Determinants of Early-life Lung Function in African Infants

Overview

Journal Thorax

Date 2016 Nov 19

PMID 27856821

Citations 39

Authors

Diane Gray

Lauren Willemse

Ane Visagie

Dorottya Czovek

Polite Nduru

Aneesa Vanker

Dan J Stein

Nastassja Koen

Peter D Sly

Zoltan Hantos

Graham L Hall

Heather J Zar

Affiliations

Soon will be listed here.

Abstract

Background: Low lung function in early life is associated with later respiratory illness. There is limited data on lung function in African infants despite a high prevalence of respiratory disease.

Aim: To assess the determinants of early lung function in African infants.

Method: Infants enrolled in a South African birth cohort, the Drakenstein child health study, had lung function measured at 6-10 weeks of age. Measurements, made with the infant breathing via a facemask during natural sleep, included tidal breathing, sulfur hexafluoride multiple breath washout and the forced oscillation technique. Information on antenatal and early postnatal exposures was collected using questionnaires and urine cotinine. Household benzene exposure was measured antenatally.

Results: Successful tests were obtained in 645/675 (95%) infants, median (IQR) age of 51 (46-58) days. Infant size, age and male gender were associated with larger tidal volume. Infants whose mothers smoked had lower tidal volumes (-1.6 mL (95% CI -3.0 to -0.1), p=0.04) and higher lung clearance index (0.1 turnovers (95% CI 0.01 to 0.3), p=0.03) compared with infants unexposed to tobacco smoke. Infants exposed to alcohol in utero or household benzene had lower time to peak tidal expiratory flow over total expiratory time ratios, 10% (95% CI -15.4% to -3.7%), p=0.002) and 3.0% (95% CI -5.2% to -0.7%, p=0.01) lower respectively compared with unexposed infants. HIV-exposed infants had higher tidal volumes (1.7 mL (95% CI 0.06 to 3.3) p=0.04) compared with infants whose mothers were HIV negative.

Conclusion: We identified several factors including infant size, sex, maternal smoking, maternal alcohol, maternal HIV and household benzene associated with altered early lung function, many of which are factors amenable to public health interventions. Long-term study of lung function and respiratory disease in these children is a priority to develop strategies to strengthen child health.

Citing Articles

Sexual dimorphism in lung transcriptomic adaptations in fetal alcohol spectrum disorders.

Naik V, Millikin D, Moussa D, Jiang H, Carabulea A, Janeski J Respir Res. 2025; 26(1):6.

PMID: 39780208 PMC: 11716060. DOI: 10.1186/s12931-025-03094-z.

Environmental exposures associated with early childhood recurrent wheezing in the mother and child in the environment birth cohort: a time-to-event study.

Asharam K, Mitku A, Ramsay L, Jeena P, Naidoo R Thorax. 2024; 79(10):953-960.

PMID: 38964859 PMC: 11503139. DOI: 10.1136/thorax-2023-221150.

Characteristics of children readmitted with severe pneumonia in Kenyan hospitals.

Marangu-Boore D, Mwaniki P, Isaaka L, Njoroge T, Mumelo L, Kimego D BMC Public Health. 2024; 24(1):1324.

PMID: 38755590 PMC: 11097591. DOI: 10.1186/s12889-024-18651-2.

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

McCready C, Zar H, Chaya S, Jacobs C, Workman L, Hantos Z Lancet Child Adolesc Health. 2024; 8(6):400-412.

PMID: 38621408 PMC: 11096865. DOI: 10.1016/S2352-4642(24)00072-5.

Intra-breath changes in respiratory mechanics are sensitive to history of respiratory illness in preschool children: the SEPAGES cohort.

Siroux V, Boudier A, Lyon-Caen S, Quentin J, Gioria Y, Hantos Z Respir Res. 2024; 25(1):99.

PMID: 38402379 PMC: 10893684. DOI: 10.1186/s12931-024-02701-9.

References

Textor J, Hardt J, Knuppel S . DAGitty: a graphical tool for analyzing causal diagrams. Epidemiology. 2011; 22(5):745. DOI: 10.1097/EDE.0b013e318225c2be. View

Tepper R, Reister T . Forced expiratory flows and lung volumes in normal infants. Pediatr Pulmonol. 1993; 15(6):357-61. DOI: 10.1002/ppul.1950150608. View

Hall G, Hantos Z, Wildhaber J, Sly P . Contribution of nasal pathways to low frequency respiratory impedance in infants. Thorax. 2002; 57(5):396-9. PMC: 1746337. DOI: 10.1136/thorax.57.5.396. View

