First name
Jessica
Middle name
L
Last name
Rice

Title

Daycare Attendance is Linked to Increased Risk of Respiratory Morbidities in Children Born Preterm with Bronchopulmonary Dysplasia.

Year of Publication

2022

Number of Pages

22-28.e1

Date Published

10/2022

ISSN Number

1097-6833

Abstract

OBJECTIVES: To test the hypothesis that daycare attendance among children with bronchopulmonary dysplasia (BPD) is associated with increased chronic respiratory symptoms and/or greater health care use for respiratory illnesses during the first 3 years of life.

STUDY DESIGN: Daycare attendance and clinical outcomes were obtained via standardized instruments for 341 subjects recruited from 9 BPD specialty clinics in the US. All subjects were former infants born preterm (<34 weeks) with BPD (71% severe) requiring outpatient follow-up between 0 and 3 years of age. Mixed logistic regression models were used to test for associations.

RESULTS: Children with BPD attending daycare were more likely to have emergency department visits and systemic steroid usage. Children in daycare up to 3 years of age also were more likely to report trouble breathing, having activity limitations, and using rescue medications when compared with children not in daycare. More severe manifestations were found in children attending daycare between 6 and 12 months of chronological age.

CONCLUSIONS: In this study, children born preterm with BPD who attend daycare were more likely to visit the emergency department, use systemic steroids, and have chronic respiratory symptoms compared with children not in daycare, indicating that daycare may be a potential modifiable risk factor to minimize respiratory morbidities in children with BPD during the preschool years.

DOI

10.1016/j.jpeds.2022.06.037

Alternate Title

J Pediatr

PMID

35803300

Title

Area deprivation and respiratory morbidities in children with bronchopulmonary dysplasia.

Year of Publication

2022

Number of Pages

2053-2059

Date Published

12/2022

ISSN Number

1099-0496

Abstract

INTRODUCTION: Infants and children diagnosed with bronchopulmonary dysplasia (BPD) have a higher likelihood of recurrent hospitalizations and asthma-like symptoms. Socio-environmental factors that influence the frequency and severity of pulmonary symptoms in these children during the preschool age are poorly understood. In this study, we used the Area Deprivation Index (ADI) to evaluate the relationship between the socio-environmental exposures in children with BPD and respiratory outcomes during the first few years of life.

METHODS: A registry of subjects recruited from outpatient BPD clinics at Johns Hopkins University (n = 909) and the Children's Hospital of Philadelphia (n = 125) between January 2008 and October 2021 was used. Subjects were separated into tertiles by ADI scores aggregated to ZIP codes. Caregiver questionnaires were used to assess the frequency of respiratory morbidities and acute care usage for respiratory symptoms.

RESULTS: The mean gestational age of subjects was 26.8 ± 2.6 weeks with a mean birthweight of 909 ± 404 g. The highest tertile (most deprived) of ADI was significantly associated with emergency department visits (aOR 1.72; p = 0.009), hospital readmissions (aOR 1.66; p = 0.030), and activity limitations (aOR 1.55; p = 0.048) compared to the lowest tertile. No association was seen with steroid, antibiotic or rescue medication use, trouble breathing, or nighttime symptoms.

CONCLUSION: In this study, children with BPD who lived in areas of higher deprivation were more likely to be rehospitalized and have ED visits for respiratory reasons. Identifying socio-environmental factors that contribute to adverse pulmonary outcomes in children with BPD may provide opportunities for earlier interventions to improve long-term pulmonary outcomes.

DOI

10.1002/ppul.25969

Alternate Title

Pediatr Pulmonol

PMID

35559602

Title

Area deprivation and respiratory morbidities in children with bronchopulmonary dysplasia.

Year of Publication

2022

Number of Pages

2053-2059

Date Published

12/2022

ISSN Number

1099-0496

Abstract

INTRODUCTION: Infants and children diagnosed with bronchopulmonary dysplasia (BPD) have a higher likelihood of recurrent hospitalizations and asthma-like symptoms. Socio-environmental factors that influence the frequency and severity of pulmonary symptoms in these children during the preschool age are poorly understood. In this study, we used the Area Deprivation Index (ADI) to evaluate the relationship between the socio-environmental exposures in children with BPD and respiratory outcomes during the first few years of life.

METHODS: A registry of subjects recruited from outpatient BPD clinics at Johns Hopkins University (n = 909) and the Children's Hospital of Philadelphia (n = 125) between January 2008 and October 2021 was used. Subjects were separated into tertiles by ADI scores aggregated to ZIP codes. Caregiver questionnaires were used to assess the frequency of respiratory morbidities and acute care usage for respiratory symptoms.

