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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis
Evanthia Perikleous, Sotirios Fouzas, Athina Karageorgiou, Paschalis Steiropoulos, Evangelia Nena, Athanasios Chatzimichael, Aggelos Tsalkidis, Emmanouil Paraskakis
Evanthia Perikleous, Athina Karageorgiou, Athanasios Chatzimichael, Aggelos Tsalkidis, Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
Sotirios Fouzas, Department of Paediatrics, University Hospital of Patras, University of Patras, Patra 26504, Greece
Paschalis Steiropoulos, Department of Pneumonology, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
Evangelia Nena, Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupoli 68100, Greece
Emmanouil Paraskakis, Paediatric Respiratory Unit, Paediatric Department, University of Crete, Heraklion 71500, Greece
Author contributions: Perikleous E and Paraskakis E designed the study, drafted the initial manuscript, and revised the manuscript; Fouzas S performed the analyses and data interpretation and drafted the initial manuscript; Perikleous E, Karageorgiou A and Paraskakis E participated in the data acquisition; Steiropoulos P, Nena E and Paraskakis E contributed to the initial conception of the study; Steiropoulos P, Nena E, Chatzimichael A, Tsalkidis A and Paraskakis E supervised the drafting of the initial manuscript and made critical revisions related to the intellectual content of the manuscript; all authors provided their approval for the final version to be published.
Institutional review board statement: The Institutional Review Board of University General Hospital of Alexandroupolis provided approval for this study (IRB No. 23927/2382/02.01.2017).
Informed consent statement: Parental approval was obtained prior to inclusion for all involved infants.
Conflict-of-interest statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article and its tables/figures. Raw data, without patient's personal information, are available upon reasonable request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Evanthia Perikleous, MD, MSc, Consultant Physician-Scientist, Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Dragana 68100, Alexandroupoli 68100, Greece. eviperikleous@hotmail.com
Received: May 9, 2021
Peer-review started: May 9, 2021
First decision: June 17, 2021
Revised: June 30, 2021
Accepted: October 25, 2021
Article in press: October 25, 2021
Published online: November 9, 2021
Processing time: 183 Days and 8.4 Hours
ARTICLE HIGHLIGHTS
Research background
Bronchiolitis is a common viral infection of lower airways and a major cause of morbidity and mortality globally, especially among infants with concomitant medical conditions. The positive effects of breastfeeding are uncontested in infant’s health in the short- and long-term.
Research motivation
There are sufficient data suggesting the advantageous effects of breastfeeding on pulmonary function, but less information regarding the influence of breastfeeding on lung function in infants with acute bronchiolitis.
Research objectives
To assess the effects of breastfeeding on tidal breathing flow-volume (TBFV) measurements of infants who recovered from acute bronchiolitis.
Research methods
TBFV analysis was conducted in 56 infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was assessed using a MasterScreen pediatric respiratory system (Jaeger/CareFusion, Hoechberg, Germany). All infants were tested according to European Respiratory Society/American Thoracic Society guidelines in the middle of natural sleep following feeding. Multivariate regression analysis was used to investigate the outcome of breastfeeding in terms of gender, history of prematurity, and family history of atopy. All analyses were conducted in IBM SPSS version 25.
Research results
There were no differences in baseline TBFV measurements between breastfeeding groups; however, children who breastfed less than 2 mo had a greater tPEF/tE change after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Additionally, a distinct dose-response relationship between tPEF/tE reversibility and duration of breastfeeding was shown (P < 0.001). In multivariable regression analysis, infants who breastfed less (beta -0.335, P = 0.010) or were exposed to cigarette smoke (beta 0.353, P = 0.007) exhibited a higher tPEF/tE change after bronchodilation, irrelevant of sex, prematurity, and family history of asthma or atopy.
Research conclusions
Infants who recovered from acute bronchiolitis and had a shorter duration of breastfeeding or were exposed to cigarette smoke, had TBFV analyses indicative of obstructive lung disease, independently of other confounding factors. Tidal breathing is undoubtedly a complicated procedure, but its measurement during infancy is promising.
Research perspectives
Additional large-scale studies are required to determine the mechanisms by which acute bronchiolitis may affect lung function in early infancy as well as later in life.
