Archive for the ‘Respiratory’ Category

ASTHMA RISK IN CHILDHOOD CAN BE PREDICTED BY SERUM BILIRUBIN LEVEL AT NEONATAL PERIOD-DR.D.K.JHA,M.D

Thursday, December 13th, 2018

Asthma is the most common chronic respiratory disorders in children.

Worldwide,the incidence of asthma has increased over the past few decades.

Mortality from asthma is still high even in this era of sophisticated diagnostic facilities and availabilities of advanced treatment modalities.

If the risk of getting asthmatic is predicted in children,the preventive measures can be applied to some extent.

Hperbilirubinemia is the most common clinical signs warranting treatment in neonates.

The level of serum bilirubin is an indicator of starting phototherapy.

In most of the cases,rise in serum bilirubin is physiological in newborns requiring only reassurance to the parents.

In some newborns,the rise in bilirubin may go unnoticed.

Now,there has been a retrospetive study of asthmatic children,relating the diseases to the level of serum bilirubin during neonatal period.

The study was conducted on 109,212 infants born at or after 35 weeks of gestation. The study centre was Kaiser Permanente Northern California Hospital.Total serum bilirubin was measured over all infants universally at the time of discharge and again at the age of one month.Other covariables were also included in the study like,age,race,ethnicity of mothers and sex,birth weight,gestational age and 5 minutes apgar scores of newborn.

The incidence of asthma,which was the main interest of study was defined as 2 or more visits to OPD with a physician diagnosed asthma and 2 or more asthma medications within a period of one year separeted by a period of one month after the child crosses the age of 2 years..

Among the infants in study group,the highest level of serum bilirubin was 18mg or more in 4.7% and 15mg or more in 16.7%.In 11.5% infants, phototherapy had to be given.

When compared with infants having serum bilirubin between 3-5.9gm/dl,the asthma risk was greater in infants having serum bilirubin level of 9-11.9mg/dl(hazard ratio [HR] 1.22; 95% CI, 1.11-1.34; P <.001),12-14.9mg/dl((HR, 1.18; 95% CI, 1.08-1.29; P <.001) and 15 to 17.9mg/dl(HR, 1.30; 95% CI 1.18-1.43; P <.001)

Interestingly the total serum bilirubin level at or more than 18 mg/dl did not show any correlation with incidence of asthma(HR, 1.04; 95% CI, 0.90-1.20; P =.9)

Induction of phototherapy did not increase the risk of asthma(HR, 1.07; 95% CI, 0.96-1.20).

The causal relationship between asthma and level of serum bilirubin could not be eastablished as the study was limited by its retrospective nature.

REFERENCES:

Kuzniewicz MW, Niki H, Walsh EM, McCulloch CE, Newman TB. Hyperbilirubinemia, phototherapy, and childhood asthma. Pediatrics. 2018;142(4):e20180662.