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Prevalence and clinical characteristics of perinatal chronic lung disease by infant gestational age
K Mavunda1, X Jiang2, C S Ambrose3
1Kidz Medical Services, Coral Gables, FL, USA.
Insights
Approximately 300 infants born at >32 weeks gestational age annually have chronic lung disease (CLD) and high mortality. Current guidelines exclude these high-risk infants from RSV immunoprophylaxis, a decision needing review.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Public Health
Background:
- Infants with chronic lung disease (CLD) face increased risk of severe respiratory syncytial virus (RSV) disease.
- Current American Academy of Pediatrics guidelines do not recommend RSV immunoprophylaxis for infants with CLD born at ≥32 weeks gestational age (wGA).
Purpose of the Study:
- To determine the number and clinical characteristics of US infants born at ≥32 wGA diagnosed with CLD.
- To evaluate the rationale for excluding this population from RSV immunoprophylaxis recommendations.
Main Methods:
- Utilized Kids' Inpatient Database birth hospitalization data (2003-2012).
- Estimated CLD prevalence by gestational age using ICD-9 codes.
- Analyzed CLD hospitalizations for length of stay, costs, ventilatory support, and inpatient mortality.
Main Results:
- Approximately 300 infants (7 per 100,000 births) born at >32 wGA were diagnosed with CLD annually.
- These infants experienced elevated hospitalization length of stay and costs.
- Inpatient mortality was highest among infants <27 wGA and >32 wGA.
Conclusions:
- A significant number of infants born at >32 wGA are diagnosed with CLD annually in the US.
- This population exhibits a high all-cause perinatal mortality rate.
- The exclusion of this high-risk group from RSV immunoprophylaxis recommendations warrants further investigation.
Background:
Children with perinatal chronic lung disease (CLD) are at elevated risk for severe respiratory syncytial virus (RSV) disease in the first two years of life. The American Academy of Pediatrics policy does not recommend RSV immunoprophylaxis for infants with CLD born at ≥32 weeks' gestational age (wGA). The objective of this study was to describe the number and clinical characteristics of US infants in this population.
Methods:
Birth hospitalization data from the Kids' Inpatient Database were utilized to estimate the prevalence of CLD (International Classification of Diseases, Ninth Revision [ICD-9] = 770.7) in 2003-2012 overall and by gestational age (ICD-9 = 765.21-765.29). CLD birth hospitalizations were evaluated by length of stay, costs, ventilatory support, and inpatient mortality.
Results:
A total of 33,537 infants were diagnosed with CLD, representing 0.2% of US births; 79% had wGA coded in the database. Among infants with CLD with wGA, 3.5% were born at >32 wGA, representing 7 of every 100,000 US births, or approximately 300 infants annually. Across all wGA categories, birth hospitalization length of stay and costs were elevated, and mechanical ventilation use ranged from 73% to 97%. All-cause inpatient mortality was highest among those <27 wGA and >32 wGA.
Conclusions:
Approximately 300 infants born at >32 wGA are diagnosed with CLD annually in the United States. The all-cause perinatal mortality rate is high in this population. The rationale for excluding this small but high-risk group of infants from the recommendations for RSV immunoprophylaxis is unclear.
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