Early exposures and inherent factors in premature newborns are associated with type 1 diabetes.

Autor: Zargari I; Pediatric Endocrinology Unit, Division of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Adar A; Pediatric Endocrinology Unit, Division of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Morag I; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Neonatal Intensive Care Unit, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel., Pinhas-Hamiel O; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel., Eyal O; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel., Keidar R; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Neonatal Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel., Loewenthal N; Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel., Levy M; Pediatric Diabetes and Obesity Clinic, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel., Dally-Gottfried O; The Center for Juvenile Diabetes and Pediatric Endocrinology and Pediatric Outpatient Clinics, Rebecca Ziv Hospital, affiliated to The School of Medicine, Bar Ilan University, Safed, Israel., Landau Z; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Endocrinology and Diabetes Unit, E. Wolfson Medical Center, Holon, Israel., Levy-Khademi F; The School of Medicine in the Hebrew University of Jerusalem, Jerusalem, Israel.; Division of Pediatric Endocrinology, Shaare Zedek Medical Center, Jerusalem, Israel., Eventov-Friedman S; The School of Medicine in the Hebrew University of Jerusalem, Jerusalem, Israel.; Neonatal Intensive Care Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Zangen D; The School of Medicine in the Hebrew University of Jerusalem, Jerusalem, Israel.; Division of Pediatric Endocrinology, Hadassah Hebrew University Medical Center, Jerusalem, Israel., Youngster I; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Pediatric Infectious Diseases Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel., Rachmiel M; Pediatric Endocrinology Unit, Division of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel. mariannar@shamir.gov.il.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. mariannar@shamir.gov.il.
Jazyk: angličtina
Zdroj: Pediatric research [Pediatr Res] 2023 Oct; Vol. 94 (4), pp. 1516-1522. Date of Electronic Publication: 2022 Apr 29.
DOI: 10.1038/s41390-022-02069-w
Abstrakt: Background: Pathophysiology of type 1 diabetes (T1D) involves immune responses that may be associated with early exposure to environmental factors among preterm newborns. The aim of this work was to evaluate for association between T1D and maternal, nutritional, and medical exposures during the neonatal period among premature newborns.
Methods: This is a multicenter, matched case-control study. Preterm newborns, who developed T1D before 18 years, were matched by sex, gestational age (GA), birth date, and medical center of birth with newborns who did not develop TID. Data included maternal medical history, birth weight (BW), length of hospitalization, enteral and parenteral medications, fluid administration, and feeding modalities during hospitalization.
Results: Fifty-two patients with T1D, 26 males, median age at T1D diagnosis 8.17 years (5.92-9.77), median GA 34 weeks (33-m36), and 132 matched controls, were included. Multivariate-conditional-regression demonstrated a significant association between T1D and any maternal illness (23.1% vs. 9.1%, OR = 4.99 (1.69-14.72), p = 0.004), higher BW-SDS (0.07 ± 0.95 vs. -0.27 ± 0.97, OR = 2.03 (1.19-3.49), p = 0.01), longer duration of glucose infusion (3 (1-5) days vs. 2 (0-4), OR = 1.23 (1.03-1.46), p = 0.02), and antibiotic therapy beyond the first week of life (19.2% vs. 6.9%, OR = 5.22 (1.32-20.70), p = 0.019). Antibiotic treatment during the first week of life was negatively associated with T1D (51.9% vs. 67.2%, OR 0.31 (0.11-0.88), p = 0.027).
Conclusions: A novel association was demonstrated between the development of T1D and early interventions and exposures among preterm newborns.
Impact: Type 1 diabetes mellitus during childhood may be associated with early exposures during the neonatal period, in addition to known maternal and neonatal metabolic parameters. Early exposure to intravenous antibiotics, differing between the first week of life and later, and longer parenteral glucose administration to preterm newborns were associated with childhood type 1 diabetes. This is in addition to familiar maternal risk factors. Future prospective studies should examine the microbial changes and immune system characteristics of preterm and term neonates exposed to parenteral antibiotics and glucose treatment, in order to validate our exploratory findings.
(© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)
Databáze: MEDLINE
Externí odkaz: