Objectives

To investigate the association between the duration of exclusive breast feeding and the development of asthma related outcomes in children at age 6 years.

Design

Prospective cohort study.

Setting

Western Australia.

Subjects

2187 children ascertained through antenatal clinics at the major tertiary obstetric hospital in Perth and followed to age 6 years.

Main outcome measures

Unconditional logistic regression to model the association between duration of exclusive breast feeding and outcomes related to asthma or atopy at 6 years of age, allowing for several important confounders: sex, gestational age, smoking in the household, and early childcare.

Results

After adjustment for confounders, the introduction of milk other than breast milk before 4 months of age was a significant risk factor for all asthma and atopy related outcomes in children aged 6 years: asthma diagnosed by a doctor (odds ratio 1.25, 95% confidence interval 1.02 to 1.52); wheeze three or more times since 1 year of age (1.41, 1.14 to 1.76); wheeze in the past year (1.31, 1.05 to 1.64); sleep disturbance due to wheeze within the past year (1.42, 1.07 to 1.89); age when doctor diagnosed asthma (hazard ratio 1.22, 1.03 to 1.43); age at first wheeze (1.36, 1.17 to 1.59); and positive skin prick test reaction to at least one common aeroallergen (1.30, 1.04 to 1.61).

Conclusion

A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth. These findings are important for our understanding of the cause of childhood asthma and suggest that public health interventions to optimise breast feeding may help to reduce the community burden of childhood asthma and its associated traits.

Key messagesAsthma is the leading cause of admission to hospital in Australian children and its prevalence is increasingWhether breast feeding protects against asthma or atopy, or both, is controversialAsthma is a complex disease, and the relative risks between breast feeding and asthma or atopy are unlikely to be large; this suggests the need for investigation in a large prospective birth cohort with timely assessment of atopic outcomes and all relevant exposuresExclusive breast feeding for at least 4 months is associated with a significant reduction in the risk of asthma and atopy at age 6 years and with a significant delay in the age at onset of wheezing and asthma being diagnosed by a doctorPublic health interventions to promote an increased duration of exclusive breast feeding may help to reduce the morbidity and prevalence of childhood asthma and atopy

A linked data file of birth records and hospital admissions was used to investigate inpatient hospital morbidity before 2 years of age for all non-Aboriginal and Aboriginal children born in Western Australia in 1986. Of the non-Aboriginal children, 31.8% were admitted to hospital at least once before the age of 2 years, with an overall admission rate of 526/1000 live births; the corresponding figures for Aboriginal children were 68.7% and 2797. The mean number of days in hospital for each non-Aboriginal child admitted was 7.4, and 26.5 for Aboriginal children. Of the total cohort, 21% of non-Aboriginal and 20% of Aboriginal children were admitted only once, and 4% of non-Aboriginal and 36% of Aboriginal children were admitted at least three times; 23% of non-Aboriginal and 24% of Aboriginal children were admitted for only one major disease category, and 1% of non-Aboriginal and 16% of Aboriginal children were in at least four categories. The highest admission rates and highest percentages of the cohort admitted were for gastrointestinal and respiratory diseases and social admissions. These results illustrate the importance for both descriptive and analytical research of relating admissions to hospital for the total population to the individual child, and of using clinically relevant disease classifications.

OBJECTIVE--To investigate the association between genital and urinary tract infections in pregnant Aboriginal women and low birth weight. DESIGN--Retrospective case-control study controlling for potential confounding variables. SETTING--Western Australia from 1985 to 1987. SUBJECTS--All Aboriginal women (n = 269) who had given birth to singleton infants weighing 2250 g or less (cases), and 269 randomly selected Aboriginal women who had given birth to singleton infants weighing 3000 g or more (controls). MAIN OUTCOME MEASURES--Proportions of women in case and control groups who had had genital and urinary tract infections; odds ratios for low birth weight when genitourinary tract infection was present; population attributable fraction of low birth weight to genitourinary tract infection. RESULTS--At the time of delivery 51% of women in the case group (109/215) had genitourinary tract infections compared with 13% of controls (35/266). After controlling for potential confounding variables the odds ratio for giving birth to infants weighing 2250 g or less when genitourinary tract infection was present was 4.0 (95% confidence interval 2.3 to 7.0). The proportion of infants with low birth weight attributable to genitourinary tract infection in the whole population of Aboriginal women was 32% (95% confidence interval 17% to 49%). CONCLUSIONS--There was a strong association between low birth weight and the presence of genitourinary tract infections in Aboriginal women both during pregnancy and at the time of delivery. A community intervention trial of screening and treatment of genitourinary infections in this population is recommended.

