Recurrent Wheezing in the Third Year of Life Among Children Born at 32 Weeks' Gestation or Later Relationship to Laboratory-Confirmed, Medically Attended Infection With Respiratory Syncytial Virus During the First Year of Life
Recurrent Wheezing in the Third Year of Life Among Children Born at 32 Weeks' Gestation or Later Relationship to Laboratory-Confirmed, Medically Attended Infection With Respiratory Syncytial Virus During the First Year of Life
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DOI：
10.1001/archpediatrics.2010.177
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发表时间：
2010-10-01
影响因子：
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通讯作者：
Kipnis, Patricia
中科院分区：
文献类型：
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作者：
Escobar, Gabriel J.;Ragins, Arona;Kipnis, Patricia
目的：量化3岁复发性喘息（RW）与呼吸道合胞病毒（RSV）感染、早产和新生儿氧暴露的关系。设计：回顾性队列研究，将住院、门诊和实验室数据库联系起来，进行队列组装和逻辑回归分析。环境：北加州综合医疗保健系统。参与者：1996年至2002年期间出生的32周孕龄或更晚，在第一和第三年成为健康计划成员9个月或更长时间的儿童共计71 102名。主要暴露：第一年经实验室确认的医学护理的呼吸道合胞病毒感染和出生住院期间补充氧气。结果测量：复发性喘息，通过门诊就诊、住院时间和哮喘处方进行量化。结果：RSV早产儿3岁RW发生率为16.23%，无RSV早产儿为6.22%。与没有RSV接触的婴儿相比，有RSV门诊接触的婴儿发生RW的风险增加（校正优势比[AOR]， 2.07; 95% CI, 1.61-2.67），无并发症的RSV住院（AOR, 4.66; 95% CI, 3.55-6.12），或长期RSV住院（AOR, 3.42; 95% CI, 2.01-5.82）。与38 ~ 40周相比，孕龄34 ~ 36周与RW风险增加相关（AOR, 1.23; 95% CI 1.07-1.41），而孕龄41周及以上具有保护作用（AOR, 0.90; 95% Cl, 0.81-0.99）。补充氧气暴露与所有水平的风险增加有关。结论：经实验室证实、医疗护理的呼吸道合气道病毒感染、早产和新生儿期接受补充氧气与3岁时RW的发展有独立的关联。
Objective: To quantify the relationship between recurrent wheezing (RW) in the third year of life and respiratory syncytial virus (RSV) infection, prematurity, and neonatal oxygen exposure.Design: Retrospective cohort study linking inpatient, outpatient, and laboratory databases for cohort assembly and logistic regression analysis.Setting: Integrated health care delivery system in Northern California.Participants: A total of 71 102 children born from 1996 to 2002 at 32 weeks' gestational age or later who were health plan members for 9 or more months in their first and third years.Main Exposures: Laboratory-confirmed, medically attended RSV infection during first year and supplemental oxygen during birth hospitalization.Outcome Measures: Recurrent wheezing, quantified through outpatient visits, inpatient hospital stays, and asthma prescriptions.Results: The rate of RW in the third year of life was 16.23% among premature infants with RSV and 6.22% among those without RSV. The risk of RW increased among infants who had an RSV outpatient encounter (adjusted odds ratio [AOR], 2.07; 95% CI, 1.61-2.67), uncomplicated RSV hospitalization (AOR, 4.66; 95% CI, 3.55-6.12), or prolonged RSV hospitalization (AOR, 3.42; 95% CI, 2.01-5.82) compared with infants without RSV encounters. Gestational age of 34 to 36 weeks was associated with increased risk of RW (AOR, 1.23; 95% CI 1.07-1.41) compared with 38 to 40 weeks, while a gestational age of 41 weeks or more was protective (AOR, 0.90; 95% Cl, 0.81-0.99). Supplemental oxygen exposure was associated with increased risk at all levels.Conclusion: Laboratory-confirmed, medically attended RSV infection, prematurity, and exposure to supplemental oxygen during the neonatal period have independent associations with the development of RW in the third year of life.