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Published on: August 7, 2017
Early childhood respiratory morbidity and antibiotic use in ex-preterm infants: a primary care population-based
Shin Tan1, Lisa Szatkowski2, William Moreton1
1Academic Child Health, School of Medicine, University of Nottingham, Nottingham, UK.
Insights
Ex-preterm infants, especially those with bronchopulmonary dysplasia (BPD) needing home oxygen, experience higher rates of childhood respiratory issues and antibiotic use. This highlights the need for better post-discharge care strategies for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Public Health
Background:
- Bronchopulmonary dysplasia (BPD) is an increasing concern in preterm infants.
- Existing research on early childhood respiratory morbidity in ex-preterm infants is limited in scope and size.
Purpose of the Study:
- To investigate rates of primary care consultations for respiratory tract infections (RTI), lower respiratory tract infections (LRTI), wheeze, and antibiotic prescriptions in ex-preterm and term children.
- To compare respiratory morbidity between preterm infants discharged with and without home oxygen.
Main Methods:
- Retrospective cohort study utilizing linked electronic primary care and hospital databases.
- Inclusion of 253,277 children born between 1997 and 2014, with 1,666 born preterm (<32 weeks gestation).
- Follow-up from primary care registration to age 5 years, with adjusted incidence rate ratios (aIRRs) calculated.
Main Results:
- Ex-preterm infants exhibited significantly higher rates of RTI, LRTI, wheeze, and antibiotic prescriptions compared to term infants.
- Preterm infants discharged with home oxygen showed substantially greater respiratory morbidity and antibiotic use than those without.
- Children from the most deprived socioeconomic groups experienced the highest rates of respiratory morbidity.
Conclusions:
- Ex-preterm infants, particularly those with BPD requiring home oxygen, face significant early childhood respiratory morbidity and increased antibiotic prescriptions.
- The rising prevalence of BPD necessitates research into effective strategies to mitigate respiratory health burdens in high-risk infants post-discharge.
- Socioeconomic deprivation is associated with increased respiratory morbidity in this population.
Background:
Globally, bronchopulmonary dysplasia (BPD) continues to increase in preterm infants. Recent studies exploring subsequent early childhood respiratory morbidity have been small or focused on hospital admissions.
Aims:
To examine early childhood rates of primary care consultations for respiratory tract infections (RTI), lower respiratory tract infections (LRTI), wheeze and antibiotic prescriptions in ex-preterm and term children. A secondary aim was to examine differences between preterm infants discharged home with or without oxygen.
Methods:
Retrospective cohort study using linked electronic primary care and hospital databases of children born between 1997 and 2014. We included 253 277 eligible children, with 1666 born preterm at <32 weeks' gestation, followed-up from primary care registration to age 5 years. Adjusted incidence rate ratios (aIRRs) were calculated.
Results:
Ex-preterm infants had higher rates of morbidity across all respiratory outcomes. After adjusting for confounders, aIRRs for RTI (1.37, 95% CI 1.33-1.42), LRTI (2.79, 95% CI 2.59-3.01), wheeze (3.05, 95% CI 2.64-3.52) and antibiotic prescriptions (1.49, 95% CI 1.44-1.55) were higher for ex-preterm infants. Ex-preterm infants discharged home on oxygen had significantly greater morbidity across all respiratory diagnoses and antibiotic prescriptions compared to those without home oxygen. The highest rates of respiratory morbidity were observed in children from the most deprived socioeconomic groups.
Conclusion:
Ex-preterm infants, particularly those with BPD requiring home oxygen, have significant respiratory morbidity and antibiotic prescriptions in early childhood. With the increasing prevalence of BPD, further research should focus on strategies to reduce the burden of respiratory morbidity in these high-risk infants after hospital discharge.
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