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Rehospitalization for respiratory illness in infants of less than 32 weeks' gestation
C K Cunningham1, J A McMillan, S J Gross
1Department of Pediatrics, State University of New York Health Science Center, Syracuse 13210.
Insights
Extremely premature infants born at less than 32 weeks gestation face a significantly higher risk of rehospitalization for respiratory illness within two years. This highlights the long-term respiratory vulnerability of very preterm infants.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Public Health
Background:
- Infants born at less than 32 weeks gestation are at increased risk for adverse health outcomes.
- Respiratory illnesses are a common cause of rehospitalization in early childhood.
Purpose of the Study:
- To determine the incidence of rehospitalization for respiratory illness in very preterm infants compared to term infants.
- To identify perinatal and seasonal risk factors associated with rehospitalization in preterm infants.
Main Methods:
- Prospective observational study of 133 preterm infants (gestational age <= 32 weeks) and a matched term control group.
- Follow-up period of 2 years to record rehospitalizations for respiratory illness.
- Analysis of perinatal factors including birth weight, gestational age, mechanical ventilation, oxygen therapy, neonatal intensive care, and bronchopulmonary dysplasia.
Main Results:
- 36% of preterm infants were rehospitalized compared to 2.5% of term infants (P < .001).
- Rehospitalized preterm infants required more mechanical ventilation, supplemental oxygen, and neonatal intensive care.
- History of bronchopulmonary dysplasia was a risk factor, but even preterm infants without it had a 10-fold increased risk compared to controls.
Conclusions:
- Very preterm infants have a substantially higher incidence of rehospitalization for respiratory illness.
- Factors beyond bronchopulmonary dysplasia, such as prolonged respiratory support, contribute to rehospitalization risk.
- Early respiratory support needs in preterm infants are indicative of future hospitalization risks.
Abstract:
All 133 surviving infants of gestational age less than or equal to 32 weeks born July 1, 1985, to June 30, 1986, as well as a socioeconomically matched full-term control group were observed prospectively for 2 years to determine the incidence of rehospitalization for respiratory illness. Perinatal and seasonal factors associated with increased risk for such hospitalizations were also examined. Forty-seven (36%) preterm infants were rehospitalized compared with 3 (2.5%) of 121 term infants (P less than .001). Preterm infants with and without rehospitalization were similar for mean birth weight (1104 +/- 329 g and 1188 +/- 360 g, respectively) and gestational age (28 +/- 2 weeks for both groups); however, infants who were subsequently rehospitalized had required more days of mechanical ventilation, supplemental oxygen therapy, and neonatal intensive care. While a history of bronchopulmonary dysplasia was a risk factor for rehospitalization (45% compared with 25% of those without bronchopulmonary dysplasia, P less than .05), preterm infants with no history of bronchopulmonary dysplasia still showed a 10-fold increase compared with control infants. Among the 43 infants who required no mechanical ventilation beyond the day of birth, 10 (23%) required rehospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)