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Master Thesis

Analyse de l’effet dose de l’exposition au tabagisme passif anténatal sur l’hospitalisation de nourrissons de moins de 2 ans pour dyspnée sifflante, au CHU de Bordeaux

Abstract : Introduction: preschool wheezing is a multifactorial disease whose expression depends on the environment. The frequency of hospitalization for wheezing increases. Prenatal tobacco smoke exposure increases the risk of asthma, there would be a dose response relation associated with this risk. 17% of women still report smoking during pregnancy. The objective of this study is to analyze the dose response relation of prenatal tobacco smoke exposure on the duration of hospitalization for wheezing in asthmatic infants under 24 months of age. The other objectives focus on the dose response relation on other parameters associated with the conditions of hospitalization and access to healthcare. Methods: it is an observational retrospective and mono-centric study. Included patients were infants with pre-school asthma, under 24 months, who had been hospitalized for at least one episode of wheezing, from January 2015 to May 2016 at the Bordeaux children's Hospital. Data collection was performed through a phone questionnaire directed to mothers of hospitalized infants. The primary endpoint was the ratio of the duration of the hospitalization stay, in days, to age, in months. Results: out off 237 patients meeting the inclusion criteria, we obtained 129 responses to the questionnaire. 36.4% had been exposed to prenatal tobacco smoke exposure compared to 63.6% unexposed. The average number of cigarettes consumed daily during pregnancy was 7.6 ± 4.7 (full range [1-20]). Between the 2 groups, there was a significant difference in the duracion of the hospitalization stay/age : 0.58 days / month in the unexposed group versus 0.9 days / month in the exposed group, p = 0.008. In univariate analysis, the consumption of one cigarette per day during pregnancy was statistically associated with an increase in the duration of hospitalization of 0.055 days / month over the first 2 years of life (slope = 0.055, correlation coefficient = 0.238, p = 0.006). In multivariate analysis, after adjusting for confounding factors, this positive association still existed but with less effect (β = 0.04, p = 0.04). Analysis of the secondary endpoints revealed a dose response relation between prenatal tobacco smoke exposure and the severity of the dyspnea during the hospitalization, maternal experience, age of first wheezing episode, use of emergency department. Discussion: we have demonstrated a dose response relation between prenatal tobacco smoke exposure and the duration of hospitalization. This association is moderate, limited by several biases, but it exists. A 12-month-old infant exposed to maternal smoking of 10 cigarettes per day has a 6-day longer hospital stay for asthma than an unexposed infant. We must continue our prevention efforts and hope that they are integrated by the target population. The pediatrician is in the front line to convey prevention messages during the hospitalization of children for respiratory problems.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01804585
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Cyrielle Collet. Analyse de l’effet dose de l’exposition au tabagisme passif anténatal sur l’hospitalisation de nourrissons de moins de 2 ans pour dyspnée sifflante, au CHU de Bordeaux. Médecine humaine et pathologie. 2018. ⟨dumas-01804585⟩

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