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Long-Term Infectious Morbidity of Premature Infants: Is There a Critical Threshold?
Sharon Davidesko1, Tamar Wainstock2, Eyal Sheiner1
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
Insights
Infants born preterm face higher long-term infectious morbidity risks. Gestational age at birth significantly impacts offspring
Area of Science:
- Neonatalogy
- Pediatric Infectious Diseases
- Epidemiology
Background:
- Premature birth is a significant risk factor for adverse health outcomes in offspring.
- Understanding the long-term infectious morbidity associated with different degrees of prematurity is crucial for public health.
- Previous studies have indicated a link between preterm birth and increased infection risk, but detailed stratification is needed.
Purpose of the Study:
- To investigate the relationship between gestational age at birth and the long-term incidence of infectious morbidity in offspring.
- To compare infectious morbidity rates across various preterm birth strata (extreme, very, moderate to late preterm) and term deliveries.
- To identify specific gestational age cutoffs associated with increased long-term infectious disease risk.
Main Methods:
- Population-based cohort analysis of 220,594 infants, stratified by gestational age at birth.
- Infectious morbidity defined by International Classification of Diseases 9 (ICD9) codes for hospitalizations.
- Kaplan-Meier survival curves and Cox proportional hazards models were used to analyze cumulative incidence and control for confounders.
Main Results:
- Preterm infants exhibited significantly higher rates of infection-related hospitalizations compared to term infants (18.4% to 19.8% vs. 11.0%).
- Moderate to late preterm birth (32-36 weeks) and very preterm birth (28-31 weeks) were independently associated with increased long-term infectious morbidity.
- A gestational age cutoff of 32 weeks and below was identified as a significant marker for increased offspring infectious morbidity risk.
Conclusions:
- Gestational age at birth is a critical determinant of long-term infectious morbidity in offspring.
- Infants born at or before 32 weeks gestation face a substantially elevated risk of long-term infectious complications.
- These findings underscore the importance of preventing preterm birth and managing infants born prematurely to mitigate future health burdens.
Abstract:
In this study, we sought to ascertain a relationship between gestational age at birth and infectious morbidity of the offspring via population-based cohort analysis comparing the long-term incidence of infectious morbidity in infants born preterm and stratified by extremity of prematurity (extreme preterm birth: 24 + 0-27 + 6, very preterm birth: 28 + 0-31 + 6, moderate to late preterm birth: 32 + 0-36 + 6 weeks of gestation, and term deliveries). Infectious morbidity included hospitalizations involving a predefined set of International Classification of Diseases 9 (ICD9) codes, as recorded in hospital records. A Kaplan-Meier survival curve compared cumulative incidence of infectious-related morbidity. A Cox proportional hazards model controlled for confounders and time to event. The study included 220,594 patients: 125 (0.1%) extreme preterm births, 784 (0.4%) very preterm births, 13,323 (6.0%) moderate to late preterm births, and 206,362 term deliveries. Offspring born preterm had significantly more infection-related hospitalizations (18.4%, 19.8%, 14.9%, and 11.0% for the aforementioned stratification, respectively, p < 0.001). Multivariate analysis found being born very or late to moderate preterm was independently associated with long-term infectious morbidity (adjusted hazard ratio (aHR) 1.5, 95% confidence interval (CI) 1.27-1.77 and aHR 1.23, 95% CI 1.17-1.3, respectively, p < 0.001). A comparable risk of long-term infectious morbidity was found in the two groups of premature births prior to 32 weeks gestation. In our population, a cutoff from 32 weeks and below demarks a significant increase in the risk of long-term infectious morbidity of the offspring.
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