RESULTS: The mean gestational age of subjects was 26.8 ± 2.6 weeks with a mean birthweight of 909 ± 404 g. The highest tertile (most deprived) of ADI was significantly associated with emergency department visits (aOR 1.72; p = 0.009), hospital readmissions (aOR 1.66; p = 0.030), and activity limitations (aOR 1.55; p = 0.048) compared to the lowest tertile. No association was seen with steroid, antibiotic or rescue medication use, trouble breathing, or nighttime symptoms.

CONCLUSION: In this study, children with BPD who lived in areas of higher deprivation were more likely to be rehospitalized and have ED visits for respiratory reasons. Identifying socio-environmental factors that contribute to adverse pulmonary outcomes in children with BPD may provide opportunities for earlier interventions to improve long-term pulmonary outcomes.

DOI

10.1002/ppul.25969

Alternate Title

Pediatr Pulmonol

PMID

35559602

Title

Health-related quality of life of caregivers of children with congenital diaphragmatic hernia.

Year of Publication

2021

Number of Pages

1659-1665

Date Published

2021 06

ISSN Number

1099-0496

Abstract

<p><strong>OBJECTIVE: </strong>Congenital diaphragmatic hernia (CDH) is a congenital defect associated with significant mortality and morbidity. We sought to assess the health-related quality of life (HRQoL) for caregivers of infants/children with CDH and determine risk factors for poorer HRQoL.</p>

<p><strong>METHODS: </strong>Families were recruited from a CDH-specific outpatient clinic and HRQoL was assessed by a validated HRQoL instrument (PedsQLTM Family Impact Module) at several time points. Mixed models were used to identify demographic and clinical factors associated with worse HRQoL for caregivers.</p>

<p><strong>RESULTS: </strong>A total of 29 subjects were recruited at a mean age of 2.4 ± 2.3 years. In terms of defect size, 6.9% had a Type A, 37.9% a Type B, 31.0% a Type C, and 24.1% a Type D. The mean HRQoL score at the first encounter was 67.6 ± 18.3; scores are reported from 0 to 100 with higher scores representing the higher reported quality of life. Lower median household incomes (p = .021) and use of extracorporeal membrane oxygenation (p = .013) were associated with poorer HRQoL scores. The presence of respiratory symptoms decreased HRQoL for caregivers, including daytime symptoms (p &lt; .001) and nighttime symptoms (p &lt; .001). While emergency department visits were not associated with a decrease in HRQoL, hospital admissions (p = .002), and reoperations for CDH (p &lt; .001) were.</p>

<p><strong>CONCLUSION: </strong>Our study found a reduced quality of life associated with socioeconomic factors and severity of ongoing disease. Further study is needed to confirm these findings and identify strategies for aiding families cope with the chronicity of this congenital disease.</p>

DOI

10.1002/ppul.25339

Alternate Title

Pediatr Pulmonol

PMID

33634600

Title

The feasibility of an air purifier and secondhand smoke education intervention in homes of inner city pregnant women and infants living with a smoker.

Year of Publication

2018

Number of Pages

524-530

Date Published

2018 01

ISSN Number

1096-0953

Abstract

<p><strong>OBJECTIVES: </strong>Secondhand smoke (SHS) and other air pollutants adversely affect the health of pregnant women and infants. A feasibility study aimed at reducing air pollution in homes of pregnant women or infants living with a smoker was completed.</p>

<p><strong>METHODS: </strong>In collaboration with the Baltimore City Health Department, women ≥ 18 years of age and either pregnant nonsmokers, or post-partum (any smoking status) with an infant age 0-12 months were recruited. Homes had at least one smoker. Intervention included two air purifiers and secondhand smoke education. Outcomes included feasibility, change in fine particulate matter (PM), air nicotine, and salivary cotinine pre- and post-intervention.</p>

<p><strong>RESULTS: </strong>Fifty women were enrolled (mean age 27 years, 92% African American, 71% single, 94% Medicaid eligible, 34% reported smoking) and 86% completed the study. Of the 50 women, 32 had infants and 18 were pregnant at time of enrollment. Post- intervention, 70% of participants reported smokers were less likely to smoke indoors, and 77% had at least one air purifier turned on at the final visit. Participant satisfaction was high (91%) and 98% would recommend air purifiers. Indoor PM was significantly decreased (P &lt; 0.001). Salivary cotinine was significantly decreased for non-smoking women (P &lt; 0.01) but not infants, and no significant change in air nicotine occurred (P = 0.6).</p>

<p><strong>CONCLUSIONS: </strong>Air purifiers with SHS education is a feasible intervention in homes of women and infants. These data demonstrate reduction in indoor PM and salivary cotinine in non-smoking adults. Air purifiers are not an alternative for smoking cessation and a home/ car smoking ban. Smoking cessation should be strongly encouraged for all pregnant women, and nonsmoking mothers with infants should be counseled to completely avoid SHS exposure. This study provides support for a future intervention evaluating clinical endpoints.</p>

DOI

10.1016/j.envres.2017.10.020

Alternate Title

Environ Res

PMID

29089103

Title

Influences of environmental exposures on preterm lung disease.

