This mentored Patient-Oriented Research Career Development Award will provide Dr. Jessica Rice with the experience and training to become an independent investigator in pediatric pulmonology with a focus on the effects of indoor air pollution (fine particulate matter, PM2.5) on respiratory morbidity in premature infants. Premature birth affects 10 percent of infants born in the U.S. and is the leading cause of infant mortality. Bronchopulmonary dysplasia (BPD) is one of the most common and serious complications of preterm birth and infants are at risk for chronic respiratory symptoms and lung function abnormalities throughout childhood and into adulthood. While exposure to indoor air pollution has been shown to be detrimental in other populations (children with asthma) and secondhand smoke (SHS) exposure has been linked to adverse respiratory outcomes in premature infants, the effect of measured indoor PM2.5 on respiratory outcomes in a vulnerable population of premature infants is not known. The central hypothesis is that exposure to PM2.5 leads to an increased risk of respiratory-related morbidity among premature infants. To test this hypothesis, we propose a prospective observational study evaluating the effect of PM2.5 in two cohorts of patients who will be followed for one year. The first cohort will be recruited at the time of initial hospital discharge and will include infants born ? 32 weeks (with and without BPD) (aim 1) and the second cohort will include preschool aged children who were born prematurely with established BPD (aim 2). These two cohorts will allow us to evaluate a full clinical spectrum of chronic lung disease related to prematurity. Outcomes will include healthcare utilization, medication use, symptoms, and markers of SHS exposure (air nicotine and salivary cotinine). The goal of this proposal is to collect preliminary data and obtain the necessary training and skills in environmental epidemiology and clinical trial methods in order to design a future intervention trial to evaluate the impact improving indoor air quality in this population. This approach focuses on identifying a modifiable risk factor and intervening early when developing tissues are most susceptible to environmental insults in order to prevent disease. Results of this study have the potential to impact clinical practice and eventually, public policy. Dr. Rice has assembled a multidisciplinary research team with extensive research and mentorship experience. Her primary mentor, Dr. Gregory Diette is the co-director of the EPA/ NIEHS funded Center for Childhood Asthma in the Urban Environment and is an international expert on inner city exposures and their contribution to obstructive lung disease. Her co-mentors Dr. Sharon McGrath-Morrow and Dr. J. Michael Collaco, are both pediatric pulmonologists and experts in the field of chronic lung disease of prematurity. Dr. Kirsten Koehler, an expert in environmental health science will provide guidance related to exposure measurement and analysis. This career development award will provide Dr. Rice with the necessary skills, training, and mentorship needed to develop her research program and will be key to her success in transitioning to an independent investigator.
The U.S. Environmental Protection Agency has concluded that fine particle pollution (PM2.5) is a serious health threat based on its association with multiple adverse health effects, but the impact of this exposure on respiratory morbidity in a vulnerable population of preterm infants with underdeveloped lungs is not known. The results of this study will further enhance our understanding of the effects of indoor air pollution on respiratory outcomes in preterm infants, and as a result will inform both clinical practice and public policy, as well as lay the groundwork for a future study evaluating the impact of an intervention to improve indoor air quality in this population.
