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Gestational age and the long-term impact on children's infectious urinary morbidity
Elisheva Padeh1, Tamar Wainstock2, Eyal Sheiner3
1Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beersheba, Israel. eli77w@gmail.com.
Insights
Infants born preterm or early term face a higher risk of childhood urinary tract infections. This risk significantly decreases with increased gestational age at birth, highlighting the importance of full-term delivery for infant health.
Area of Science:
- Perinatal Medicine
- Pediatric Urology
- Public Health
Background:
- Prematurity poses significant health risks to newborns.
- Understanding the long-term health consequences of varying gestational ages is crucial for optimizing infant care.
- Infectious urinary morbidity is a common concern in childhood.
Purpose of the Study:
- To investigate the association between different gestational ages at birth and the incidence of childhood infectious urinary morbidity.
- To quantify the risk of urinary tract infections in offspring based on gestational age at delivery.
Main Methods:
- Population-based cohort analysis of singleton deliveries between 1991 and 2014.
- Gestational age categorized into early preterm (<34 weeks), late preterm (34-36 6/7 weeks), early term (37-38 6/7 weeks), full term (39-40 6/7 weeks), late term (41-41 6/7 weeks), and post-term (>42 weeks).
- Infectious urinary morbidity-related hospitalizations up to age 18 assessed using survival curves and Cox multivariable models, excluding congenital malformations.
Main Results:
- A total of 238,620 deliveries were analyzed.
- Urinary-related hospitalization rates declined with increasing gestational age: 1.7% (early preterm), 0.9% (late preterm), 0.6% (early term), and 0.5% (full/late/post-term).
- Preterm and early-term deliveries were independently associated with increased pediatric urinary morbidity compared to full-term deliveries (aHRs ranging from 1.26 to 3.305).
Conclusions:
- Deliveries at preterm and early-term gestational ages are independently linked to a higher risk of pediatric urinary morbidity.
- The risk of infectious urinary morbidity in offspring decreases progressively as gestational age advances.
- Optimizing gestational age at birth is a key factor in reducing the incidence of childhood urinary tract infections.
Purpose:
Given the negative impact of prematurity on offspring's health, we sought to determine whether different gestational ages at birth impact differently on the prevalence of childhood infectious urinary morbidity in the offspring.
Methods:
In this population-based cohort analysis, all singleton deliveries occurring between 1991 and 2014 at a single regional tertiary medical center were included. Gestational age upon delivery was sub-divided into early preterm (< 34 weeks), late preterm (34-36 6/7 weeks), early term (37-38 6/7 weeks), full term (39-40 6/7 weeks), late term (41-41 6/7 weeks) and post-term (> 42 weeks). Congenital malformations were excluded. Rates of infectious urinary morbidity-related hospitalizations of offspring up to age 18 years were assessed using a survival curve and a Cox multivariable model.
Results:
During the study period, 238,620 deliveries met the inclusion criteria. Urinary-related hospitalization (n = 1395) rates decreased as gestational age increased, from 1.7% in the early preterm group, 0.9% in the late preterm group, 0.6% in the early-term group and only 0.5% in the full, late and post-term groups (p > 0.001; chi-square test for trends). In the Cox model, controlled for maternal age, preterm as well as early-term deliveries exhibited an independent association with pediatric urinary morbidity as compared with full term (early preterm: aHR-3.305, 95% CI 2.4-4.54; late preterm: aHR-1.63, 95% CI 1.33-1.99; early term: aHR-1.26, 95% CI 1.1-1.43, p = 0.01).
Conclusions:
Deliveries occurring at preterm and at early term are independently associated with pediatric urinary morbidity in the offspring. This risk decreases as gestational age advances.