Early Daycare Attendance Research Articles

Small-for-Gestational-Age Status and the Risk of Kawasaki Disease: A Nationwide Birth Cohort in Japan.

Kawasaki disease (KD) is a pediatric disease of unknown etiology that commonly affects infants in East Asia. Infants born small for gestational age (SGA) have weaker immune systems and are more susceptible to infection. Using data from a nationwide Japanese birth cohort study conducted in 2010 (n=34,579), we investigated whether SGA increases the risk of KD. SGA was defined as birth weight below the 10th percentile for gestational age. The outcome was hospitalization for KD between 6 and 30 months of age. The association between SGA and hospitalization for KD, adjusted for child and maternal factors, was examined using logistic regression. Of the 231 children hospitalized for KD, 9.5% were SGA. Further statistical analysis showed that SGA did not increase the odds ratio (OR) of hospitalization for KD (adjusted OR 1.12, 95% confidence interval 0.71-1.75). This result was not changed with stratification by early daycare attendance and preterm status. Reasons for the lack of association may include the multifactorial pathogenesis of KD; in addition, the types of infections to which SGA infants are predisposed may differ from those triggering KD. Overall, our large nationwide study found no association between SGA and KD.

Age-specific associations of early daycare, older siblings, severe airway infection, and preterm birth with subsequent atopic diseases.

The effects of infection and developmental adaptations in infancy on the prevalence of subsequent atopy-related diseases at different ages during childhood are not fully determined. This study aims to examine the similarities and differences in the age-specific association of asthma, allergic rhinitis/conjunctivitis, and atopic dermatitis with early-life infection-related factors (i.e., daycare, older siblings, and severe airway infection) and developmental adaptations (i.e., preterm birth and rapid weight gain) in children. In this longitudinal cohort study (n=47,015), children were followed from 0.5 to 11years. The potential risks and protective factors, including daycare attendance at 0.5years, existence of older siblings, history of hospitalization due to cold/bronchitis/bronchiolitis/pneumonia during 0.5-1.5years, preterm birth, and rapid weight gain in the first 2.5years, were assessed using multivariable logistic regression with adjustments for potential confounders. A protective association was observed between early-life daycare attendance and asthma at 5.5-9years, which disappeared after 10years. A protective association was also noted throughout childhood between early daycare attendance and older siblings with allergic rhinitis/conjunctivitis. However, the association between early daycare and atopic dermatitis was found to be risky during childhood. In contrast, the early-life history of hospitalization owing to cold/bronchitis/bronchiolitis/pneumonia was identified to be a risk factor for developing both asthma and allergic rhinitis/conjunctivitis. Preterm birth was a significant risk factor for childhood asthma. Different age-specific patterns were demonstrated in the relationship between early daycare, severe airway infection, preterm birth, and atopy-related diseases in childhood.

Atopic Dermatitis Phenotypes in Preschool and School-Age Children: A Latent Class Analysis

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in childhood. Few data are available about AD phenotypes and their nationwide distribution. We performed a cross-sectional multicenter study involving some of the main Italian pediatric allergy centers from 9 Italian cities. A structured questionnaire was administered to 371 children with AD. Patients were divided in 2 groups: preschool children (aged ≤5 years) and schoolchildren (aged 6-14 years). A latent class analysis was used to detect AD phenotypes and to investigate their association with risk factors and other atopic diseases. Latent class analysis identified 5 AD phenotypes in preschoolers ("moderate-severe AD, high comorbidity", 8%; "moderatesevere AD, low comorbidity", 35%; "mild AD, low comorbidity", 20%; "mild AD, respiratory comorbidity", 32%; "mild AD, food-induced comorbidity", 5%) and 4 AD phenotypes in schoolchildren ("moderate-severe AD, high comorbidity", 24%; "moderate-severe AD, low comorbidity", 10%; "mild AD, low comorbidity", 16%; "mild AD, respiratory comorbidity", 49%). Parental history of asthma and eczema, early day-care attendance, and exposure to molds were significantly associated with the "moderate-severe AD, high comorbidity" phenotype in preschool children (P<.05). The "moderate-severe AD" phenotypes were also associated with the highest burden in terms of medication use and limitations in daily activities. The detection of different AD phenotypes highlights the need for a stratified approach to the management of this complex disease and for further studies to predict the course of AD and to develop more efficient therapeutic strategies.

