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Author: admin, 02.12.2015. Category: Cause Of Ringing In Ears

Background: Prenatal and early-life periods may be critical windows for harmful effects of air pollution on infant health. Objectives: We studied the association of air pollution exposure during pregnancy and the first year of life with respiratory illnesses, ear infections, and eczema during the first 12–18 months of age in a Spanish birth cohort of 2,199 infants. Methods: We obtained parentally reported information on doctor-diagnosed lower respiratory tract infections (LRTI) and parental reports of wheezing, eczema, and ear infections. Conclusions: Our findings support the hypothesis that early-life exposure to ambient air pollution may increase the risk of upper and lower respiratory tract infections in infants. Citation: Aguilera I, Pedersen M, Garcia-Esteban R, Ballester F, Basterrechea M, Esplugues A, Fernandez-Somoano A, Lertxundi A, Tardon A, Sunyer J. Most studies investigating the effects of outdoor air pollution on respiratory health, allergic symptoms, and ear infections during early childhood have focused on postnatal exposure, and only some of them have applied air pollution modeling techniques to obtain individual estimates of exposure (Brauer et al.
Our aim was to investigate, in a Spanish population-based birth cohort, associations of exposure to outdoor air pollution during pregnancy and during the first year of life with respiratory illness, eczema, and ear infections during the first 12–18 months of life.
Statistical analyses were performed using Stata version 10.1 (StataCorp, College Station, TX, USA). About 37% of the infants had a diagnosis of LRTI during the first 12–18 months of life (Table 2), with almost all (98%) classified as bronchitis or bronchiolitis. Table 2 – Children reported to have had at least one episode of each health outcome during the first 12–18 months of age [n (%)].
Figure 1 – Distribution of exposures to outdoor NO2 (A) and benzene (B) during pregnancy and first year of life by study area. Unadjusted and adjusted associations between exposure to air pollutants and development of health outcomes based on random-effects meta-analyses are shown in Table 3.
RRs for LRTI and ear infections in association with exposure to NO2 and benzene were slightly higher for exposure during the second trimester compared with other trimesters. Figure 2 – Adjusted associations from random-effects meta-analyses between exposure to outdoor NO2 or benzene during pregnancy and LRTI, wheezing, eczema, and ear infections at 12–18 months of age in several subsamples of the cohort. In this prospective birth cohort study, we found associations with exposure to ambient air pollution during pregnancy and the first year of life with LRTI and ear infections during the first 12–18 months of life, although the high correlation between pre- and postnatal exposures did not allow us to identify whether either or both periods were driving the observed effects. We found similar patterns in the associations for NO2 and benzene despite their moderate correlation. Differences in the proportions of children reported to have one or more episodes of each outcome may reflect differences in the length of follow-up among the four areas, which ranged from 12 to 18 months.
A major strength of our study is the prospective design beginning in early pregnancy, which allowed us to collect individual data on health outcomes and potential confounders using similar protocols in the four study areas.
The main limitation is that health data were obtained through questionnaires rather than clinical records.
Associations between NO2 and LRTI, and to a lesser extent wheezing, are consistent with positive associations previously reported for respiratory infections and wheezing among 2-year-old infants in other European areas with similar NO2 exposure levels (Brauer et al. Pre- and postnatal exposure to tobacco smoke is a risk factor for ear infections in early childhood, but evidence of an effect of ambient air pollution is inconclusive (Heinrich and Raghuyamshi 2004). Several studies have also estimated associations between prenatal exposure to air pollution and respiratory health outcomes early in life. Air pollution exposures during pregnancy and first year of life tend to be highly correlated, which limits the interpretation of estimates from mutually adjusted models (Clark et al. A pooled analysis of 12 studies on parental smoking and children’s respiratory health suggested independent effects of pre- and postnatal tobacco smoke exposures (Pattenden et al.
