Novel immunologic and physiologic predictors of pediatric lung disease in premature children. A prospective cohort study
BACKGROUND: Very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia have poorer lung function later in life than full term counterparts. Asthma and abnormal lung function affect up to 70% of VLBW infants (~1.5% of all births) but, despite the need to diagnose asthma at an early age to evaluate early preventive interventions, long-term lung disease can only be confirmed later in life. GAP: The need for sedation during evaluations of pulmonary function at a young age and the absence of good biomarkers for asthma greatly contribute to this diagnostic limitation. Forced oscillatory test (FOT) uses the children’s spontaneous respiration without sedation to indicate the condition of the small and large airways and allergen-specific serum IgE or sIgE (i.e. Ara h1, Bet v1) is able to predict pediatric asthma inception. The combined use of FOT and sIgE determinations may change the landscape for early prediction of long-term lung disease in VLBW infants. HYPOTHESIS: We hypothesize that FOT and sIgE reactivity to specific allergens in children 2.5-4 years of age will synergize to predict atopic and non-atopic asthma. We further hypothesize that FOT and sIgE reactivity to specific allergens in this age group will predict the severity of asthma. METHODS: We propose to leverage our existing NIH-funded prospective cohort of 352 VLBW infants enrolled at birth and currently aged 2-4 years to evaluate the predictive value of FOT and sIgE reactivity to specific allergens for the diagnosis and severity of asthma according to ISAAC criteria at age 5-6 years. RESULTS: Pending IMPACT: Early life, accurate and simple prediction of asthma in premature babies should allow -after validation in similar populations- early, personalized evaluation of novel interventions to prevent a serious and growing lifelong public health problem that affects quality of life and life expectancy.