Effect of Indoor Fine Particulate Matter Exposure on Respiratory Health Outcomes in Premature Infants

项目摘要和总结 这个指导以患者为导向的研究职业发展奖将为杰西卡·赖斯博士提供 经验和培训，成为一个独立的研究者在儿科肺病的重点是 室内空气污染（细颗粒物，PM2.5）对早产儿呼吸道疾病的影响。 早产影响了美国10%的婴儿，是婴儿死亡的主要原因。 支气管肺发育不良（BPD）是早产最常见和最严重的并发症之一， 婴儿在整个童年时期都有慢性呼吸道症状和肺功能异常的风险， 长大成人虽然暴露于室内空气污染已被证明是有害的其他人群 （哮喘儿童）和二手烟（SHS）暴露与不良呼吸道疾病有关。 早产儿的结果，测量的室内PM2.5对易受伤害的婴儿呼吸结果的影响， 早产儿人数不详。核心假设是，暴露于PM2.5会导致 早产儿中与流产相关的发病率风险增加。为了验证这一假设，我们提出了一个 一项前瞻性观察性研究，评估PM2.5对两个队列患者的影响，这些患者将接受以下随访： 一年第一个队列将在首次出院时招募，将包括出生时≤ 32周（有和无BPD）（目标1），第二个队列将包括学龄前儿童， 早产儿，具有既定的BPD（目标2）。这两个队列将使我们能够评估一个完整的临床 与早产相关的慢性肺病谱。结果将包括医疗保健利用率， 药物使用、症状和SHS暴露标志物（空气尼古丁和唾液可替宁）。这个目标 建议是收集初步数据，并获得必要的环境培训和技能， 流行病学和临床试验方法，以设计未来的干预试验，以评估影响 改善这一人群的室内空气质量。这种方法的重点是确定一个可改变的风险因素， 当发育中的组织最容易受到环境损害时， 疾病这项研究的结果有可能影响临床实践，并最终影响公共政策。博士 赖斯组建了一个多学科的研究团队，具有广泛的研究和指导经验。她 主要导师Gregory Diette博士是EPA/ NIEHS资助的儿童哮喘中心的联合主任 在城市环境领域，是内城暴露及其对城市环境贡献方面的国际专家 阻塞性肺病她的共同导师Sharon McGrath-Morrow博士和J. Michael Collaco博士都是 儿科肺病学家和早产儿慢性肺病领域的专家。Kirsten Koehler博士， 环境健康科学专家将提供与接触测量和分析有关的指导。 这个职业发展奖将为赖斯博士提供必要的技能，培训和指导 发展她的研究计划，这将是她成功过渡到独立调查员的关键。

Project Abstract and Summary This mentored Patient-Oriented Research Career Development Award will provide Dr. Jessica Rice with the experience and training to become an independent investigator in pediatric pulmonology with a focus on the effects of indoor air pollution (fine particulate matter, PM2.5) on respiratory morbidity in premature infants. Premature birth affects 10 percent of infants born in the U.S. and is the leading cause of infant mortality. Bronchopulmonary dysplasia (BPD) is one of the most common and serious complications of preterm birth and infants are at risk for chronic respiratory symptoms and lung function abnormalities throughout childhood and into adulthood. While exposure to indoor air pollution has been shown to be detrimental in other populations (children with asthma) and secondhand smoke (SHS) exposure has been linked to adverse respiratory outcomes in premature infants, the effect of measured indoor PM2.5 on respiratory outcomes in a vulnerable population of premature infants is not known. The central hypothesis is that exposure to PM2.5 leads to an increased risk of respiratory-related morbidity among premature infants. To test this hypothesis, we propose a prospective observational study evaluating the effect of PM2.5 in two cohorts of patients who will be followed for one year. The first cohort will be recruited at the time of initial hospital discharge and will include infants born ≤ 32 weeks (with and without BPD) (aim 1) and the second cohort will include preschool aged children who were born prematurely with established BPD (aim 2). These two cohorts will allow us to evaluate a full clinical spectrum of chronic lung disease related to prematurity. Outcomes will include healthcare utilization, medication use, symptoms, and markers of SHS exposure (air nicotine and salivary cotinine). The goal of this proposal is to collect preliminary data and obtain the necessary training and skills in environmental epidemiology and clinical trial methods in order to design a future intervention trial to evaluate the impact improving indoor air quality in this population. This approach focuses on identifying a modifiable risk factor and intervening early when developing tissues are most susceptible to environmental insults in order to prevent disease. Results of this study have the potential to impact clinical practice and eventually, public policy. Dr. Rice has assembled a multidisciplinary research team with extensive research and mentorship experience. Her primary mentor, Dr. Gregory Diette is the co-director of the EPA/ NIEHS funded Center for Childhood Asthma in the Urban Environment and is an international expert on inner city exposures and their contribution to obstructive lung disease. Her co-mentors Dr. Sharon McGrath-Morrow and Dr. J. Michael Collaco, are both pediatric pulmonologists and experts in the field of chronic lung disease of prematurity. Dr. Kirsten Koehler, an expert in environmental health science will provide guidance related to exposure measurement and analysis. This career development award will provide Dr. Rice with the necessary skills, training, and mentorship needed to develop her research program and will be key to her success in transitioning to an independent investigator.