Relationship between all fevers or fever after vaccination, and atopy and atopic disorders at 18 and 36 months

BACKGROUND: Studies have reported that early febrile episodes and febrile episodes with infections are associated with a decreased risk of developing atopy. OBJECTIVE: To examine further the association between presence of and number of febrile episodes are with atopy and atopic diseases and if there was a difference between all fevers and fever after vaccination. METHODS: We studied 448 infants in a Singapore mother-offspring cohort study (Growing Up in Singapore Towards Healthy Outcomes) which had complete data for the exposures and outcomes of interest. Fever was defined as more than 38.0℃ and was self-reported. The presence of and number of febrile episodes were examined for association with outcome measures, namely parental reports of doctor-diagnosed asthma and eczema, and rhinitis, which was evaluated by doctors involved in the study at 18 and 36 months. These outcomes were considered atopic if there were 1 or more positive skin prick tests. RESULTS: The presence of all fevers from 0–6 months of age was associated with reduced odds of having atopy at 36 months of age (unadjusted odds ratio [OR], 0.628; 95% confidence interval [CI], 0.396–0.995). The presence of fever after vaccination from 0–24 months of age was associated with reduced odds of having atopy at 36 months of age (OR, 0.566; 95% CI, 0.350–0.915). The presence of all fevers from 0–6 months of age was associated with reduced odds of having atopic eczema at 36 months (OR, 0.430; 95% CI, 0.191–0.970). Fever was associated with increased odds of having doctor-diagnosed asthma and rhinitis. CONCLUSION: There was an inverse relationship between the presence of all fevers from 0–6 months of age and the development of atopy and eczema at 36 months of age. Fever after vaccination might be considered a subclinical infection that did not show the same effect in early life.

The methodology of the GUSTO cohort study: a novel approach in studying pediatric allergy

Growing Up in Singapore Towards healthy Outcomes (GUSTO) is Singapore's largest birth cohort study to date. The main aim of GUSTO is to evaluate the role of developmental factors in the early pathways to metabolic compromise. Detailed data is collected for a range of environmental exposures in the parents and offspring, and allergic disorders are among a number of outcomes assessed in infancy and childhood. Under the Allergy domain of GUSTO, this integrated study will describe the epidemiology of allergic manifestations and different phenotypes in the Asian context and help shed light on the association of metabolic disease to allergy. Epigenetic mechanisms and associations with other childhood disorders will also be explored. The aim of this report is to focus on methodology of GUSTO, and to suggest similar approaches (i.e., integrated cohort studies on pediatric allergy) worldwide. Recruitment commenced in 2009 with a cohort of 1,163 pregnant mothers in their first trimester. The mothers and children were followed throughout pregnancy and follow-up will continue until the child reaches 3 years of age. Preliminary results showed that 39.8% of the mothers had a personal history of having at least one allergic disease, which included asthma, eczema and allergic rhinitis. Further data collection and analyses are still ongoing. Allergy is a complex spectrum of disorders with numerous poorly-understood aspects. The ongoing GUSTO cohort study, with its longitudinal design and multi-disciplinary nature, may provide new insights into developmental influences on allergy. As a Singapore-based study, it will be the first integrated allergy cohort in Southeast Asia, of which recruitment started during pregnancy.

Comparison of bedside test kits for prediction of preterm delivery: phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) test and fetal fibronectin test

<p><b>OBJECTIVE</b>The objective of the study was to compare the effectiveness of bedside test kits for pIGFBP-1 and fetal fibronectin test in predicting preterm delivery.</p><p><b>MATERIALS AND METHODS</b>Patients presenting with symptoms of preterm labour between 24 and 34 weeks of gestation were recruited. Both pIGFBP-1 and fetal fibronectin bedside tests were performed. Managing obstetricians and patients were blinded to the pIGFBP-1 and fetal fibronectin results. Tocolysis and steroid therapy were administered to all the recruited patients. Outcome data were collected after delivery.</p><p><b>RESULTS</b>One hundred and eight patients were recruited into the study. Fourteen patients had to be excluded from the final analysis due to incomplete data and failure to meet inclusion criteria. Ninety-four patients had complete data for analysis. Among those with negative pIGFBP-1 and fetal fibronectin results, the median [+/-standard deviation (SD)] gestational age at delivery was 37.4 weeks (+/-2.8 weeks) and 37.4 weeks (+/-2.1 weeks), respectively. Among those with positive pIGFBP-1 and fetal fibronectin results, the median (+/-SD) gestational age at delivery was 32.9 weeks (+/-4.0 weeks) and 34.2 weeks (+/-4.2 weeks), respectively (P <0.001 for both pIGFBP-1 and fetal fibronectin). A positive result with either test was associated with a significantly reduced admission-to-delivery interval. The median admission-to-delivery interval was 2.8 weeks shorter in the group with positive pIGFBP-1 results compared to those with a negative pIGFBP-1 result (2.3 weeks compared with 5.1 weeks) (P <0.001). This is 1.8 weeks shorter in the group with positive fibronectin results, compared to those with a negative result (3.3 weeks compared with 5.1 weeks) (P=0.002). Both pIGFBP-1 and fetal fibronectin tests have high negative predictive value (NPV) in predicting risk of delivery within 48 hours, 7, or 14 days (1.00; 0.92; 0.92 and 0.97; 0.89; 0.89, respectively).</p><p><b>CONCLUSIONS</b>Both pIGFBP-1 and fetal fibronectin tests are effective adjuvant bedside test kits for the prediction of preterm delivery in patients presenting with signs or symptoms of preterm labour. pIGFBP-1 has the higher NPV of 1.00 in predicting risk of delivery within 48 hours.</p>