Determinants of lung function development from birth to age 5 years: an interrupted time series analysis of a South African birth cohort

IF 19.9 1区 医学 Q1 PEDIATRICS
Carlyle McCready MSc , Prof Heather J Zar PhD , Shaakira Chaya MD , Carvern Jacobs MSc , Lesley Workman MPH , Prof Zoltan Hantos PhD , Prof Graham L Hall PhD , Prof Peter D Sly PhD , Prof Mark P Nicol PhD , Prof Dan J Stein PhD , Anhar Ullah MSc , Prof Adnan Custovic PhD , Prof Francesca Little PhD , Diane M Gray PhD
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引用次数: 0

Abstract

Background

Early life is a key period that determines long-term health. Lung development in childhood predicts lung function attained in adulthood and morbidity and mortality across the life course. We aimed to assess the effect of early-life lower respiratory tract infection (LRTI) and associated risk factors on lung development from birth to school age in a South African birth cohort.

Methods

We prospectively followed children enrolled in a population-based cohort from birth (between March 5, 2012 and March 31, 2015) to age 5 years with annual lung function assessment. Data on multiple early-life exposures, including LRTI, were collected. The effect of early-life risk factors on lung function development from birth to age 5 years was assessed using the Generalised Additive Models for Location, Scale and Shape and Interrupted Time Series approach.

Findings

966 children (475 [49·2%] female, 491 [50·8%] male) had lung function measured with oscillometry, tidal flow volume loops, and multiple breath washout. LRTI occurred in 484 (50·1%) children, with a median of 2·0 LRTI episodes (IQR 1·0–3·0) per child. LRTI was independently associated with altered lung function, as evidenced by lower compliance (0·959 [95% CI 0·941–0·978]), higher resistance (1·028 [1·016–1·041]), and higher respiratory rate (1·018 [1·063–1·029]) over 5 years. Additional impact on lung function parameters occurred with each subsequent LRTI. Respiratory syncytial virus (RSV) LRTI was associated with lower expiratory flow ratio (0·97 [0·95–0·99]) compared with non-RSV LRTI. Maternal factors including allergy, smoking, and HIV infection were also associated with altered lung development, as was preterm birth, low birthweight, female sex, and coming from a less wealthy household.

Interpretation

Public health interventions targeting LRTI prevention, with RSV a priority, are vital, particularly in low-income and middle-income settings.

Funding

UK Medical Research Council Grant, The Wellcome Trust, The Bill & Melinda Gates Foundation, US National Institutes of Health Human Heredity and Health in Africa, South African Medical Research Council, Hungarian Scientific Research Fund, and European Respiratory Society.

从出生到 5 岁肺功能发育的决定因素:对南非出生队列的间断时间序列分析。
背景早年是决定长期健康的关键时期。儿童时期的肺发育可预测成年后的肺功能以及整个生命过程中的发病率和死亡率。我们旨在评估南非出生队列中早期下呼吸道感染(LRTI)及相关风险因素对出生至学龄期肺发育的影响。我们收集了包括 LRTI 在内的多种早期生活暴露数据。研究结果966名儿童(475名[49-2%]女性,491名[50-8%]男性)接受了肺功能测量,测量方法包括振荡测量法、潮气量环流法和多次呼吸冲洗法。484名儿童(50-1%)发生了LRTI,每名儿童的LRTI发作次数中位数为2-0次(IQR为1-0-3-0)。LRTI 与肺功能的改变密切相关,5 年内顺应性降低(0-959 [95% CI 0-941-0-978])、阻力增加(1-028 [1-016-1-041])、呼吸频率增加(1-018 [1-063-1-029])就是证明。随后的每一次 LRTI 都会对肺功能参数产生额外的影响。与非 RSV LRTI 相比,呼吸道合胞病毒(RSV)LRTI 与较低的呼气流量比(0-97 [0-95-0-99])相关。包括过敏、吸烟和艾滋病病毒感染在内的母体因素也与肺部发育的改变有关,早产、低出生体重、女性性别和来自不富裕家庭也与肺部发育的改变有关。资助英国医学研究委员会拨款、惠康基金会、比尔-盖茨基金会、美国国立卫生研究院、非洲人类遗传与健康、南非医学研究委员会、匈牙利科学研究基金和欧洲呼吸学会。
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来源期刊
Lancet Child & Adolescent Health
Lancet Child & Adolescent Health Psychology-Developmental and Educational Psychology
CiteScore
40.90
自引率
0.80%
发文量
381
期刊介绍: The Lancet Child & Adolescent Health, an independent journal with a global perspective and strong clinical focus, presents influential original research, authoritative reviews, and insightful opinion pieces to promote the health of children from fetal development through young adulthood. This journal invite submissions that will directly impact clinical practice or child health across the disciplines of general paediatrics, adolescent medicine, or child development, and across all paediatric subspecialties including (but not limited to) allergy and immunology, cardiology, critical care, endocrinology, fetal and neonatal medicine, gastroenterology, haematology, hepatology and nutrition, infectious diseases, neurology, oncology, psychiatry, respiratory medicine, and surgery. Content includes articles, reviews, viewpoints, clinical pictures, comments, and correspondence, along with series and commissions aimed at driving positive change in clinical practice and health policy in child and adolescent health.
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