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Respiratory symptoms in children of low birth weight
1Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Insights
Children born with low birth weight who received neonatal respiratory treatment, particularly mechanical ventilation, had more frequent coughs by age 7. However, wheezing and school absences were similar to peers, indicating targeted respiratory support needs.
Area of Science:
- Pediatrics
- Neonatology
- Respiratory Medicine
Background:
- Low birth weight (LBW) infants are at increased risk for respiratory complications.
- Neonatal respiratory support, including oxygen therapy and mechanical ventilation, is common in LBW infants.
- Long-term respiratory outcomes in LBW children require further investigation.
Purpose of the Study:
- To assess the long-term respiratory health at age 7 in children born with low birth weight (LBW).
- To compare respiratory symptoms, including cough and wheeze, between LBW children and a reference group.
- To investigate the association between neonatal respiratory interventions and subsequent respiratory morbidity.
Main Methods:
- A cohort study involving 121 LBW children (birth weight < 2000 g) and a reference group of schoolchildren.
- Respiratory history recorded via questionnaire at age 7.
- Categorization of LBW children based on neonatal respiratory illness severity (no illness, oxygen only, mechanical ventilation).
Main Results:
- LBW children showed significantly higher prevalence of frequent and troublesome cough compared to the reference group, especially those with very low birth weight (< 1500 g) and neonatal respiratory treatment.
- Neonatal mechanical ventilation was not associated with increased respiratory symptoms compared to oxygen treatment alone.
- Prevalence of cough at age 7 was independently associated with the level of neonatal intensive care (oxygen score).
- Wheezing was weakly correlated with neonatal oxygen score and maternal smoking, but not in excess compared to the reference group.
- School absenteeism due to respiratory symptoms was similar between LBW and reference groups.
Conclusions:
- Frequent cough is a significant long-term respiratory issue for LBW children, particularly those requiring intensive neonatal respiratory care.
- The level of neonatal intensive care, rather than specific interventions like mechanical ventilation versus oxygen alone, is associated with persistent cough.
- While wheezing and school absences were not elevated, targeted monitoring for persistent cough in LBW survivors is warranted.
Abstract:
We recorded the respiratory history by questionnaire in a 7 year old cohort of children whose birth weight was under 2000 g and an unselected reference group of local schoolchildren of the same age. Complete data were obtained in 121 low birthweight children (90% of those studied): 62 who had no neonatal respiratory illness, 25 who had oxygen treatment only, and 34 who received mechanical ventilation (of whom 10 had bronchopulmonary dysplasia). The low birthweight children were no more likely to wheeze than the reference group, but frequent and troublesome cough was significantly more common, especially among children of very low birth weight (under 1500 g) who had received neonatal respiratory treatment. Neonatal mechanical ventilation was not associated with increased symptoms when compared with neonatal oxygen treatment alone. The prevalence of cough at the age of 7 was independently associated with the level of neonatal intensive care as defined by oxygen score. Although there was no excess of wheeze in the cohort compared with the reference group, there was a weak correlation between wheeze and the neonatal oxygen score as well as with maternal smoking. Loss of schooling due to respiratory symptoms in the nine months before this study was no greater in children of low birth weight than in the reference group.