The exact mechanism whereby in utero exposure to ambient air pollution might increase the risk of postnatal respiratory infections is not known, but it has been hypothesized that air pollutants may affect the developing immune system which could increase susceptibility to virally induced infections after birth (Jedrychowski et al. This study supports the hypothesis that in utero or early exposure to ambient air pollution may affect the development of the respiratory system and increase the risk of upper and lower respiratory tract infections. EHP is now using Editorial Manager for manuscript submissions. All user accounts have been transferred to Editorial Manager—just log into Editorial Manager and reset your password. DisclaimerPublication of articles in EHP does not mean that the National Institute of Environmental Health Sciences (NIEHS) condones, endorses, approves, or recommends the use of any products, services, materials, methodology, or policies stated therein.
A Finnish study finds babies who grow up with pets - especially dogs - are less likely to develop colds and other respiratory infections by the time they're toddlers.
The study, published online July 9 in Pediatrics, tracked 397 kids in Finland from before they were born until they turned 1-year-old.
The researchers determined that 245 of the babies had a dog in the home (62 percent) and 136 babies (34 percent) had cat contact. While respiratory infections and symptoms such as colds and wheezing are common in infants, an analysis revealed that babies who had early contact with dogs or cats were significantly healthier during the study and were 30 percent less likely to experience coughs, ear infections and symptoms such as stuffiness, runny nose, sneezing and congestion (rhinitis).
Babies born in homes with dogs were also 44 percent less likely to develop another common ailment in kids: ear infections. The strongest benefits were seen in children who had a dog inside at home for six hours a day or fewer, rather than at home all day, which might suggest what dogs track in may help boost early immunity.
What's more, bringing a pet in the home in the hopes of curing a child with severe or allergies or asthma may not have the intended effect. Fancy living somewhere with low taxes, affordable real estate and a reasonable cost of living? Choose your location from the list below to access local contests, events, resources and other local parenting and family info.
If your local area isn’t listed hit close for national contests, recipes, blogs and great parenting information. The overuse of antibiotics to treat ear infections is on the rise, but what many parents don’t realize is that 80% of kids will get better without needing an antibiotic at all.  In fact, the American Academy of Pediatrics recommends a “watch and wait” period of 48-72 hours to see if symptoms resolve prior to resorting to antibiotics (1). Perform lymphatic massage to promote fluid drainage.  Apply gentle pressure adjacent to the ear massaging towards the cheek and down the sides of the neck (3). Speak to your Naturopathic Doctor about other immuno-supportive therapies like: Echinacea, elderberry, vitamin D, probiotics, and fish oil that may be appropriate for your child (4). Children are 6-24 months of age and have signs of a severe infection, or are experiencing symptoms in both ears. We estimated individual exposures to nitrogen dioxide (NO2) and benzene with temporally adjusted land use regression models.
Aguilera, Centre for Research in Environmental Epidemiology, Doctor Aiguader 88, 08003 Barcelona, Spain. A population-based birth cohort was established between 2003 and 2008 in four Spanish regions (Asturias, Gipuzkoa, Sabadell, and Valencia) as part of the multicenter INMA-INfancia y Medio Ambiente [Environment and Childhood] project. We developed area-specific land use regression (LUR) models of nitrogen dioxide (NO2) and benzene to estimate residential-based exposures during pregnancy and the first year of life. LUR models were applied to predict outdoor levels of both pollutants at the residential addresses. Information on doctor-diagnosed lower respiratory tract infection (LRTI) and symptomatic wheezing, eczema, and ear infections were obtained through interviewer-led questionnaires at each follow-up.
Potential confounding and effect modification variables (Table 1) were obtained through questionnaires administered during the first and third trimesters of pregnancy, at birth, and during infants’ follow-up. Most women were nulliparous (58%), nonsmokers during the entire pregnancy (82%) but exposed to passive smoking (62.5%), and had at least secondary education (77%). Thirty-eight percent of mothers reported that their child had one or more symptomatic episodes of wheezing, 33% reported one or more ear infections, and 22% reported at least one episode of eczema.


Boxes extend from the 25th to the 75th percentile, horizontal bars represent the median, whiskers extend 1.5 times the length of the IQR above and below the 75th and 25th percentiles, respectively, and outliers are represented as points. Because most of the associations were adjusted by cotinine levels measured in urine at 32 weeks of pregnancy, which reflect very recent exposure to tobacco smoke, we ran additional models adjusted for questionnaire-based smoking variables instead, but associations remained essentially unchanged (data not shown). We did not find clear or consistent evidence of associations between exposure to air pollution and eczema or wheezing symptoms. NO2 is a widely used marker of traffic-related air pollution, whereas benzene levels can reflect both traffic and industrial activities, depending on the characteristics of the study area.