Association of early daycare attendance with allergic disorders in children: a longitudinal national survey in Japan

The association between early daycare attendance and risk of allergic diseases remains inconclusive. Therefore, we examined the association among Japanese children on a long-term basis using a nationwide longitudinal survey data. We estimated the association between daycare attendance at age 6 or 18 months and allergy development using information on outpatient visits for atopic dermatitis (AD), food allergy (FA), and asthma and admission for asthma up to 12 years of age as a proxy for developing these diseases, with multilevel logistic regression. Early daycare attendance was associated with increased odds of AD at ages 2.5–3.5 years: the adjusted odds ratio (OR) was 1.34 [95% CI: 1.21, 1.47]. The association with FA was equivocal. The odds of asthma was increased before age 3.5 years and afterwards decreased: the adjusted ORs were 1.60 [1.44, 1.77] for ages 1.5–2.5 years and 0.77 [0.69, 0.87] for ages 5.5–7 years. The effect of early daycare attendance depends on the type of allergies.

Childhood brain tumours, early infections and immune stimulation: A pooled analysis of the ESCALE and ESTELLE case-control studies (SFCE, France)

BackgroundFew studies have investigated whether early infections and factors potentially related to early immune stimulation might be involved in the aetiology of childhood brain tumours (CBT). In this study, we investigated the associations between CBT with early day-care attendance, history of early common infections, atopic conditions (asthma/wheezing, eczema, allergic rhinitis), early farm residence/visits and contact with animals. MethodsWe pooled data from two nationwide French case-control studies, the ESCALE and ESTELLE studies. Children with a CBT diagnosed between 1 and 14 years of age were identified directly from the French National Registry of Childhood Cancers, while population controls were recruited from telephone subscribers. Odds-ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression adjusted for potential confounders. ResultsThe analyses included 469 cases and 2719 controls. We found no association between attending a day-care centre (OR: 0.9, 95%CI: 0.7–1.2) or having had repeated common infections (OR: 0.9, 95%CI: 0.7–1.2) in the first year of life and the risk of CBT. There was also no association with a history of asthma/wheezing (OR: 0.8, 95%CI: 0.56–1.1). Farm visits (OR: 0.6, 95%CI: 0.5–0.8) as well as contact with pets (OR: 0.8, 95%CI: 0.6–1.0) in the first year of life were inversely associated with CBT. ConclusionsOur findings suggest a protective effect of early farm visits and contact with pets, but not with other markers of early immune stimulation. This might be related to immune stimulation but needs further investigation.

Cytomegalovirus Seroprevalence Among Children and Adolescents in Germany: Data From the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 2003-2006.

Background. Congenital cytomegalovirus (CMV) infection can cause severe birth defects. The majority of children with congenital CMV are born to CMV-seropositive women; however, transmission from mother to fetus and resulting defects are more likely to occur when mothers experience seroconversion during pregnancy. The objective of this study was to provide a population-based estimate of CMV seropositivity and to identify factors that correlate with the detection of CMV-immunoglobulin (Ig)G antibodies. Methods. Cytomegalovirus-specific IgG antibodies were determined by enzyme-linked immunosorbent assay in 13 876 serum samples from children and adolescents (aged 1-17 years). Cytomegalovirus seroprevalence was correlated with children's age, gender, migration background, country of origin, place of birth, socioeconomic status, breast feeding, daycare attendance, order and number of siblings, and residence in East versus West Germany. Results. Age-adjusted seroprevalence was 27.4% (95% confidence interval, 25.8-29.0). Cytomegalovirus seroprevalence increased with age (21.5% at ages 1-2; 32.0% at ages 14-17). Cytomegalovirus seropositivity was significantly associated with migration background, country of origin and place of birth, and (among migrants only) with low socioeconomic status. Risk factors for CMV acquisition included the birth order of siblings, breastfeeding, early daycare attendance, and living in East Germany. Conclusions. In Germany, CMV seroprevalence increases with age, irrespective of gender. These data highlight risk factors associated with seroprevalence and help to identify a target age for the application of a CMV vaccine.