The measurement of lactate dehydrogenase activity has been used to evaluate the growth of the T1 vaccine strain of Mycoplasma mycoides var. mycoides in broth during the production of vaccine. Estimations were made during incubation at 37 C and storage at 4 C. The results were compared with titers of the vaccine obtained by two conventional methods of assessing viability titers: the counting of colonies formed on solid medium and a 50% end point titer found after dilutions were made in broth. The method of measuring lactate dehydrogenase activity allowed the rapid enumeration of organisms during incubation of the culture, but estimations made on vaccine stored at 4 C did not compare well with the two conventional methods of assessing viability. The lactate dehydrogenase activity of the culture has enabled rapid monitoring of the production stages of this vaccine.

A highly significant correlation coefficient (r = 0.97, n = 18) was found between the concentration of lactate dehydrogenase measurable after the organisms had been disrupted and the concentration of colony-forming units during the logarithmic phase of growth of a broth culture of the T1 strain of Mycoplasma mycoides var. mycoides. A concentration of 4.60 × 10-7 milliunits of lactate dehydrogenase for each colony-forming unit was established. This relationship was used to convert the concentration of lactate dehydrogenase in the culture into an estimate of the concentration of viable mycoplasma. The lactate dehydrogenase was estimated by following the oxidation of reduced nicotinamide adenine dinucleotide, in the presence of pyruvate substrate, at 366 nm in a spectrophotometer. The nicotinamide adenine dinucleotide oxidase system probably contributed a small amount of enzyme activity to the test when lactate dehydrogenase was measured in this way. The method has been described and evaluated for the estimation of titers from 107 to 5 × 109 colony-forming units per ml.

A drug-induced lipidosis of the central nervous system of chickens is reported. Membranous cytoplastic neuronal inclusions similar to those seen in Tay-sach's disease in man and in spontaneous or drug-induced disease in swine were seen by electron microscopy. Fat was demonstrated in frozen sections.

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Investigations using ammonium citrate-15N and urea-15N showed that children in the acute stage of kwashiorkor and marasmus receiving a diet of adequate protein content retained a considerable percentage of the label from both compounds. Excretion of both total 15N and urea-15N was subnormal and elimination was virtually completed 36 hr after administration of the isotope. During recovery from kwashiorkor total 15N excretion had approached normal a month after commencement of rehabilitation. Urea-15N excretion was still slightly subnormal after 3 months. In marasmus urea-15N formed a normal proportion of total 15N excretion after 1 month, although total 15N excretion then was still low. Ammonia nitrogen was retained to a greater extent than urea nitrogen in all cases. As it is known that a considerable amount of urea is degraded to ammonia in the gastrointestinal tract, it seems probable that urea nitrogen became available for use after this degradation. Examination of blood from one marasmic child after feeding ammonia-15N and from another after intravenous injection of urea-15N showed incorporation of the label into blood cells and plasma proteins. This did not occur in well nourished controls. It is concluded that ammonia and urea as sources of nonessential nitrogen may play an important part in protein metabolism in the malnourished child.

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Neutrophil alkaline phosphatase levels have been studied in a group of 194 pregnant women, using a modified technique which permits more rapid counting of the required number of neutrophils with a degree of consistency comparable with standard methods.

No correlation was found between neutrophil alkaline phosphatase levels and the period of gestation; in contrast to previous findings, no differences were observed between the means for tests done in early pregnancy and those performed later in pregnancy. There was no demonstrable relationship between neutrophil alkaline phosphatase levels and age, parity, and white cell count. Elevated levels were also observed in women taking oral contraceptives. Thus, although the neutrophil alkaline phosphatase has diagnostic value in certain other disease states, the above findings suggest that it is of little or no value in pregnancy.

The possibility of hormonal control of the elevated level of neutrophil alkaline phosphatase seen in pregnancy and simulated pregnancy is discussed, as is the possible relationship to increases in serum alkaline phosphatase in pregnancy.