{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:52:51Z","timestamp":1791211971781,"version":"4.1.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The COVID-19 pandemic dramatically reduced early-life respiratory viral exposures, yet the long-term respiratory consequences for pandemic-born children remain unclear. We aimed to compare respiratory morbidity at age 4 between children born during versus before the pandemic and assess whether atopic risk modifies this association. This single-center birth cohort follow-up study included children born in February\u2013March 2020 (COVID-19 cohort) and pre-pandemic controls born during the same period in 2019. Respiratory outcomes at age 4 were assessed using a structured telephone questionnaire (The International Study of Wheezing in Infants). The primary outcome was composite respiratory morbidity (CRM), defined as use of a short-acting bronchodilator (SABA), inhaled and\/or oral corticosteroids, and\/or emergency room visits for respiratory symptoms. Of 588 eligible children, 329 (55.9%) completed follow-up (139 COVID-19, 190 controls); baseline characteristics, including atopy prevalence, were comparable between cohorts. CRM during the fourth year of life was significantly more common in the COVID-19 cohort (39.6% vs. 27.4%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02). In stratified analyses, CRM was markedly higher among atopic-risk pandemic-born children (atopic subgroup:\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200947 COVID-19,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200968 controls) (66% vs. 27.9%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), but not among non-atopic children (26.1% vs. 27%). Multivariable logistic regression confirmed a significant COVID-19 cohort\u2009\u00d7\u2009atopy interaction for CRM (OR 5.04, 95% CI 1.83\u201313.89,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), while neither factor alone was independently associated with the outcome.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    :\u00a0Birth during the COVID-19 pandemic was associated with increased preschool respiratory morbidity, particularly among children with atopic risk. These findings suggest that altered early-life microbial exposures may modify respiratory morbidity trajectories according to host atopic susceptibility.\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Children born during the COVID-19 pandemic had fewer respiratory infections and wheezing episodes in infancy due to reduced viral circulation.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Atopic predisposition is among the strongest risk factors for recurrent wheezing and persistent asthma in preschool children.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Pandemic-born children show significantly higher composite respiratory morbidity at age 4, but exclusively among those with atopic risk (OR 5.04).<\/jats:italic>\n                              \u2022\n                              <jats:italic>Neither pandemic birth nor atopy alone predicts excess morbidity\u2014only their combination does, suggesting host susceptibility shapes long-term respiratory trajectories.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07394-4","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T01:49:26Z","timestamp":1791164966000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Respiratory morbidity at age 4 across COVID-19 and pre-pandemic birth cohorts: the role of atopic risk"],"prefix":"10.1007","volume":"185","author":[{"given":"Alma","family":"Kamar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avigdor","family":"Mandelberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"NatalyRosenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Tasher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Michleson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi","family":"Meridor Eisner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi","family":"Ovadia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaara","family":"Shen Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Manor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Armoni Domany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"issue":"4","key":"7394_CR1","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1002\/ppul.25822","volume":"57","author":"N Rosenfeld","year":"2022","unstructured":"Rosenfeld N, Mandelberg A, Dalal I, Tasher D, Kamar A, Schnapper M, Armoni Domany K (2022) The impact of the COVID-19 pandemic on respiratory morbidity during infancy: a birth-cohort study. 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The study was approved by the Helsinki Committee of Wolfson Medical Center (approval number WOMC-0152\u201323). Verbal informed consent was obtained in accordance with institutional ethics committee approval, which waived written consent given the observational telephone-based design.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"802"}}