Background

Extremely low birth weight (ELBW; <1000 g) infants are at risk for both asthma and problems like inattention, hyperactivity, anxiety, and depression. Asthma predicts behavioral and emotional problems in term-born children. The nature of these associations is poorly understood. We tested 3 models of association: independent risk, mediation, and effect modification to explore interplay among birth weight, asthma, and behavioral and emotional problems.

Methods

We used data from a prospective cohort of ELBW infants born 1992 to 1995. Exposure was ELBW; primary outcomes were parent-reported diagnosis of asthma and symptoms of inattention, hyperactivity, anxiety, and depression at age 8 years. Covariates included child sex and maternal socioeconomic status.

Results

There were 139 ELBW and 101 normal BW (>2500 g) children followed to 8 years. ELBW children were more likely to have asthma (35.7% vs 14.4%, P < .05). Inattention, hyperactivity, depression, and anxiety scores were higher among ELBW children and children with asthma. ELBW was a common cause of asthma and anxiety. There was no evidence of mediation or effect modification by asthma on the effect of ELBW on behavior and emotion symptoms.

Conclusion

Asthma does not underlie or amplify the effect of ELBW on behavioral and emotional problems at school age, suggesting that increased risk for respiratory morbidity and neurodevelopment represent largely independent consequences of developmental vulnerability related to ELBW. Noting the impact of chronic illnesses on neurodevelopment in other populations, data focused on symptom trajectories over time in a larger cohort may be necessary to shed further light onto this question.

中文翻译：

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极低出生体重、哮喘和行为的相互关系：共同原因、中介和适度的研究。

背景

极低出生体重 (ELBW；<1000 克) 的婴儿有患哮喘和注意力不集中、多动、焦虑和抑郁等问题的风险。哮喘可预测足月儿的行为和情绪问题。人们对这些关联的性质知之甚少。我们测试了 3 种关联模型：独立风险、中介和效应修正，以探索出生体重、哮喘以及行为和情绪问题之间的相互作用。

方法

我们使用了来自 1992 年至 1995 年出生的 ELBW 婴儿的前瞻性队列的数据。主要结局是父母报告的哮喘诊断以及 8 岁时注意力不集中、多动、焦虑和抑郁的症状。协变量包括儿童性别和母亲的社会经济地位。

结果

有 139 名 ELBW 和 101 名正常 BW (>2500 g) 儿童随访至 8 岁。ELBW 儿童更可能患有哮喘（35.7% 对 14.4%，P < .05）。ELBW 儿童和哮喘儿童的注意力不集中、多动、抑郁和焦虑评分较高。ELBW 是哮喘和焦虑的常见原因。没有证据表明哮喘对 ELBW 对行为和情绪症状的影响有调节作用或效果改变。

结论

哮喘并不构成或放大 ELBW 对学龄期行为和情绪问题的影响，这表明呼吸系统疾病和神经发育风险的增加在很大程度上代表了与 ELBW 相关的发育脆弱性的独立后果。注意到慢性疾病对其他人群神经发育的影响，可能需要在更大的队列中集中在一段时间内症状轨迹的数据来进一步阐明这个问题。