Gestational Medication Use, Birth Conditions, and Early Postnatal Exposures for Childhood Asthma

Our aim is to explore (1) whether gestational medication use, mode of delivery, and early postnatal exposure correlate with childhood asthma, (2) the dose responsiveness of such exposure, and (3) their links to early- and late-onset asthma. We conducted a matched case-control study based on the Taiwan Children Health Study, which was a nationwide survey that recruited 12-to-14-year-old school children in 14 communities. 579 mothers of the participants were interviewed by telephone. Exclusive breastfeeding protected children from asthma. Notably, childhood asthma was significantly associated with maternal medication use during pregnancy, vacuum use during vaginal delivery, recurrent respiratory tract infections, hospitalization, main caregiver cared for other children, and early daycare attendance. Exposure to these factors led to dose responsiveness in relationships to asthma. Most of the exposures revealed a greater impact on early-onset asthma, except for vacuum use and daycare attendance.

Early Daycare Attendance Increase the Risk for Respiratory Infections and Asthma of Children

Objectives: To study the impact of daycare attendance on airways infections and “allergic” symptoms of children aged 1–8 years in Northeast Texas. Methods: Self-administrated questionnaires were distributed to parents through Women, Infants and Children offices, daycare centers, elementary schools, clinic centers, hospitals, and churches. The health outcomes consisted of “allergic” symptoms, and respiratory tract disorders. Questions on child care included; type of daycare settings (proxy for the number of children in daycare), time spent at daycare centers per week, and age of entry to a daycare center.Results: A total of 3766 children participated in this study, giving a response rate of 71%. Daycare attendance was associated with more frequent respiratory tract infections and “allergic” symptoms, compared to home care. A dose–response relationship between time spent at daycare centers and prevalence of respiratory tract disorders and asthma and allergies was observed. Earlier age exposure at daycare centers was a risk factor for rhinitis up to 7–8 years.Conclusions: Daycare attendance had a substantial negative influence on health status of children aged 1–8 years in Northeast Texas.

Risk Factors for Wheezing, Eczema and Rhinoconjunctivitis in the Previous 12 Months among Six-Year-Old Children in Himeji City, Japan: Food Allergy, Older Siblings, Day-Care Attendance and Parental Allergy History

The aim of this study was to clarify whether some environmental and genetic factors (food allergy, older siblings, early day-care attendance and parents' allergy history) are related to the development of allergic symptoms (wheezing in the previous 12 months [WP], eczema symptoms in the previous 12 months [EP], and rhinoconjunctivitis symptoms in the previous 12 months [RP]) in Japanese children. Using the modified version of the International Study on Asthma and Allergies in Childhood (ISSAC) questionnaire, we studied the prevalence of WP, EP and RP among six-year-old children attending 72 primary schools throughout Himeji City, Japan, during the two years from 2005 to 2006. Food allergy and parents' history of allergy showed a significant relationship with the prevalence of WP, EP and RP. Day-care attendance in the first two years of life and presence of older siblings showed a significant inverse relationship with the prevalence of RP. However, neither day-care attendance nor presence of older siblings was related to the development of W and ER. Among Japanese children, food allergy and parents' history of allergy are risk factors for WP, ES or RS. However, early day-care attendance and presence of older siblings might be protective factors against RS. Infections in early life may affect the prevalence of rhinoconjunctivitis in six-year-old children.

Early Life Factors Associated with Incidence of Physician-diagnosed Asthma in Preschool Children: Results from the Canadian Early Childhood Development Cohort Study

Background. Asthma is a common childhood illness. The objective of this study is to determine the incidence of physician-diagnosed asthma in preschool years and its relationship to host, prenatal and postnatal factors, early childhood factors, parental factors, household factors and demographic factors. Methods. The study sample was comprised of 8,499 infants and toddlers (<2 years at baseline) enrolled in the Canadian Early Childhood Development Study. Incidence of asthma was determined when the children were in preschool age (2 to 5 years). Results. The 4-year cumulative incidence at preschool age was 13.7% for physician-diagnosed asthma. History of early childhood wheezing before 2 years of age was a significant risk factor for incidence of asthma in preschool years (hazard ratio (HR): 2.32; 95% confidence interval (CI): 2.04–2.65). Factors that were protective for the development of asthma were breastfeeding more than 3 months (HR: 0.82; 95% CI: 0.69–0.97); history of nose or throat infection often in childhood (HR: 0.79; 95% CI: 0.67–0.93); early daycare attendance (HR: 0.85; 95% CI: 0.74–0.98); presence of two or more siblings at birth, (HR: 0.79; 95% CI: 0.64–0.97); and dwelling in rural non- central metropolitan areas (HR: 0.81; 95% CI: 0.69–0.95). Male sex, low birth weight, childhood allergy, single parent, maternal smoking during pregnancy, maternal medication use, parental atopy, and low SES at baseline were significant risk factors for the incidence of physician-diagnosed asthma in preschool years. Conclusion. This study emphasizes the role of wheezing in infant and toddler age on early onset of asthma during preschool years. The results also provide additional importance of early exposures to environmental factors such as early infections, daycare attendance, and rural environment in the development of proper immune dynamics to prevent asthma.