Year of Publication

2021

Number of Pages

1271-1279

Date Published

2021 10

ISSN Number

1747-6356

Abstract

<p>Introduction: Environmental factors play a critical role in the progression or resolution of chronic respiratory diseases. However, studies are limited on the impact of environmental risk factors on individuals born prematurely with lung disease after they leave the neonatal intensive care unit and are discharged into the home environment. Areas covered: In this review, we cover current knowledge of environmental exposures that impact outcomes of preterm respiratory disease, including air pollution, infections, and disparities. The limited data do suggest that certain exposures should be avoided and there are potential preventative strategies for other exposures. There is a need for additional research outside the neonatal intensive care unit that focuses on individual and community-level factors that affect long-term outcomes. Expert opinion: Preterm respiratory disease can impose a significant burden on infants, children, and young adults born prematurely, but may improve for many individuals over time. In this review, we outline the exposures that may potentially hasten, delay, or prevent resolution of lung injury in preterm children.</p>

DOI

10.1080/17476348.2021.1941886

Alternate Title

Expert Rev Respir Med

PMID

34114906

Title

Mortality in Outpatients with Bronchopulmonary Dysplasia.

Year of Publication

2021

Date Published

2021 Oct 06

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVES: </strong>To study the demographic and clinical characteristics of preterm infants with bronchopulmonary dysplasia (BPD) to identify the factors most strongly predictive of outpatient mortality, with the goal of identifying those individuals at greatest risk.</p>

<p><strong>STUDY DESIGN: </strong>Demographic and clinical characteristics were retrospectively reviewed for 862 subjects recruited from an outpatient BPD clinic. Characteristics of the deceased and living participants were compared using nonparametric analysis. Regression analysis was performed to identify factors associated with mortality.</p>

<p><strong>RESULTS: </strong>Of the 862 subjects, 13 (1.5%) died during follow-up, for an overall mortality rate of approximately 15.1 deaths per 1000 subjects. Two patients died in the postneonatal period (annual mortality incidence, 369.9 per 100 000), 9 died between age 1 and 4&nbsp;years (annual mortality incidence, 310.2 per 100 000), and 2 died between age of 5 and 14&nbsp;years (annual mortality incidence, 71.4 per 100 000). After adjusting for gestational age and BPD severity, mortality was found to be associated with the amount of supplemental oxygen required at discharge from the neonatal intensive care unit (adjusted hazard ratio [aHR], 4.10; P&nbsp;=&nbsp;.001), presence of a gastrostomy tube (aHR, 8.13; P&nbsp;=&nbsp;.012), and presence of a cerebrospinal fluid (CSF) shunt (aHR, 4.31; P&nbsp;=&nbsp;.021).</p>

<p><strong>CONCLUSIONS: </strong>The incidence of mortality among preterm infants with BPD is substantially higher than that seen in the general population. The need for greater amounts of home supplemental oxygen and the presence of a gastrostomy tube or CSF shunt were associated with an increased risk of postdischarge mortality. Future studies should focus on clarifying risk factors for the development of severe disease to allow for early identification and treatment of those at highest risk.</p>

DOI

10.1016/j.jpeds.2021.09.055

Alternate Title

J Pediatr

PMID

34624317

Title

Impact of road proximity on infants and children with bronchopulmonary dysplasia.

Year of Publication

2020

Number of Pages

369-375

Date Published

2020 02

ISSN Number

1099-0496

Abstract

<p><strong>INTRODUCTION: </strong>Infants born prematurely are at high risk for morbidities, including lung disease (bronchopulmonary dysplasia [BPD]). Little is known regarding environmental factors that can impact outcomes in BPD. We sought to assess the role of traffic-related air pollution (TRAP) on respiratory outcomes in BPD.</p>

<p><strong>METHODS: </strong>A total of 784 subjects were included from the Johns Hopkins BPD clinic. Caregivers completed questionnaires on environmental exposures and respiratory outcomes (acute care use and chronic symptoms). Distance to the nearest major roadway was derived from subjects' geocoded residential addresses.</p>

<p><strong>RESULTS: </strong>Approximately half of the subjects (53.8%) lived within 500 m of a major roadway. Subjects who lived within 500 m of a major roadway were more likely to be non-white (P = .006), have a lower estimated household income (P &lt; .001) and live in more densely populated zip codes (P &lt; .001) than those who lived further than 500 m away. For every 1 km increase in distance between residence and roadway, the likelihood of activity limitations decreased by 35% (P = .005). No differences in acute care use were seen with proximity to major roadways.</p>

<p><strong>CONCLUSIONS: </strong>Proximity to a major roadway was associated with chronic respiratory symptoms, such as activity limitations (eg, dyspnea), and tended to be associated with nighttime symptoms as well. Self-reported minorities and families with lower estimated household incomes may be more likely to be exposed to TRAP. Further research is necessary to define the effects of TRAP versus other sources of indoor and outdoor air pollution as well as to determine the best ways of combatting pollution-related respiratory morbidities.</p>

DOI

10.1002/ppul.24594

Alternate Title

Pediatr Pulmonol

PMID

31804768

Title

Indoor Air Pollution Sources and Respiratory Symptoms in Bronchopulmonary Dysplasia.

