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Effect of an Intervention to Promote Breastfeeding on Asthma, Lung Function, and Atopic Eczema at Age 16 Years
JAMA Pediatrics ( IF 26.1 ) Pub Date : 2018-01-02 , DOI: 10.1001/jamapediatrics.2017.4064
Carsten Flohr 1 , A. John Henderson 2 , Michael S. Kramer 3 , Rita Patel 2 , Jennifer Thompson 4 , Sheryl L. Rifas-Shiman 4 , Seungmi Yang 3, 5 , Konstantin Vilchuck 6 , Natalia Bogdanovich 6 , Mikhail Hameza 6 , Richard M. Martin 2, 7 , Emily Oken 4
Affiliation  

Importance Atopic diseases, including asthma and atopic eczema, are the most common chronic conditions of childhood. Objective To investigate whether an intervention to promote prolonged and exclusive breastfeeding protects against asthma, atopic eczema, and low lung function in adolescence. Design, Setting, and Participants Follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster randomized trial in 30 Belarusian maternity hospitals and affiliated polyclinics; recruitment of 17 046 healthy term infants took place from June 15, 1996, to December 31, 1997. Data analysis was conducted from May 9, 2016, to April 21, 2017. The primary analytic approach was by modified intention-to-treat analysis. Interventions Randomization to receive a breastfeeding promotion intervention vs usual care. Main Outcomes and Measures Spirometry and flexural eczema on standardized skin examination by study pediatricians were the primary outcomes; secondary outcomes were self-reported asthma diagnosis ever, and wheezing and flexural eczema symptoms in the previous year. Results A total of 13 557 (79.5%) participants were followed up from September 15, 2012 to July 15, 2015. The intervention (7064 [79.7%]) and control (6493 [79.4%]) groups were similar at follow-up (3590 [50.8%] and 3391 [52.2%] male; mean [SD] age, 16.2 [0.6] and 16.1 [0.5] years, respectively). In the intervention group, 0.3% (21 of 7064) had flexural eczema on skin examination and mean (SD) forced expiratory volume in the first second of expiration/forced vital capacity (FEV1/FVC) ratio z score was −0.10 (1.82), compared with 0.7% (43 of 6493) and 0.35 (1.34), respectively, in the control group. In modified intention-to-treat analysis, accounting for clustering by polyclinic, a 54% lower risk of flexural eczema on skin examination was observed in the intervention compared with the control group (odds ratio [OR], 0.46; 95% CI, 0.25 to 0.86). Self-reported flexural eczema symptoms in the past year (OR, 0.57; 95% CI, 0.27 to 1.18), asthma (OR, 0.76; 95% CI, 0.47 to 1.23), and wheezing in the past year (OR, 0.66; 95% CI, 0.37 to 1.18) were less frequently reported in the intervention compared with the control group, but 95% CIs were wide and included the null. There was no significant difference in the FEV1/FVC ratio z score (&bgr; −0.15; 95% CI, −0.76 to 0.45). All results were similar with additional adjustment for baseline characteristics, on instrumental variable analysis, and with multiple imputation among all 17 046 randomized participants. Conclusions and Relevance A breastfeeding promotion intervention reduced flexural dermatitis risk but had no detectable effect on lung function or questionnaire-derived measures of atopic eczema or asthma in adolescence in a setting where atopic eczema and allergies are rare. Trial Registration clinicaltrials.gov Identifier: NCT01561612

中文翻译:

促进母乳喂养的干预措施对 16 岁哮喘、肺功能和特应性湿疹的影响

重要性 特应性疾病,包括哮喘和特应性湿疹,是儿童期最常见的慢性病。目的 调查促进长期纯母乳喂养的干预措施是否可以预防青春期哮喘、特应性湿疹和低肺功能。促进母乳喂养干预试验 (PROBIT) 的设计、设置和参与者随访,这是一项在 30 家白俄罗斯妇产医院和附属综合诊所进行的集群随机试验;招募17 046名健康足月儿于1996年6月15日至1997年12月31日进行。数据分析时间为2016年5月9日至2017年4月21日。主要分析方法为改良意向治疗分析. 干预 随机化以接受促进母乳喂养的干预与常规护理。主要结果和措施 研究儿科医生对标准化皮肤检查的肺活量测定和弯曲性湿疹是主要结果;次要结果是自我报告的哮喘诊断,以及前一年的喘息和弯曲湿疹症状。结果 2012年9月15日至2015年7月15日共随访13 557名(​​79.5%)参与者。干预组(7064 [79.7%])和对照组(6493 [79.4%])在随访时相似(3590 [50.8%] 和 3391 [52.2%] 男性;平均 [SD] 年龄,分别为 16.2 [0.6] 和 16.1 [0.5] 岁)。在干预组中,0.3%(7064 人中的 21 人)在皮肤检查时有弯曲湿疹,呼气第一秒用力呼气量/用力肺活量 (FEV1/FVC) 比值 z 得分为 -0.10 (1.82) ,而分别为 0.7%(6493 个中的 43 个)和 0.35 个(1.34 个),在对照组。在改进的意向治疗分析中,考虑到综合诊所的聚集,与对照组相比,干预组在皮肤检查中观察到弯曲性湿疹的风险降低了 54%(优势比 [OR],0.46;95% CI,0.25到 0.86)。过去一年自我报告的弯曲性湿疹症状(OR,0.57;95% CI,0.27 至 1.18)、哮喘(OR,0.76;95% CI,0.47 至 1.23)和过去一年的喘息(OR,0.66;与对照组相比,95% CI,0.37 至 1.18)在干预中的报告频率较低,但 95% 的 CI 很宽并且包括无效。FEV1/FVC 比值 z 评分无显着差异(&bgr; -0.15;95% CI,-0.76 至 0.45)。所有结果都相似,对基线特征进行了额外调整,在工具变量分析中,并对所有 17 046 名随机参与者进行多重插补。结论和相关性 母乳喂养促进干预降低了弯曲性皮炎的风险,但在特应性湿疹和过敏罕见的情况下,对青春期的肺功能或问卷衍生的特应性湿疹或哮喘的测量没有可检测到的影响。试验注册clinicaltrials.gov 标识符:NCT01561612
更新日期:2018-01-02
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