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Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns: Secondary Analysis of a Randomized Trial

2018; Elsevier BV; Volume: 198; Linguagem: Inglês

10.1016/j.jpeds.2018.02.032

1097-6833

Katherine C. Wai, Anna Maria Hibbs, Martina A. Steurer, Dennis M. Black, Jeanette Asselin, Eric C. Eichenwald, Philip L. Ballard, Roberta A. Ballard, Roberta L. Keller, Suzanne Hamilton Strong, Jill Immamura-Ching, Margaret Orfanos-Villalobos, Cassandra Williams, David J. Durand, Jeffrey D. Merrill, Dolia Horton, Loretta Pacello, April Willard, William E. Truog, Cheryl Gauldin, Anne Holmes, Patrice Johnson, Kerrie Meinert, Anne Marie Reynolds, Janine Lucie, Patrick D. Conway, Michael Sacilowski, Michael Leadersdorff, Pam Orbank, Karen Wynn, Robin H. Steinhorn, M. DeUngria, Janine Y. Khan, Karin Hamann, Molly Schau, B. Hopkins, J. Brunn Jenson, Carmen Garcia, Aruna Parekh, Jila Shariff, Rose McGovern, Jeff Adelman, Adrienne Combs, Mary Tjersland, Dennis E. Mayock, Elizabeth Howland, Susan K. Walker, Jim Longoria, Holly Meo, Amir Khan, Georgia E. McDavid, Katrina Burson, Richard Hinojosa, Christopher N. Johnson, Karen Martin, Sarah K. Martin, Shawna Rogers, Sharon Wright, Mark L. Hudak, Kimberly Barnette, A. Kellum, Michelle Burcke, Christie Hayes, Stephanie Chadwick, Danielle Howard, Carla Kennedy, Renee Prince, Jennifer Helderman, T. Michael O’Shea, Beatrice M. Stefanescu, Kelly Warden, Patty Brown, Jennifer Griffin, Laura Conley, Catherine M. Bendel, Michael Georgieff, Bridget Davern, Marla M. Mills, Sharon Ritter, Carol L. Wagner, Rita M. Ryan, Deanna Fanning, J. Alan Roberson, Mark C. Mammel, Andrea Lampland, Pat A. Meyers, Angela Brey, Ellen Bendel‐Stenzel, Neil Mulrooney, Cathy Worwa, Pam Dixon, G. Ebert, Cathy Hejl, Molly Maxwell, Kristin McCullough, Ramasubbareddy Dhanireddy, Mohammed T. El Abiad, Ajay J. Talati, Sheila Dempsey, Kathy Gammage, Gayle Gower, Kathy James, Pam LeNoue, Victor McKay, Suzi Bell, Dawn Bruton, Michelle Beaulieu, Richard Williams, Rajan Wadhawan, Robin Barron-Nelson, Shane Taylor, Sherry E. Courtney, Carol Sikes, Gary Lowe, Betty Proffitt, Elizabeth E. Rogers, Cheryl Chapin, Hart Horneman, Karin Hamann, Susan Kelley, Karin L. Knowles, Nancy A. Newton, Eric Vittinghoff, Jean Hietpas, L. Denton, Lisa Palermo, Lucy Wu,

Birth, Development, and Health

Objective To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. Study design We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Results Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. Conclusions Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. Trial registration ClinicalTrials.gov: NCT01022580. To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences.