Litt Jonathan S, Minich Nori, Taylor H Gerry, Tiemeier Henning
Department of Neonatology, Beth Israel Deaconess Medical Center (JS Litt), Boston, Mass; Department of Pediatrics, Harvard Medical School (JS Litt), Boston, Mass; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health (JS Litt and H Tiemeier), Boston, Mass.
Department of Pediatrics, Case Western Reserve University School of Medicine (N Minich and HG Taylor), Cleveland, Ohio.
Acad Pediatr. 2020 Sep-Oct;20(7):975-982. doi: 10.1016/j.acap.2020.05.010. Epub 2020 May 21.
Extremely low birth weight (ELBW; <1000 g) infants are at risk for both asthma and problems like inattention, hyperactivity, anxiety, and depression. Asthma predicts behavioral and emotional problems in term-born children. The nature of these associations is poorly understood. We tested 3 models of association: independent risk, mediation, and effect modification to explore interplay among birth weight, asthma, and behavioral and emotional problems.
We used data from a prospective cohort of ELBW infants born 1992 to 1995. Exposure was ELBW; primary outcomes were parent-reported diagnosis of asthma and symptoms of inattention, hyperactivity, anxiety, and depression at age 8 years. Covariates included child sex and maternal socioeconomic status.
There were 139 ELBW and 101 normal BW (>2500 g) children followed to 8 years. ELBW children were more likely to have asthma (35.7% vs 14.4%, P < .05). Inattention, hyperactivity, depression, and anxiety scores were higher among ELBW children and children with asthma. ELBW was a common cause of asthma and anxiety. There was no evidence of mediation or effect modification by asthma on the effect of ELBW on behavior and emotion symptoms.
Asthma does not underlie or amplify the effect of ELBW on behavioral and emotional problems at school age, suggesting that increased risk for respiratory morbidity and neurodevelopment represent largely independent consequences of developmental vulnerability related to ELBW. Noting the impact of chronic illnesses on neurodevelopment in other populations, data focused on symptom trajectories over time in a larger cohort may be necessary to shed further light onto this question.
极低出生体重（ELBW；<1000克）婴儿有患哮喘以及注意力不集中、多动、焦虑和抑郁等问题的风险。哮喘可预测足月儿的行为和情绪问题。这些关联的本质尚不清楚。我们测试了3种关联模型：独立风险、中介作用和效应修正，以探讨出生体重、哮喘与行为和情绪问题之间的相互作用。
我们使用了1992年至1995年出生的ELBW婴儿前瞻性队列的数据。暴露因素为ELBW；主要结局为家长报告的8岁时哮喘诊断以及注意力不集中、多动、焦虑和抑郁症状。协变量包括儿童性别和母亲的社会经济地位。
共有139名ELBW儿童和101名正常体重（>2500克）儿童随访至8岁。ELBW儿童患哮喘的可能性更高（35.7%对14.4%，P<.05）。ELBW儿童和患哮喘儿童的注意力不集中、多动、抑郁和焦虑评分更高。ELBW是哮喘和焦虑的常见病因。没有证据表明哮喘对ELBW对行为和情绪症状的影响有中介作用或效应修正作用。
哮喘并非ELBW对学龄期行为和情绪问题产生影响的基础或放大因素，这表明呼吸疾病发病率增加和神经发育风险在很大程度上是与ELBW相关的发育脆弱性的独立后果。鉴于慢性病对其他人群神经发育的影响，可能需要在更大队列中关注症状随时间的轨迹数据，以进一步阐明这个问题。