All outcomes were more common in Asturias than in the other study areas, possibly because mothers reported on illnesses through 18 months when their children were 29 months of age on average, which could have led to over-reporting of outcomes.
An additional strength is the use of temporally adjusted LUR models to estimate individual exposures during specific time periods.
Recall bias and potential misclassification of the outcomes are possible, particularly in infants with less distinctive symptoms as compared with older children (Braback and Forsberg 2009). Two recent studies reported modest but significant positive associations between short-term air pollution exposure and emergency department visits for ear infections (Zemek et al. Some of the factors that increase the risk of wheezing and respiratory infections in infants have less or no association with atopic eczema, which suggests differences in etiology between eczema and wheezing in infancy (Linneberg et al. Infants from a Polish cohort whose mothers were exposed to higher levels of polycyclic aromatic hydrocarbons during pregnancy (measured through 48-hr personal monitoring) had more frequent and longer episodes of several respiratory symptoms during the first year of life, including ear infections and wheezing (Jedrychowski et al. The high correlation between exposures during pregnancy and first year of life did not allow us to disentangle associations with pre- versus postnatal exposures. Conclusions and opinions are those of the individual authors and advertisers only and do not reflect the policies or views of the NIEHS. Weekly questionnaires were given to parents that asked about their child's health and whether they owned a pet. By study's end, 65 percent of children lived in homes without a dog and almost 76 percent lived in a cat-free home, so not everyone with a pet had it throughout the entire study. Kids with dogs were also 29 percent less likely to have used antibiotics in the past year than children without pets. Kristi Prince, ND is a Naturopathic Doctor in Cobourg with a focus on Family Medicine and Women's Health.  She is also a soon-to-be registered lactation consultant. We used log-binomial regression models and a combined random-effects meta-analysis to estimate the effects of air pollution exposure on health outcomes across the four study locations. Early-Life Exposure to Outdoor Air Pollution and Respiratory Health, Ear Infections, and Eczema in Infants from the INMA Study. Ear infections are one of the leading causes of physician visits in young children as a major complication of a preceding upper respiratory infection, and they have been moderately associated with ambient air pollution (Brauer et al. Women were enrolled during the first routine prenatal care visit at the primary health care center or hospital, provided that they fulfilled the inclusion criteria (age ? 16 years, wish to deliver in the reference hospital, no communication problems, singleton pregnancy, and no assisted conception) (Guxens et al. Ambient levels of NO2 and benzene were measured with Radiello passive samplers during several periods of one week each (Fundazione Salvatore Maugeri, Padua, Italy). For women and infants who changed their residential address during the study period, we calculated an average exposure estimate weighted by the time spent at each residence.
Cotinine levels were measured in a 24-hour sample of urine collected in the third trimester of pregnancy using the Cotinine 175 Micro-Plate EIA Kit (Ora Sure Technologies, Inc., Bethlehem, PA, USA). Similarly, for postnatal exposures we estimated associations in the subset of infants who were not attending child care at the time of follow-up, under the assumption that they spent more time at or around their residence. The percentage of maternal smoking increased in the postnatal follow-up (26%) but remained lower than paternal smoking (39%). The latter outcome is also positively associated with exposure to both pollutants during the first year of life. Because swimming pool attendance was particularly high in the Sabadell cohort at 14 months of age (65% vs. Rather than a potential causative agent by itself, benzene may be acting as a surrogate for a mixture of predominantly traffic-driven pollutants, similar to NO2.
Excluding infants from Asturias resulted in wider CIs, particularly for RRs associated with benzene exposure, but associations were not modified to any great extent. However, despite their spatial accuracy, LUR estimates are still a proxy for personal exposure, which may be influenced by individual time–activity patterns (Nethery et al. In contrast with studies that characterize exposures based on measurements from nearest fixed monitoring stations (Mortimer et al.
