Archivos para 2 febrero 2009



Early introduction of fish decreases the risk of eczema in infants

Bernt Alm 1*, Nils Åberg 2, Laslo Erdes 3, Per Möllborg 4, Rolf Pettersson 5, Gunnar Norvenius 2, Emma Goksör 2 and Göran Wennergren 2

Background: The prevalence of eczema in infants has increased in western societies. It has been suggested that environmental factors and the introduction of food affect the risk of eczema.

Aims: To investigate the current prevalence of eczema among infants in western Sweden, to describe current patterns of food introduction and to assess risk factors for eczema at one year of age.

Methods: Data were obtained from a prospective, longitudinal study of a cohort of infants born in the region of western Sweden in 2003; 8176 families (50% of the birth cohort) were randomly selected and, at six months of age, they received an invitation to participate, together with a questionnaire. The families that agreed received another questionnaire when the infants were twelve months old. Answers to both questionnaires and Medical birth register data were obtained for 4921 infants, i.e. 60.2% of the originally selected population.

Results: At one year of age, 20.9% of the infants had previous or current eczema. The median age at onset was four months. In the multivariable analysis, a familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval 1.50-2.33) or the mother (OR 1.4; 95% CI 1.30-1.84), remained as an independent risk factor. Beneficial effects of introducing fish before nine months of age (OR 0.76; 95% CI 0.62-0.94) and having a bird in the home (OR 0.35; 95% CI 0.17-0.75) were seen. We found no effects from short-term breast-feeding, the age at which milk or eggs were introduced, a cat or dog in the home or parental smoking.

Conclusions: One in five infants suffer from eczema during its first year of life. A familial occurrence of eczema increased the risk. Beneficial effects were seen from introducing fish before nine months of age or having a bird in the home. The duration of breast-feeding or the age at which milk or eggs were introduced did not affect the risk of eczema.


Prescribing trends in asthma: a longitudinal observational study

S Turner1, M Thomas2, J von Ziegenweidt3, D Price2,3

Background: Inhaled corticosteroids (ICS) are effective treatment for childhood asthma. Cross-sectional studies indicate that some asthmatic children are treated with excessively high doses of ICS and are at risk of serious adverse effects.

Objective: To describe longitudinal trends in asthma prescribing for children, with particular reference to very-high-dose (unlicensed) ICS prescribing.

Design: Retrospective, cross-sectional, observational study of general practitioner prescribing for asthma drugs in children aged under 12 years with a recorded asthma diagnosis between 1992 and 2004 using the General Practice Research Database (GPRD).

Results: Data were available for an average of 357 956 children per year. The percentage of children prescribed ICS increased from 2.7 in 1992 to 7.0 in 1997 and 1998 and then fell to 3.3 in 2004. In children under 5 years with asthma, very-high-dose ICS prescriptions (>400 µg/day) fell from 10.6% of all ICS prescriptions in 1992 to 4.5% by 2004. In contrast, very-high-dose ICS prescriptions (>800 µg/day) for asthmatic children aged 5–11 years rose from 1.1% in 1992 to 4.6% in 2004. Oral corticosteroid prescribing in under 5-year-olds who had been prescribed ICS fell from 37.1% in 1992 to 21.7% 1999 and remained constant thereafter; the respective percentages for those aged 5–11 years olds were 20.1 and 12.4.

Conclusions: Trends for corticosteroid prescribing in childhood asthma changed dramatically between 1992 and 2004. There are several plausible reasons for this.


Environmental exposures and respiratory morbidity among very low birth weight infants at 1 year of life

J S Halterman1, K A Lynch1, K M Conn1, T E Hernandez1, T T Perry2, T P Stevens1

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

Objectives: (1) Assess the rates of respiratory morbidity and exposure to indoor respiratory triggers in a population of VLBW infants at 1 year; (2) determine the association between exposures and respiratory morbidity.

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

Results: At 1 year, 9% of infants had physician-diagnosed asthma, 47% required >=1 acute visit and 11% required hospitalisation for respiratory illness. The majority of infants (82%) were exposed to at least one indoor respiratory trigger. Infants living with a smoker (61% vs 40%) and infants exposed to pests (62% vs 39%) were more likely than unexposed infants to require acute care for respiratory problems. In a multivariate regression controlling for demographics, birth weight, bronchopulmonary dysplasia, and family history of asthma or allergies, both living with a smoker (OR 2.62; CI 1.09 to 6.29) and exposure to pests (OR 4.41; CI 1.22 to 15.94) were independently associated with the need for acute care for respiratory illnesses.

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

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