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Prematurity and Long-Term Respiratory Morbidity-What Is the Critical Gestational Age Threshold?
Gil Gutvirtz1, Tamar Wainstock2, Eyal Sheiner1
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 8457108, Israel.
Insights
Infants born before 30 weeks gestation face significantly higher risks of long-term respiratory issues. This study identifies 30 weeks as a critical threshold for reducing respiratory morbidity in preterm infants.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Perinatal Epidemiology
Background:
- Prematurity is a leading cause of infant respiratory morbidity.
- Preterm infants experience both short-term and long-term respiratory complications.
- Identifying critical gestational age thresholds can inform clinical management and improve outcomes.
Purpose of the Study:
- To determine if a specific gestational age threshold exists for significant long-term respiratory morbidity in preterm infants.
- To analyze the association between gestational age at birth and respiratory hospitalizations up to age 18.
- To pinpoint a potential critical window for intervention to mitigate respiratory risks.
Main Methods:
- Population-based cohort analysis of 220,563 singleton deliveries over 23 years.
- Comparison of four gestational age groups: term, moderate-to-late preterm, very preterm, and extremely preterm.
- Kaplan-Meier survival curves and Cox proportional hazards models to assess cumulative incidence and risk of respiratory hospitalizations.
Main Results:
- Preterm infants had significantly higher rates of respiratory morbidity hospitalizations compared to term infants (p < 0.001).
- Delivery before 32 weeks gestation doubled the risk of long-term respiratory morbidity.
- Hospitalization rates attenuated beyond 30 weeks' gestation, suggesting a critical threshold.
Conclusions:
- Gestational age of 30 weeks appears to be a critical threshold for long-term respiratory morbidity in offspring.
- Infants born before 30 weeks face substantially elevated risks of respiratory-related hospitalizations.
- This finding highlights the importance of optimizing care for extremely preterm infants to reduce lifelong respiratory burden.
Abstract:
Respiratory morbidity is a hallmark complication of prematurity. Children born preterm are exposed to both short- and long-term respiratory morbidity. This study aimed to investigate whether a critical gestational age threshold exists for significant long-term respiratory morbidity. A 23-year, population-based cohort analysis was performed comparing singleton deliveries at a single tertiary medical center. A comparison of four gestational age groups was performed according to the WHO classification: term (≥37.0 weeks, reference group), moderate to late preterm (32.0-36.6 weeks), very preterm (28.0-31.6 weeks) and extremely preterm (24.0-27.6 weeks). Hospitalizations of the offspring up to the age of 18 years involving respiratory morbidities were evaluated. A Kaplan-Meier survival curve was used to compare cumulative hospitalization incidence between the groups. A Cox proportional hazards model was used to control for confounders and time to event. Overall, 220,563 singleton deliveries were included: 93.6% term deliveries, 6% moderate to late preterm, 0.4% very preterm and 0.1% extremely preterm. Hospitalizations involving respiratory morbidity were significantly higher in children born preterm (12.7% in extremely preterm children, 11.7% in very preterm, 7.0% in late preterm vs. 4.7% in term, p < 0.001). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory-related hospitalizations in the preterm groups (log-rank, p < 0.001). In the Cox regression model, delivery before 32 weeks had twice the risk of long-term respiratory morbidity. Searching for a specific gestational age threshold, the slope for hospitalization rate was attenuated beyond 30 weeks' gestation. In our population, it seems that 30 weeks' gestation may be the critical threshold for long-term respiratory morbidity of the offspring, as the risk for long-term respiratory-related hospitalization seems to be attenuated beyond this point until term.
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