Abstract Rationale Bronchopulmonary dysplasia (BPD) is one of the most common and serious complications of preterm birth. Exposure to adverse environmental conditions during lung development can lead to chronic respiratory disease later in life. While indoor air pollution’s detrimental effects are documented in other populations, and secondhand smoke has been linked to poor respiratory outcomes in premature infants, there is a lack of evidence on the impact of measured indoor PM2.5 on respiratory outcomes in preterm infants. We hypothesized that indoor PM2.5 exposure increases respiratory related morbidity in this population. Methods A 12-month prospective observational cohort study was conducted in preterm children ( = 32 weeks gestational age) aged 0-60 months at enrollment, who had a diagnosis of BPD. Baseline data collection included home characteristics and NICU history. Outcomes measured were total healthcare utilization events for respiratory illnesses, total systemic steroid and antibiotic courses for respiratory illnesses, and a validated BPD control questionnaire (4-week recall) administered at 1,3,6,9, and 12 months. Indoor PM2.5 was continuously measured using the AirVisual Pro, with data collected in 1-minute intervals over a 4-week period preceding each follow up. Mean PM2.5 values were calculated. A baseline salivary cotinine level in each child was also collected. Generalized linear mixed models were used with inverse probability weighting to account for missingness in the PM2.5 exposure data. Results The study enrolled 120 subjects (42% females). The mean gestational age was 26 weeks, and average birth weight was 832 grams. At enrollment, the mean age was 22 months (range 0.16-56). All participants had BPD, predominantly categorized as severe per 2001 NIH criteria. Nearly half of the participants identified as non-white and 46% had public insurance. While 6% of subjects reported smoking in the home, 19% of children had a salivary cotinine 1 ng/ml. Annual mean PM2.5 was 9.2 µg/m3. In adjusted analysis, PM2.5 concentration was significantly associated with an increased rate of healthcare utilization, antibiotic use, and an increased odd of respiratory symptoms (Table 1). Participants with an annual mean PM2.5 above the median (5.4 µg/m3) had twice the rate of healthcare utilization events and three times the rate of antibiotic use compared to those with annual mean PM2.5 below the median (Table 1). Conclusions These findings suggest that indoor air pollution is a modifiable risk factor for respiratory health in infants with BPD. These results support developing future interventions to improve indoor environmental conditions for these children. This abstract is funded by: NIH
Rice et al. (Fri,) studied this question.
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