However, associations between in utero exposure and respiratory outcomes in children appear to decline with age (Zlotkowska and Zejda 2005). We found slightly stronger associations with exposures during the second trimester of pregnancy, although differences must be interpreted with caution given the moderate to high correlations among trimester-specific exposures and the small differences in effect estimates. Further study of this birth cohort is needed to determine whether exposure to air pollution during the first years of life is associated with the development of asthma at later ages. Does traffic exhaust contribute to the development of asthma and allergic sensitization in children: findings from recent cohort studies. Air pollution from traffic and the development of respiratory infections and asthmatic and allergic symptoms in children.
Outdoor, but not indoor, nitrogen dioxide exposure is associated with persistent cough during the first year of life.
Residential exposure to outdoor air pollution during pregnancy and anthropometric measures at birth in a multicenter cohort in Spain. Prenatal exposure to residential air pollution and infant mental development: modulation by antioxidants and detoxification factors.
Prenatal ambient air exposure to polycyclic aromatic hydrocarbons and the occurrence of respiratory symptoms over the first year of life.
Effects of prenatal and perinatal exposure to fine air pollutants and maternal fish consumption on the occurrence of infantile eczema. Influence of ambient air pollutant sources on clinical encounters for infant bronchiolitis. Differential effects of risk factors on infant wheeze and atopic dermatitis emphasize a different etiology. Polycyclic aromatic hydrocarbons, environmental tobacco smoke, and respiratory symptoms in an inner-city birth cohort. Residential proximity to main roads during pregnancy and the risk of allergic disorders in Japanese infants: the Osaka Maternal and Child Health Study. Respiratory health and individual estimated exposure to traffic-related air pollutants in a cohort of young children. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children.
Air pollution and pulmonary function in asthmatic children: effects of prenatal and lifetime exposures. Parental smoking and children’s respiratory health: independent effects of prenatal and postnatal exposure. Air pollution and emergency department visits for otitis media: a case-crossover study in Edmonton, Canada. More contact with the dog was associated with fewer health problems in general, which led the researchers to believe that early contact with an animal may mature the immune system in infancy, helping toddlers better ward off disease.Owning a cat was also tied to protective health benefits, but the effect was much weaker.


Associations were slightly stronger among infants whose mothers spent more time at home during pregnancy. Measurements taken in the different sampling campaigns were averaged to represent annual mean levels in each study area. We derived individual exposures to NO2 and benzene during pregnancy by multiplying the LUR estimate by the ratio between the average concentrations measured at the fixed stations over the woman’s pregnancy period and over the whole air pollution sampling period. Parents were also asked whether the children had eczema, wheezing episodes, and ear infections from birth until follow-up.
In a second step, we performed a meta-analysis using random-effects models combining the relative risk estimates from each area, and estimated p-values for the chi-square test for heterogeneity.
The percentage of missing data among the covariates ranged from 0 to 5.4% (data not shown). NO2 exposure estimates were higher in the predominantly urban Valencia and Sabadell cohorts, whereas benzene levels were highest in Asturias, probably due to the additional contribution of industrial emissions (Figure 1). Relative risk estimates suggest a positive association between postnatal exposure to benzene and eczema, but the rest of RRs for this outcome are close to unity. 45% in the other cohorts), we stratified the analysis by this variable, but RRs for ear infections and NO2 were comparable in both groups (results not shown).
In general, associations were slightly stronger for air pollution exposure during the second trimester of pregnancy compared with other trimesters.
Results from the few existing cohort studies on air pollution and eczema or allergic sensitization in young children are inconsistent, and comparisons are limited by differences in exposure assessment among studies (Brauer et al.
Pre- and postnatal exposures to several air pollutants, including NO2, have been positively associated with asthma in preschool-age children (Clark et al. 2008), our exposure assessment approach emphasized spatial over temporal variation, which may have contributed to the very high correlations between pre- and postnatal exposures in our study. From a biological perspective, both periods are likely to influence respiratory health given that lung development is a continuum of different phases that start in the embryogenesis and finish in early adolescence (Pinkerton and Joad 2006). To our knowledge, apart from the study in the Valencia subsample of the INMA cohort (Esplugues et al. Air pollution exposure during the first year was highly correlated with prenatal exposure, so we were unable to discern the relative importance of each exposure period. Follow-up interviews were performed during the third trimester of pregnancy, and for infants at 6 and 18 months in Asturias, at 14 months in Gipuzkoa, at 6 and 14 months in Sabadell, and at 12 months in Valencia. Potential predictor variables such as traffic indicators, surrounding land uses, topography, and population density were derived in the geographic information system ArcGIS version 9.1 (ESRI, Redlands, CA, USA).
