Oxygen and Phototherapy in perinatal period: Risk of Acute Lymphoctyic Leukemia

围产期吸氧和光疗：急性淋巴细胞白血病的风险

• 批准号: 7319207
• 负责人: NIGEL SEFTON PANETH
• 金额: $ 7.55万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7319207
• 关键词: Acute; Acute Lymphocytic Leukemia; Acute leukemia; Age; Apgar Score; Attention; Bilirubin; Biological; Birth; Birth Certificates; Birth Weight; Caring; Case-Control Studies; Child; Childhood; Childhood Acute Lymphocytic Leukemia; Childhood Leukemia; Community Health; Condition; Confounding Factors (Epidemiology); Databases; Diagnosis; Education; Epidemiologic Studies; Ethnic Origin; Exposure to; Fetal Distress; Gender; Gestational Age; Hematologic Neoplasms; Histologic; Hospitals; Icterus; Infant; Inpatients; Intervention; Lead; Length of Stay; Link; Matched Case-Control Study; Measures; Medical Records; Mental Depression; Methods; Michigan; Mothers; Neonatal; Newborn Infant; Oxygen; Parental Ages; Perinatal; Perinatal Exposure; Phase; Phase II Clinical Trials; Phototherapy; Population; Pregnancy; Process; Records; Reproductive History; Research Proposals; Risk; Risk Factors; Rural; Serum; Week; abstracting; base; case control; day; interest; leukemia; neoplasm registry; perinatal health; perinatal intervention; residence; respiratory; Acute; Acute Lymphocytic Leukemia; Acute leukemia; Age; Apgar Score; Attention; Bilirubin; Biological; Birth; Birth Certificates; Birth Weight; Caring; Case-Control Studies; Child; Childhood; Childhood Acute Lymphocytic Leukemia; Childhood Leukemia; Community Health; Condition; Confounding Factors (Epidemiology); Databases; Diagnosis; Education; Epidemiologic Studies; Ethnic Origin; Exposure to; Fetal Distress; Gender; Gestational Age; Hematologic Neoplasms; Histologic; Hospitals; Icterus; Infant; Inpatients; Intervention; Lead; Length of Stay; Link; Matched Case-Control Study; Measures; Medical Records; Mental Depression; Methods; Michigan; Mothers; Neonatal; Newborn Infant; Oxygen; Parental Ages; Perinatal; Perinatal Exposure; Phase; Phase II Clinical Trials; Phototherapy; Population; Pregnancy; Process; Records; Reproductive History; Research Proposals; Risk; Risk Factors; Rural; Serum; Week; abstracting; base; case control; day; interest; leukemia; neoplasm registry; perinatal health; perinatal intervention; residence; respiratory

DESCRIPTION (provided by applicant): A growing body of evidence suggests that perinatal factors may increase the risk of acute lymphoblastic leukemia (ALL), the most common hematological malignancy in children. We propose to conduct a matched case-control study to investigate the relationship of ALL to 3 perinatal interventions: maternal O2 therapy, neonatal O2 therapy, and neonatal phototherapy for jaundice. For each of these exposures, a plausible biological rationale supports the hypothesis that they may contribute to the leukemogenic process, and for two of them - neonatal O2 and phototherapy - epidemiologic studies have shown associations with childhood leukemia. Maternal O2 exposures have not yet been studied in relation to ALL. Children with histologically- confirmed ALL diagnosed before age 10 and born in one of the 13 largest hospitals in Michigan from 1985- 2002 (n = 200) will be ascertained in the Michigan Cancer Registry. In Phase 1, records of ALL cases will be linked by the Michigan Department of Community Health to their birth certificates and to hospital discharge abstracts from the Michigan Inpatient Database (MIDB). From the birth certificate file, we will match 2 control surviving children of the same gender, ethnicity, birth weight ( 250 grams) and gestational age ( two weeks) born within 2 weeks of the case in the same hospital. From birth certificates we will examine parental age and education, rural vs. urban residence, mother's reproductive history, pregnancy and delivery complications in cases and controls. From MIDB we will obtain length of hospital stay, major diagnoses and major interventions. Phase II of this study expands the search for perinatal exposure information by going to hospitals of birth and care of cases and controls, and reviewing maternal and neonatal hospital (and NICU) medical records for evidence of the exposures of interest, including detailed measures of extent and duration of oxygen use in mothers and infants, and of phototherapy in infants. We will also abstract information on conditions that predispose to oxygen and phototherapy use such as fetal distress and prolonged labor (maternal O2), Apgar score, respiratory conditions (neonatal O2) and serum bilirubin levels measured at different ages (phototherapy). Studies thus far suggest that a considerable fraction of ALL might be attributable to perinatal health care interventions that could be modified. If this is so, we have a possible way to reduce the burden of ALL in the population. The study we propose, which incorporates detailed maternal and neonatal medical record information with a large, population-based approach to case ascertainment and careful matching of control children would be the first case-control study of this topic in the US, and will provide a more robust estimate of the association of perinatal oxygen and phototherapy use to ALL risk than is available now. This study will try to find out whether giving oxygen to mothers in labor, and to their babies after birth, increases the risk of acute lymphocytic leukemia later in childhood. We will also study whether phototherapy, which is used to treat jaundice in babies, might increase the risk of leukemia. If these treatments increase the risk of leukemia, it should be possible to find alternative ways to manage newborn problems that minimize exposure to these treatments

