risk factors were only detected in group A.Conclusion: PTIs had a higher prevalence of bronchiolitis, recurrent wheezing and asthma; risk factors for asthma are the following: older siblings, allergic father, atopic dermatitis and antibiotic treatment in the first 3 years of life and prematurity itself, which also acted as protective factor for atopic dermatitis. What is known: • In recent decades, there has been a significant increase in the birth of premature babies and consequently, also in the pathologies secondary to the prematurity: a greater number of complications and disorders related to the development and maturation of many organs and systems, especially the respiratory system. Several studies, especially in full-term infants and very preterm infants, have tried to elucidate the risk factors that may influence the development of persistent or chronic respiratory problems such asasthma, but little is known about the aetiology of these disorders in the late or moderate preterm infants. Inthis group of children, the role played by certain factors (early use of antibiotics, chorioamnionitis, smokeexposure, paternal asthma, etc.) on late respiratory morbidity, or asthma, is inconclusive. • Moderate-to-late preterm infants are more predisposed to developing recurrent wheezing/asthma and should adopt control measures. What is new: • Our work provides data related to little-understood aspects of respiratory diseases in this group of late or moderate preterm infants (gestational age between 32 weeks plus 1 day and 35 weeks plus 0 days), by monitoring their evolution from birth to 7-8 years of age, compared with another group of full-term newborns. We aimed to establish the prevalence of bronchiolitis and recurrent wheezing in these children during their first years of life. • The prevalence of school-aged asthma and the risk factors for contracting it were also investigated.
关于胎龄（GA）超过 32 周的早产儿（PTI）的呼吸发病率和哮喘风险知之甚少。这是一项从出生到 7-8 岁的前瞻性研究，比较了两组：（a）PTI（GA 32 周+1 天至 35 周+0 天，无合并症）和（b）足月婴儿（FTI；GA≥37 周）。确定了细支气管炎和哮喘的风险和保护因素。共有 232 名儿童（每组 116 名）被纳入研究。66 名（56.9%）PTI 和 43 名（37.1%）FTI 出现细支气管炎（p=0.002）。PTI 组反复喘息为 52 例（44.8%），FTI 组为 36 例（31.0%）（p=0.03）。PTI 组在校年龄哮喘为 27 例（23.3%），FTI 组为 8 例（6.9%）（p=0.020）。仅在 A 组中检测到哮喘的危险因素。结论：PTI 更易患细支气管炎、反复喘息和哮喘；哮喘的危险因素为：年长的兄弟姐妹、有过敏史的父亲、特应性皮炎和 3 岁前的抗生素治疗以及早产本身，早产本身也可作为特应性皮炎的保护因素。已知信息：• 近几十年来，早产儿的出生率显著增加，因此，早产儿相关的疾病也有所增加：更多与许多器官和系统发育和成熟相关的并发症和疾病，尤其是呼吸系统。许多研究，尤其是在足月婴儿和极早产儿中，试图阐明可能影响持续性或慢性呼吸问题（如哮喘）发展的危险因素，但关于晚期或中度早产儿的这些疾病的病因知之甚少。在这组儿童中，某些因素（早期使用抗生素、绒毛膜羊膜炎、吸烟暴露、父亲哮喘等）在晚期呼吸发病率或哮喘中的作用尚无定论。• 中晚期早产儿更容易出现反复喘息/哮喘，应采取控制措施。新发现：• 通过监测其从出生到 7-8 岁的发育情况，我们为这组晚期或中度早产儿（胎龄为 32 周加 1 天至 35 周加 0 天）的呼吸系统疾病的一些尚未充分了解的方面提供了相关数据，并与另一组足月新生儿进行了比较。我们旨在确定这些儿童在其生命的最初几年中患细支气管炎和反复喘息的发生率。• 还调查了学龄期哮喘的发病率和发病风险因素。