We applied the same procedure to estimate exposures during each trimester of pregnancy and the first year of life. For these outcomes, parents were not specifically asked to report doctor-diagnosed conditions only. As a comparative analysis, we performed additional models using a biological approach: We included all the a priori selected covariates regardless of their p-value or effect on the exposure–outcome association. Finally, we stratified by duration of breastfeeding (none, ? 6 months and > 6 months), maternal intake of fruits and vegetables during pregnancy (categorized using the median value), and maternal circulating vitamin D (categorized by tertiles) to examine potential effect modification by factors that may increase antioxidant and detoxification capacity, as suggested in a recent analysis of air pollution and neurodevelopment in the same cohort (Guxens et al. There are no substantial differences between crude and adjusted effect estimates for any of the two pollutants.
Associations were slightly stronger when we limited analyses to infants whose mothers spent more time at home during pregnancy, both in the present study and in a previous analysis of birth outcomes (Estarlich et al. 1995), and many children who wheeze early in life have only a few episodes and do not wheeze at later ages. Results from the sensitivity analyses did not clarify the relative importance of each exposure period, because infants who did not attend child care were also more prone to be born to mothers who had spent more time at home during pregnancy. 2011), only one other cohort study of 232 asthmatic children assessed trimester-specific exposures during pregnancy in relation to allergic sensitization at 6–11 years of age (Mortimer et al.
The hospital ethics committees in the participating regions approved the study, and all women provided written informed consent before participation.
Multiple linear regression models were built using a supervised forward stepwise procedure.
We also estimated relative risks associated to an interquartile range (IQR) increase in NO2 and benzene exposure to be able to compare the effect of the two pollutants on health outcomes. Models adjusted for all of the potential covariates identified a priori produced slightly higher RRs with wider 95% CIs (results not shown). Excluding the Asturias cohort did not show meaningful differences for any of the outcomes and resulted in wider confidence intervals for all the RRs for benzene exposure. 2011), but we did not observe consistent changes in estimates after excluding infants attending child care at the time of follow-up. Nevertheless, even transient early wheeze is associated with asthma diagnosis later in childhood (Savenije et al. In a subset of 352 children from the present study, LUR estimates of NO2 exposure levels during pregnancy and home outdoor measurements of NO2 in the first year of life were not significantly associated with LRTI or with wheezing during the first year of life (Esplugues et al. Therefore, it is not clear from our data which period (if any) was more relevant to health effects. The first years of life are thought to be the most important period for the development of asthma and allergies (Landau 2006).
There is increasing evidence from experimental and epidemiologic studies that the prenatal period is a critical window for harmful effects of toxic chemicals on respiratory health early in life and beyond (Pinkerton and Joad 2006). Traffic-related variables, altitude, and land uses (urban, industrial, or agricultural) were the main predictor variables in the final LUR models. Associations were essentially unchanged when preterm births and low birth weight children were excluded, as well as after excluding infants whose mothers smoked during pregnancy or after birth. Because both the respiratory and immune systems are still under development, exposure to air pollution during this period may be critical for lasting adverse effects on respiratory health (Bateson and Schwartz 2008). However, the effect of air pollution exposure during pregnancy on respiratory health and allergic responses early in life has been examined in only a small number of studies; these differed considerably with regard to exposure assessment and outcome definitions, which included physician records of asthma diagnosis (Clark et al.
Models explained 52–75% of the variability in measured NO2 levels, and 44–73% of the variability in measured benzene levels, depending on the study area.
Further research on the effect of air pollution exposure during specific developmental periods in utero may contribute to identify the relevant mechanism(s) involved.
2005, 2011), and symptoms such as cough, sore throat, runny nose, or difficult breathing (Jedrychowski et al. The RRs close to unity for eczema in association with NO2 exposure in our study are consistent with their findings. 2010), and only one examined associations according to the time period of exposure during pregnancy (Esplugues et al.



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