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Prematurity as an Independent Risk Factor for the Development of Pulmonary Disease
Julie L Fierro1, Molly Passarella2, Scott A Lorch3
1Division of Pulmonology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Premature infants without bronchopulmonary dysplasia (BPD) face significant respiratory risks, including asthma and hospitalizations. Management of care, including pulmonary referrals, differs between infants with and without BPD.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Public Health
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting premature infants.
- Infants born prematurely are at increased risk for respiratory morbidity.
- Understanding long-term pulmonary outcomes and care disparities is crucial for this vulnerable population.
Purpose of the Study:
- To compare the risk of pulmonary morbidity in premature infants with and without BPD.
- To identify differences in the management of respiratory care for these infants.
- To inform clinical practice regarding the respiratory health of all premature infants.
Main Methods:
- Retrospective chart review of 811 infants born before 30 weeks gestation (2006-2015).
- Multivariate models analyzed the impact of BPD on respiratory diagnoses, medication use, specialist visits, and healthcare utilization.
- Adjusted for gestational age, sex, insurance, and race.
Main Results:
- Infants with BPD had higher rates of asthma diagnosis (75% vs. 60%) and pulmonology referrals (RR 5.98).
- Infants with BPD were more likely to be hospitalized for respiratory conditions (50% vs. 30%; RR 2.44).
- Significant differences observed in pulmonary referral timing and inhaled corticosteroid prescription rates.
Conclusions:
- While BPD increases asthma and readmission risks, a substantial proportion of infants without BPD also experience these issues.
- Care management, including specialist referrals and medication use, shows disparities.
- All premature infants should be considered at high risk for respiratory morbidity, necessitating proactive management.
Objectives:
To determine if premature infants without bronchopulmonary dysplasia (BPD) are at similar risk for developing pulmonary morbidity as compared with those with BPD and if there are differences in management of care.
Study Design:
We retrospectively abstracted information from our electronic medical record from January 1, 2006, to December 31, 2015, for primary care patients born at <30 weeks of gestation (n = 811). Multivariate models determined the impact of BPD on a diagnosis of respiratory disease, respiratory medications, subspecialty visits, and emergency department use or hospitalizations after adjusting for gestational age, sex, insurance type, and race.
Results:
Infants with BPD were more likely to be diagnosed with asthma than those without BPD (75% vs 60%; OR, 1.8; 95% CI, 1.27-2.54), but not all respiratory conditions (OR, 1.56; 95% CI, 0.7-3.51), and were more likely to be referred to a pulmonologist (relative risk, 5.98; 95% CI, 4.1-8.74). Infants with BPD were more likely to be hospitalized for respiratory conditions than those without BPD (50% vs 30%; relative risk, 2.44; 95% CI, 1.73-3.45).
Conclusions:
Although infants with BPD were more likely to have a diagnosis of asthma and be readmitted for respiratory conditions, 60% of infants without BPD were also diagnosed with asthma and 30% were readmitted. There were significant differences in the management of patients, including time to pulmonary referral and prescription rates for inhaled corticosteroids. Practitioners should consider all patients born prematurely at high risk for respiratory morbidity.
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