Myer L, Stein D, Grimsrud A, Seedat S, Williams D . Social determinants of psychological distress in a nationally-representative sample of South African adults. Soc Sci Med. 2008; 66(8):1828-40. PMC: 3203636. DOI: 10.1016/j.socscimed.2008.01.025. View

Schibler A, Hall G, Businger F, Reinmann B, Wildhaber J, CERNELC M . Measurement of lung volume and ventilation distribution with an ultrasonic flow meter in healthy infants. Eur Respir J. 2002; 20(4):912-8. DOI: 10.1183/09031936.02.00226002. View

Tager I, Hanrahan J, Tosteson T, Castile R, Brown R, Weiss S . Lung function, pre- and post-natal smoke exposure, and wheezing in the first year of life. Am Rev Respir Dis. 1993; 147(4):811-7. DOI: 10.1164/ajrccm/147.4.811. View

Hoo A, Dezateux C, Hanrahan J, Cole T, Tepper R, Stocks J . Sex-specific prediction equations for Vmax(FRC) in infancy: a multicenter collaborative study. Am J Respir Crit Care Med. 2002; 165(8):1084-92. DOI: 10.1164/ajrccm.165.8.2103035. View

Vanker A, Barnett W, Brittain K, Gie R, Koen N, Myers B . Antenatal and early life tobacco smoke exposure in an African birth cohort study. Int J Tuberc Lung Dis. 2016; 20(6):729-37. DOI: 10.5588/ijtld.15.0697. View

Stern D, Morgan W, Wright A, Guerra S, Martinez F . Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet. 2007; 370(9589):758-64. PMC: 2831283. DOI: 10.1016/S0140-6736(07)61379-8. View

10.

Zar H, Barnett W, Stadler A, Gardner-Lubbe S, Myer L, Nicol M . Aetiology of childhood pneumonia in a well vaccinated South African birth cohort: a nested case-control study of the Drakenstein Child Health Study. Lancet Respir Med. 2016; 4(6):463-72. PMC: 4989125. DOI: 10.1016/S2213-2600(16)00096-5. View

11.

Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn J . Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2014; 385(9966):430-40. DOI: 10.1016/S0140-6736(14)61698-6. View

12.

Sozo F, Vela M, Stokes V, Kenna K, Meikle P, de Matteo R . Effects of prenatal ethanol exposure on the lungs of postnatal lambs. Am J Physiol Lung Cell Mol Physiol. 2010; 300(1):L139-47. PMC: 3023283. DOI: 10.1152/ajplung.00195.2010. View

13.

Nguyen T, Hoo A, Lum S, Wade A, Thia L, Stocks J . New reference equations to improve interpretation of infant lung function. Pediatr Pulmonol. 2012; 48(4):370-80. DOI: 10.1002/ppul.22656. View

14.

Hoo A, Stocks J, Lum S, Wade A, Castle R, Costeloe K . Development of lung function in early life: influence of birth weight in infants of nonsmokers. Am J Respir Crit Care Med. 2004; 170(5):527-33. DOI: 10.1164/rccm.200311-1552OC. View

15.

Robinson P, Latzin P, Verbanck S, Hall G, Horsley A, Gappa M . Consensus statement for inert gas washout measurement using multiple- and single- breath tests. Eur Respir J. 2013; 41(3):507-22. DOI: 10.1183/09031936.00069712. View

16.

Shrier I, Platt R . Reducing bias through directed acyclic graphs. BMC Med Res Methodol. 2008; 8:70. PMC: 2601045. DOI: 10.1186/1471-2288-8-70. View

17.

Gray D, Willemse L, Visagie A, Smith E, Czovek D, Sly P . Lung function and exhaled nitric oxide in healthy unsedated African infants. Respirology. 2015; 20(7):1108-14. PMC: 4623783. DOI: 10.1111/resp.12579. View

18.

Gray D, Czovek D, Smith E, Willemse L, Alberts A, Gingl Z . Respiratory impedance in healthy unsedated South African infants: effects of maternal smoking. Respirology. 2015; 20(3):467-73. PMC: 4670479. DOI: 10.1111/resp.12463. View

19.

Lazic T, Wyatt T, Matic M, Meyerholz D, Grubor B, Gallup J . Maternal alcohol ingestion reduces surfactant protein A expression by preterm fetal lung epithelia. Alcohol. 2007; 41(5):347-55. PMC: 2083706. DOI: 10.1016/j.alcohol.2007.07.006. View

20.

Ueda Y, Stick S, Hall G, Sly P . Control of breathing in infants born to smoking mothers. J Pediatr. 1999; 135(2 Pt 1):226-32. DOI: 10.1016/s0022-3476(99)70026-0. View