Determinants of lung function development from birth to age 5 years: an interrupted time series analysis of a South African birth cohort.

Journal: The Lancet. Child & adolescent health

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Affiliated Institutions:  Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary. Children's Lung Health, Telethon Kids Institute and School of Allied Health, Curtin University, Perth, WA, Australia. Children's Health and Environment Program, Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia. Marshall Centre, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Unit on Risk & Resilience, University of Cape Town, Cape Town, South Africa. National Heart and Lung Institute, Imperial College London, London, UK. Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa. Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa. Electronic address: diane.gray@uct.ac.za.

Abstract summary 

Early life is a key period that determines long-term health. Lung development in childhood predicts lung function attained in adulthood and morbidity and mortality across the life course. We aimed to assess the effect of early-life lower respiratory tract infection (LRTI) and associated risk factors on lung development from birth to school age in a South African birth cohort.We prospectively followed children enrolled in a population-based cohort from birth (between March 5, 2012 and March 31, 2015) to age 5 years with annual lung function assessment. Data on multiple early-life exposures, including LRTI, were collected. The effect of early-life risk factors on lung function development from birth to age 5 years was assessed using the Generalised Additive Models for Location, Scale and Shape and Interrupted Time Series approach.966 children (475 [49·2%] female, 491 [50·8%] male) had lung function measured with oscillometry, tidal flow volume loops, and multiple breath washout. LRTI occurred in 484 (50·1%) children, with a median of 2·0 LRTI episodes (IQR 1·0-3·0) per child. LRTI was independently associated with altered lung function, as evidenced by lower compliance (0·959 [95% CI 0·941-0·978]), higher resistance (1·028 [1·016-1·041]), and higher respiratory rate (1·018 [1·063-1·029]) over 5 years. Additional impact on lung function parameters occurred with each subsequent LRTI. Respiratory syncytial virus (RSV) LRTI was associated with lower expiratory flow ratio (0·97 [0·95-0·99]) compared with non-RSV LRTI. Maternal factors including allergy, smoking, and HIV infection were also associated with altered lung development, as was preterm birth, low birthweight, female sex, and coming from a less wealthy household.Public health interventions targeting LRTI prevention, with RSV a priority, are vital, particularly in low-income and middle-income settings.UK Medical Research Council Grant, The Wellcome Trust, The Bill & Melinda Gates Foundation, US National Institutes of Health Human Heredity and Health in Africa, South African Medical Research Council, Hungarian Scientific Research Fund, and European Respiratory Society.

Authors & Co-authors:  McCready Carlyle C Zar Heather J HJ Chaya Shaakira S Jacobs Carvern C Workman Lesley L Hantos Zoltan Z Hall Graham L GL Sly Peter D PD Nicol Mark P MP Stein Dan J DJ Ullah Anhar A Custovic Adnan A Little Francesca F Gray Diane M DM

Study Outcome 

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Citations : 
Authors :  14
Identifiers
Doi : S2352-4642(24)00072-5
SSN : 2352-4650
Study Population
Female
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Study Design
Study Approach
Country of Study
South Africa
Publication Country
England