Support for 2 variants of eczema

Studies investigating the natural history and risk factors for eczema have historically considered eczema as a single entity, without regard for the individual's atopic status. The association between atopy and eczema is complex, and as many as (2/3) of patients with eczema are not atopic. To investigate the risk factors for eczema in relation to the child's atopic status in a cohort of high-risk children. A prospective birth cohort of 263 children was followed for 5 years and closely examined for eczema. Antenatal and postnatal data on environmental exposures were collected by interview. Skin prick test to define atopic status was performed at 6 months and 2 and 5 years of age. Of the subjects, 66.1% had eczema in the first 5 years, and the majority (85.5%) reported onset of rash in the first year. A third of those with eczema were not atopic (nonatopic/intrinsic eczema). Children with atopic eczema (extrinsic eczema) were more likely to be male, to have been breast-fed longer, and to have a history of food allergies, allergic rhinitis, and current wheeze. Nonatopic eczema was more common in girls, and an association was found with early daycare attendance. This study supports the presence of 2 variants of eczema: atopic eczema occurring early in childhood and nonatopic eczema with early daycare attendance. It is likely that environmental factors have a different effect on these 2 variants of eczema, and future studies should thus consider eczema as 2 variants in determining the effect of attributable risks.

Symptoms of common maternal infections in pregnancy and risk of islet autoimmunity in early childhood.

The aim of this study was to test whether symptoms of maternal infections during pregnancy and indicators of postnatal infections predict development of islet autoimmunity in children at genetically increased risk of type 1 diabetes. A total of 871 children with type 1 diabetes-associated HLA genotypes born in Denver, Colorado, and 391 siblings or offspring of individuals with type 1 diabetes referred from clinics in the Denver metropolitan area were enrolled soon after birth and seen in the clinic at age <or=15 months. Information on indicators of infection was collected by structured interviews soon after birth and at ages 3-15 months. Clinic visits were scheduled at ages 9, 15, and 24 months, and yearly thereafter. The outcome was positivity for one or more islet autoantibodies (to GAD(65), insulin, or IA-2/ICA512) at two or more consecutive visits. During a mean follow-up of 4.2 years, 52 children developed islet autoimmunity. Children whose mother reported at least one symptom of infection during pregnancy (mostly respiratory or gastrointestinal) had a significantly lower risk of islet autoimmunity compared with other children (hazard ratio 0.48; 95% CI 0.27-0.83). After stratification, the association appeared among girls (0.21; 0.09-0.48) but not among boys (1.09; 0.47-2.51) with a P value for interaction of 0.005. Symptoms of neonatal infections, early daycare attendance, exposure to cats or dogs, and household crowding were not related to islet autoimmunity. Symptoms of maternal infections in pregnancy predicted a significantly lower risk of islet autoimmunity in young girls, suggesting a protective effect of such infections.

Markers of infection, breast-feeding and childhood acute lymphoblastic leukaemia.

Infections are suspected to play a role in the aetiology of childhood leukaemia. In 1989–95, we evaluated the relation between childhood acute lymphoblastic leukaemia and pre- and postnatal markers of exposure to infection, as well as breast-feeding. A population-based case-control study was carried out in certain regions of Québec, Canada, in 1989–95 including 491 incident cases diagnosed between 1980 and 1993 and aged between 0 and 9 years. An identical number of healthy controls matched for age, sex and region of residence at the date of diagnosis was included. Having older siblings, mother's use of antibiotics during pregnancy, and being born second or later were all associated with increased risk of leukaemia while early day-care attendance (odds ratio (OR) = 0.49; 95% CI 0.31–0.77), and breast-feeding (OR = 0.68; 95% CI 0.49–0.95) were significantly protective. A marker of population mixing was not a risk factor. When including all variables defining family structure in a model, having older siblings at time of diagnosis was a risk factor among children diagnosed before 4 years of age (OR = 4.54; 95% CI 2.27–9.07) whereas having older siblings in the first year of life was protective among children diagnosed at 4 years of age or later (OR = 0.46; 95% CI 0.22–0.97). © 2000 Cancer Research Campaign http://www.bjcancer.com