Hospital admissions for lower respiratory tract infections after early-, late-, and post-term birth
Paula Haataja1,2, Päivi Korhonen1,2, Riitta Ojala1,2
1Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
Insights
Early-term birth increases the risk of lower respiratory tract infections (LRTI) in children. Conversely, late-term and post-term births are linked to a reduced risk of LRTI, particularly bronchiolitis/bronchitis.
Area of Science:
- Pediatrics
- Neonatal Health
- Respiratory Medicine
Background:
- Emerging data suggest early-term births correlate with increased later respiratory morbidity.
- Post-term births may offer a protective effect against this risk.
Purpose of the Study:
- To investigate the impact of early-term, late-term, and post-term birth on hospital admissions for lower respiratory tract infections (LRTI) up to age seven.
- To identify maternal and perinatal factors associated with LRTI risk.
Main Methods:
- A register study analyzed 948,695 Finnish births (1991-2008).
- Compared hospital admissions for bronchiolitis/bronchitis and pneumonia in early-term, late-term, and post-term births versus full-term births.
- Utilized adjusted Cox proportional hazards models to identify risk factors for LRTI admissions up to age seven.
Main Results:
- Early-term birth was associated with a higher risk of LRTI admissions (bronchiolitis/bronchitis HR 1.21, pneumonia HR 1.16).
- Late-term and post-term births showed a decreased risk for bronchiolitis/bronchitis admissions (HR 0.93 and 0.89, respectively).
- Identified several risk factors including young maternal age, smoking, male sex, C-section, SGA, low Apgar score, and neonatal interventions.
Conclusions:
- Early-term birth is linked to increased LRTI risk, while late-term and post-term births are associated with reduced risk of bronchiolitis/bronchitis.
- Modifiable risk factors for LRTI include maternal smoking, elective C-section, neonatal ventilation, and antibiotic therapy.
Background:
Recent data suggest that early-term births are associated with later respiratory morbidity (LRTI), and post-term births may decrease this risk.
Objectives:
The objective was to determine the impact of early-term, late-term, and post-term birth on hospital admission for LRTI up to the age of seven years. Additionally, we explored maternal and perinatal factors associated with the risk of admission for LRTIs.
Methods:
The association of early-term (37+0 -38+6 weeks), late-term (41+0 -41+6 weeks), and post-term (≥42 weeks) birth with hospital admissions for lower respiratory tract infections (LRTI) in comparison with infants born full-term (39+0 -40+6 weeks) was assessed and early predictors of LRTI were established. The register study included 948 695 infants born in Finland in 1991-2008. Data were analysed in four-term subgroups. Hospital admissions for bronchiolitis/bronchitis and pneumonia were collected up to 7 years of age. Adjusted Cox proportional hazards models were used to assess risk factors of LRTI admissions.
Results:
The rates of hospital admission in the early-, full-, late-, and post-term groups were 6.7%, 5.5%, 5.1%, and 4.8% for bronchiolitis/bronchitis, and 2.8%, 2.4%, 2.3%, and 2.3% for pneumonia. Early-term birth was associated with an increased risk of admission for bronchiolitis/bronchitis (hazard ratio HR 1.21, 95% confidence interval CI 1.18, 1.23) and pneumonia (HR 1.16, 95% CI 1.12, 1.20), while late-term (HR 0.93, 95% CI 0.91, 0.95) and post-term births (HR 0.89, 95% CI 0.85, 0.93) were associated with a decreased risk of bronchiolitis/bronchitis admission compared with the full-term group. Maternal age ≤ 20 years, smoking during pregnancy, male sex, caesarean delivery, small for gestational age, 1-minute Apgar score < 4, ventilator support, and neonatal antibiotic therapy were associated with an increased risk of LRTI admission, while being firstborn, born in a level-II hospital and in the Northern region was associated with decreased risk.
Conclusion:
Early-term birth was associated with a higher risk of all LRTI admissions while late-term and post-term births were associated with lower risk of bronchiolitis/bronchitis admission. Modifiable risk factors of LRTIs were smoking during pregnancy, birth by elective caesarean delivery, neonatal ventilator support, and antibiotic therapy.
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