Environmental Triggers in VLBW

Introduction: Preterm infants have a substantially increased risk of developing respiratory illnesses. The goal of this study was to considerthe impact of modifiable postnatal exposures on respiratorymorbidity among a cohort of very low birth weight (VLBW) infants.

Objectives: (1) Assess the rates of respiratory morbidity and exposure toindoor respiratory triggers in a population of VLBW infantsat 1 year; (2) determine the association between exposures andrespiratory morbidity.

Methods: We enrolled 124 VLBW infants into a prospective cohort study.Parents were called at 1 year to assess respiratory outcomesand environmental exposures. We used bivariate and multivariateanalyses to assess the relationship between environmental exposuresand acute care for respiratory illnesses.

Results: At 1 year, 9% of infants had physician-diagnosed asthma, 47%required

1 acute visit and 11% required hospitalization forrespiratory illness. The majority of infants (82%) were exposedto at least one indoor respiratory trigger. Infants living witha smoker (61% vs 40%) and infants exposed to pests (62% vs 39%)were more likely than unexposed infants to require acute carefor respiratory problems. In a multivariate regression controllingfor demographics, birth weight, bronchopulmonary dysplasia,and family history of asthma or allergies, both living witha smoker (OR 2.62; CI 1.09 to 6.29) and exposure to pests (OR4.41; CI 1.22 to 15.94) were independently associated with theneed for acute care for respiratory illnesses.

Conclusions: In this sample, respiratory morbidity and exposure to triggerswere common. VLBW infants may benefit from interventions thatdecrease exposure to respiratory triggers.

Comments: It is common to have high morbidity in preterm infants due to exposure of resp. triggers. It needs lots of anticipatory guidance for both parents and primary physicians to stress on the importance of this issue. If we take simple measures against it we can avoid lots of those episodes of respiratory tract illnesses and also can reduce the morbidity significantly. JMK.

It's not clear to me whether the authors are really talking about exposure to "pests" (dust mites, cockroaches, bothersome siblings?) , or if they meant "pets" (dogs, cats, etc).

Halterman JS, Lynch KA, Conn KM, et al. Environmental exposures and respiratory morbidity among very low birth weight infants at 1 year of life. Arch Dis Child 2009; 94: 28-32. [Full text] [PDF]