Recurrent wheezing in preterm infants: Prevalence and risk factors

Simões, Maria Cristina Ribeiro dos Santos; Inoue, Yuri; Matsunaga, Natasha Y.; Carvalho, Maria R.V.; Ribeiro, Gisleine L.T.; Morais, Eliane O.; Ribeiro, Maria A.G.O.; Morcillo, André M.; Ribeiro, José D.; Toro, Adyléia A.D.C.

doi:10.1016/j.jped.2018.06.007

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Original articles • J. Pediatr. (Rio J.) 95 (6) • Nov-Dec 2019 • https://doi.org/10.1016/j.jped.2018.06.007 copy

Recurrent wheezing in preterm infants: Prevalence and risk factors^☆ ☆ Please cite this article as: Simões MC, Inoue Y, Matsunaga NY, Carvalho MR, Ribeiro GL, Morais EO, et al. Recurrent wheezing in preterm infants: Prevalence and risk factors. J Pediatr (Rio J). 2019;95:720-7. , ^☆☆ ☆☆ Study conducted at Centro de Investigações em Pediatria (CIPED), Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the prevalence and risk factors associated with progression to recurrent wheezing in preterm infants.

Methods:

The cross-sectional study was carried out in 2014 and 2015 and analyzed preterm infants born between 2011 and 2012. The search for these children was performed in a university maternity hospital and a Special Immunobiological Reference Center. The evaluation was performed through a questionnaire applied during a telephone interview.

Results:

The study included 445 children aged 39 (18-54) months. In the univariate analysis, the risk factors with the greatest chance of recurrent wheezing were birth weight <1000 g, gestational age <28 weeks, living with two or more siblings, food allergy, and atopic dermatitis in the child, as well as food allergy and asthma in the parents. In the multivariate analysis, there was a significant association between recurrent wheezing and gestational age at birth <28 weeks, food allergy and atopic dermatitis in the child, and living with two or more children. Of the 445 analyzed subjects, 194 received passive immunization against the respiratory syncytial virus, and 251 preterm infants were not immunized. There was a difference between the gestational age of these subgroups (p < 0.001). The overall prevalence of recurrent wheezing was 27.4% (95% CI: 23.42-31.70), whereas in the children who received passive immunization it was 36.1% (95% CI: 29.55-43.03).

Conclusions:

Personal history of atopy, lower gestational age, and living with two or more children had a significant association with recurrent wheezing. Children with lower gestational age who received passive immunization against the respiratory syncytial virus had a higher prevalence of recurrent wheezing than the group with higher gestational age.

Keywords
Asthma; Respiratory sounds; Respiratory syncytial virus; Prevalence; Risk factors; Prevention and control

		N	%
Number of children		445
Male gender		236	53.0
Ethnicity	White	305	68.5
	Black	132	29.7
	Asian	7	1.60
Informant: mother		356	80.0
Maternal schooling	Elementary school	93	21.2
	High school	200	45.7
	College/university	145	33.1
Use of Palivizumab		194	43.6
Wheezing in the first year		230	51.7
Hospital admissions for wheezing		95	21.3
Hospital admissions for pneumonia		71	16.0
RW in the first year of life		103	23.1
Recurrent wheezing		122	27.4
Use of bronchodilators		259	58.3
Use of inhaled corticosteroids		139	31.2
Use of oral corticosteroids		208	46.7
Medical diagnosis of asthma		95	21.3
		Median	IQR
Age at the interview (months)		39	8
Gestational age (weeks)		32	6
Birth weight (g)		1690	1217
Breastfeeding (months)		3.0	8
Age at the first wheezing crisis (months)		6.0	9

	Recurrent wheezing		Total	OR	95% CI	p
	N	%	Total	OR	95% CI	p
Gender
Male	65	27.5	236	1.01	0.67-1.54	0.949
Female	57	27.3	209	1.00
Ethnicity
Black	36	27.3	132	0.97	0.61-1.53	0.898
Asian	1	14.3	7	0.43	0.05-3.64	0.440
White	85	27.9	305	1.00
Maternal schooling
Elementary School	24	25.8	93	0.80	0.45-1.43	0.450
High School	51	25.5	200	0.79	0.49-1.26	0.321
College/University	44	30.3	145	1.00
Birth weight (g)
500-1000	32	40.0	80	2.38	1.33-4.27	0.004
1000-1500	34	29.8	114	1.52	0.88-2.63	0.136
1500-2000	20	22.2	90	1.02	0.55-1.90	0.949
>2000	35	21.9	160	1.00
Gestational age at birth (weeks)
24-27	29	48.3	60	3.35	2.57-15.51	<0.001
28-31	36	29.0	124	1.46	0.90-2.38	0.124
32-36	57	21.8	261
Breastfeeding (months)
Did not receive	41	34.2	120	1.85	0.95-3.62	0.072
≤3	24	22.6	106	1.04	0.51-2.14	0.909
3-6	26	27.4	95	1.34	0.66-2.74	0.419
6-12	15	29.4	51	1.48	0.65-3.37	0.344
>12	16	21.9	73	1.00
Daycare attendance
Yes	86	27.6	312	1.01	0.64-1.60	0.950
No	36	27.3	132	1.00
Exposure to pets
Yes	65	27.3	238	0.99	0.65-1.61	0.974
No	56	27.5	204	1.00
Number of children at the household
2 or more	43	35.8	120	1.76	1.05-2.95	0.032
1	36	23.4	154	0.96	0.57-1.61	0.880
0	40	24.1	166	1.00
Smoking during pregnancy
Yes	12	32.4	37	1.30	0.63-2.68	0.472
No	109	26.9	405	1.00
Caregiver smoking
Yes	20	23.0	87	0.75	0.43-1.30	0.307
No	101	28.5	355	1.00
Food allergy in child
Yes	16	43.2	37	2.17	1.09-4.31	0.027
No	106	26.0	408	1.00
Atopic dermatitis in child
Yes	20	45.5	44	2.44	1.29-4.61	0.006
No	101	25.4	397	1.00
Food allergy in parents
Yes	12	44.4	27	2.27	1.03-5.01	0.042
No	108	26.0	415	1.00
Asthma in parents
Yes	39	36.1	108	1.74	1.10-2.78	0.019
No	82	24.5	335	1.00
Use of Palivizumab
No	52	20.7	251	0.46	0.30-0.71	<0.001
Yes	70	36.1	194	1.00

	Adjusted OR	95% CI	p
Atopic dermatitis in child
Yes	2.96	1.51-5.80	0.002
No	100
Food allergy in child
Yes	2.56	1.20-5.43	0.015
No	1.00
Gestational age (weeks)
24 to 27	4.33	2.31-8.12	<0.001
28 to 31	1.49	0.87-2.53	0.145
32 to 36	1.00
Number of children
Two or more	2.05	1.18-3.56	0.011
One	0.94	0.54-1.63	0.828
None	1.00

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E-mail: jped@jped.com.br

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[1] * Corresponding author. E-mail:mcris.simoes@gmail.com (M.C. Simões).