Bernt Alm

Neonatal Antibiotic Treatment Is a Risk Factor for Early Wheezing

OBJECTIVE. The use of antibiotics in infancy and subsequent changes in the intestinal bacterial flora have been discussed as risk factors for the development of asthma. However, it has been difficult to exclude the possibility that antibiotics have been given in early episodes of wheezing. As a result, there has been a risk of reverse causation. To minimize the risk of reverse causation, we have focused on the effect of antibiotics that are already administered on the neonatal ward. METHODS. In a cohort study of infants born in western Sweden in 2003, we studied the development of wheezing. The families of the infants were randomly selected and sent a questionnaire at child ages 6 and 12 months. The response rate was 68.5% to the 6-month questionnaire and 68.9% to the 12-month questionnaire. RESULTS. At 12 months, 20.2% of infants had had 1 or more episodes of wheezing, and 5.3% had had 3 or more episodes. Inhaled corticosteroids had been taken by 4.1% of the infants. Independent risk factors for wheezing disorder treated with inhaled corticosteroids were neonatal antibiotic treatment, male gender, gestational age of <37 weeks, having a mother with asthma, having a sibling with asthma or eczema, and breastfeeding for <5 months. CONCLUSIONS. Treatment with antibiotics in the neonatal period was an independent risk factor for wheezing that was treated with inhaled corticosteroids at 12 months of age. These results indirectly support the hypothesis that an alteration in the intestinal flora can increase the risk of subsequent wheezing.

Early introduction of fish decreases the risk of eczema in infants

Background: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. Aims: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. Methods: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant’s birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). Results: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. Conclusions: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk.

Factors associated with discontinuation of breastfeeding before 1 month of age.

Background: Breastfeeding is associated with many benefits for both mother and child. Initiation rates are high in Sweden. Recently a slight decline is seen.

Early protective and risk factors for allergic rhinitis at age 4½ yr.

To cite this article: Alm B, Goksör E, Thengilsdottir H, Pettersson R, Möllborg P, Norvenius G, Erdes L, Åberg N, Wennergren G. Early protective and risk factors for allergic rhinitis at age 4½ years. Pediatr Allergy Immunol 2011; 22: 398–404.

Caffeine and alcohol as risk factors for sudden infant death syndrome. Nordic Epidemiological SIDS Study.

OBJECTIVE To assess whether alcohol and caffeine are independent risk factors for sudden infant death syndrome (SIDS). MATERIALS AND METHODS Analyses based on data from the Nordic epidemiological SIDS study, a case control study in which all parents of SIDS victims in the Nordic countries from 1 September 1992 to 31 August 1995 were invited to participate with parents of four controls, matched for sex and age at death. Odds ratios (ORs) were calculated by conditional logistic regression analysis. RESULTS The crude ORs for caffeine consumption > 800 mg/24 hours both during and after pregnancy were significantly raised: 3.9 (95% confidence interval (CI), 1.9 to 8.1) and 3.1 (95% CI, 1.5 to 6.3), respectively. However, after adjustment for maternal smoking in 1st trimester, maternal age, education and parity, no significant effect of caffeine during or after pregnancy remained. For maternal or paternal alcohol use, no significant risk increase was found after adjusting for social variables, except for heavy postnatal intake of alcohol by the mother, where the risk was significantly increased. CONCLUSIONS Caffeine during or after pregnancy was not found to be an independent risk factor for SIDS after adjustment for maternal age, education, parity, and smoking during pregnancy. Heavy postnatal but not prenatal intake of alcohol by the mother increased the risk.

Population-based waist circumference and waist-to-height ratio reference values in preschool children

Aim:  To establish new reference values for measurements of waist circumference and waist‐to‐height ratio in preschool children.

Preschool wheeze - impact of early fish introduction and neonatal antibiotics.

Aim:  The aim of this study was to analyse the risk factors for preschool wheeze with special reference to the early introduction of fish and early antibiotic treatment. To avoid reverse causation regarding antibiotics, we focused on the influence of broad‐spectrum antibiotics given during the first week of life.

Asthma in late adolescence – farm childhood is protective and the prevalence increase has levelled off

Wennergren G, Ekerljung L, Alm B, Eriksson J, Lötvall J, Lundbäck B. Asthma in late adolescence – farm childhood is protective and the prevalence increase has levelled off.
Pediatr Allergy Immunol 2010: 21: 806–813.
© 2010 John Wiley & Sons A/S

Early fish introduction and neonatal antibiotics affect the risk of asthma into school age

The early introduction of fish has been reported to reduce the risk of wheezing disorder in early childhood, while broad‐spectrum antibiotics in the first week have been associated with an increased risk. However, it is uncertain whether the effects remain into school age. The aim was to explore these risk factors for doctor‐diagnosed asthma at 8 years.

SIDS risk factors and factors associated with prone sleeping in Sweden.

Objective: To compare the current prevalence of risk factors for sudden infant death syndrome (SIDS) in Sweden with a decade earlier, and assess factors associated with prone sleeping. Methods: The results of a cohort study (Infants of Western Sweden) and a population based case-control study (Nordic Epidemiological SIDS Study) were examined. Subjects were 5600 healthy 6 month old infants born in 2003 in the Western Sweden region and 430 healthy Swedish infants born between 1991 and 1995. Results: Prone sleeping decreased from 31.8% to 5.6% and supine sleeping increased from 35.3% to 47.3%. Side or side/supine sleeping increased from 25.2% to 43.8%. Maternal smoking during pregnancy decreased from 23.5% to 9.5%. The risk for prone sleeping increased if the mother was unemployed (OR 2.4, 95% CI 1.5 to 4.0), if she was a heavy smoker in the third trimester (OR 44.1, 95% CI 1.6 to 1199.6), and if the child was irritable (OR 2.5, 95% CI 1.3 to 5.1), shared a bedroom with siblings (OR 2.6, 95% CI 1.0 to 6.6), or never used a dummy (OR 3.2, 95% CI 1.9 to 5.4). Conclusions: Parents have complied with advice to prevent SIDS given at infant welfare centres for the last 10 years. A change in the preferred sleeping position from side variants to exclusively supine, and reducing the number of pregnant women smoking may be beneficial. Use of a prone sleeping position was associated with maternal employment status, maternal smoking, temperament of the child, dummy use, and sharing a bedroom with siblings.