描述（由申请人提供）： 越来越多的证据表明，围产期因素可能会增加急性淋巴细胞白血病（ALL）的风险，这是儿童最常见的血液系统恶性肿瘤。我们建议进行一项匹配的病例对照研究，以研究所有与3种围产期干预措施的关系：母体O2治疗，新生儿O2治疗和黄疸的新生儿光疗。对于这些暴露中的每一个，一个合理的生物学理由支持了它们可能有助于白血病过程的假设，而对于其中的两个 - 新生儿O2和光疗 - 流行病学研究表明，它们与儿童白血病有关联。与所有人有关的母体O2暴露尚未研究。从1985年至2002年，在密歇根州的13家最大的医院之一（n = 200）中，将在组织学上确认所有被诊断出的儿童在密歇根州的13家医院之一出生。在第1阶段，密歇根州社区卫生部将所有案件的记录与他们的出生证明和医院出院摘要（MIDB）联系起来。从出生证书档案中，我们将与2个控制性别，种族，出生体重（250克）和胎龄（两周）在同一医院发生的2周内出生的幸存儿童。从出生证明中，我们将检查父母的年龄和教育，农村与城市居住，母亲的生殖历史，病例和对照中的怀孕和分娩并发症。从MIDB开始，我们将获得住院时间，重大诊断和重大干预措施。这项研究的第二阶段通过前往出生和护理病例和控制的医院来扩展寻找围产期暴露信息，并审查孕产妇和新生医院（和NICU）医疗记录，以证明感兴趣的暴露证据，包括详细的量度和氧气使用时间和氧气使用时间，以及在婴儿疗法中的氧气使用量，以及摄影的疗程。我们还将抽象有关易于氧气和使用光疗的疾病的信息，例如胎儿窘迫和长期劳动（母体O2），APGAR评分，呼吸条件（新生儿O2）和血清胆红素水平在不同年龄（光疗疗法）。迄今为止的研究表明，所有的一小部分可能归因于可以修改的围产期医疗干预措施。如果是这样的话，我们有一种可能减轻人口负担的方法。我们提出的研究将详细的母体和新生儿病历信息与基于人群的大型案例确定方法和对照儿童的仔细匹配的方法结合在一起，这是美国对该主题的第一个病例对照研究，将对围产量氧气和光疗疗法使用的所有风险比现在都提供的更强大的估计。这项研究将试图找出劳动中的母亲以及出生后的婴儿是否会增加氧气，从而增加了儿童晚期急性淋巴细胞性白血病的风险。我们还将研究用于治疗婴儿黄疸的光疗是否可能增加白血病的风险。如果这些疗法增加白血病的风险，则应该可以找到替代方法来管理新生儿问题，以最大程度地减少对这些治疗的接触