Year of Publication

2020

Number of Pages

85-90.e2

Date Published

2020 07

ISSN Number

1097-6833

Abstract

<p><strong>OBJECTIVE: </strong>To evaluate the impact of exposure to indoor air pollution on respiratory health outcomes (healthcare utilization, symptoms, medication use) in infants and children with bronchopulmonary dysplasia (BPD).</p>

<p><strong>STUDY DESIGN: </strong>A total of 244 subjects were included from the Johns Hopkins Bronchopulmonary Dysplasia registry. Parents completed an environmental exposure questionnaire including secondhand smoke and indoor combustion (gas/propane heat, gas or wood stove, gas/wood burning fireplace) exposures in the home. Respiratory symptoms, both acute (healthcare utilization, steroid/antibiotic use) and chronic (cough/wheeze, nocturnal cough, use of beta-agonists, tolerance of physical activity), were also collected.</p>

<p><strong>RESULTS: </strong>Three-quarters of the infants were exposed to at least 1 combustible source of air pollution in the home, and this exposure was associated with an increased risk of hospitalization in infants and children on home respiratory support. Only 14% of the study population reported secondhand smoke exposure, but we found that this was associated with chronic respiratory symptoms, including activity limitation and nocturnal cough. Infants on respiratory support also had increased daytime cough and wheezing. Approximately one-third reported having an air purifier in the home, and its presence attenuated the effect of secondhand smoke exposure on reported activity limitation.</p>

<p><strong>CONCLUSIONS: </strong>Exposure to combustible sources of indoor air pollution was associated with increased respiratory morbidity in a group of high risk of infants with BPD. Our results support that indoor air pollution is a modifiable risk factor for respiratory health in infants with BPD.</p>

DOI

10.1016/j.jpeds.2020.03.010

Alternate Title

J Pediatr

PMID

32417083

Title

Allergen-Specific Immunotherapy in the Treatment of Pediatric Asthma: A Systematic Review.

Year of Publication

2018

Date Published

2018 05

ISSN Number

1098-4275

Abstract

<p><strong>CONTEXT: </strong>Treatment options for allergic asthma include allergen avoidance, pharmacotherapy, and allergen immunotherapy.</p>

<p><strong>OBJECTIVES: </strong>Summarize and update current evidence for the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in pediatric allergic asthma.</p>

<p><strong>DATA SOURCES: </strong>PubMed, Embase, Cochrane Central Register of Controlled Trials (January 1, 2005, through May 8, 2017), ClinicalTrials.gov, and the US Food and Drug Administration Adverse Event Reporting System. We reevaluated trials from our 2013 systematic review.</p>

<p><strong>STUDY SELECTION: </strong>We included studies with children ≤18 years of age in which researchers reported on prespecified outcomes and had an intervention arm receiving aeroallergen SCIT or SLIT. Only randomized controlled trials (RCTs) were included for efficacy. RCTs and non-RCTs were included for safety outcomes.</p>

<p><strong>DATA EXTRACTION: </strong>Two reviewers extracted data. We included 40 studies (17 SCIT trials, 11 SLIT trials, 8 non-RCTs for SCIT safety, and 4 non-RCTs for SLIT safety).</p>

<p><strong>RESULTS: </strong>We found moderate-strength evidence that SCIT reduces long-term asthma medication use. We found low-strength evidence that SCIT improves asthma-related quality of life and forced expiratory volume in 1 second. There was also low-strength evidence that SLIT improves medication use and forced expiratory volume in 1 second. There was insufficient evidence on asthma symptoms and health care use.</p>

<p><strong>LIMITATIONS: </strong>There were no trials in which researchers evaluated asthma symptoms using a validated tool. Study characteristics and outcomes were reported heterogeneously.</p>

<p><strong>CONCLUSIONS: </strong>In children with allergic asthma, SCIT may reduce long-term asthma medication use. Local and systemic allergic reactions are common, but anaphylaxis is reported rarely.</p>

DOI

10.1542/peds.2017-3833

Alternate Title

Pediatrics

PMID

29572287

WATCH THIS PAGE

Subscription is not available for this page.