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Assessing Respiratory Immune Responses to Haemophilus Influenzae
Published on: June 29, 2021
Health service utilisation for acute respiratory infections in infants graduating from the neonatal intensive care
Paul G Stevenson1, Matthew N Cooper1, Wesley Billingham1
1Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
Insights
Infants discharged from the Neonatal Intensive Care Unit (NICU) face a significant burden of respiratory infections into early childhood. Extremely preterm infants and those with chronic lung disease (CLD) are at highest risk for hospital admissions due to acute respiratory infections (ARI).
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Public Health
Background:
- Neonatal Intensive Care Units (NICU) aim to improve infant outcomes, yet many infants experience adverse health events post-discharge.
- Respiratory infectious morbidity remains a significant concern for infants after NICU admission.
Purpose of the Study:
- To describe the longer-term respiratory infectious morbidity in infants discharged from the NICU.
- To identify risk factors for acute respiratory infection (ARI) hospitalizations in this vulnerable population.
Main Methods:
- Utilized state-wide, population-based, probabilistically linked administrative data from Western Australia.
- Analyzed a cohort of 23,784 infants admitted to the sole tertiary NICU between 2002-2013, with follow-up to 2015.
- Examined incidence rates of emergency department presentations and hospitalizations for ARI, considering gestational age and chronic lung disease (CLD).
Main Results:
- Overall ARI hospitalization rate was 71.4/1000 child-years, peaking in infants aged 0-5 months (242.9/1000).
- Extremely preterm infants (<28 weeks gestation) were 6.5 times more likely, and those with CLD were 5.0 times more likely, to be admitted for ARI.
- Bronchiolitis and upper respiratory tract infections were the most common ARI diagnoses.
Conclusions:
- A substantial burden of acute respiratory infections (ARI) persists in children post-NICU discharge, particularly for extremely preterm infants and those with chronic lung disease (CLD).
- Urgent priorities include developing early-life interventions to prevent respiratory infections in these high-risk children and understanding the lifelong impact on lung health.
Background:
Despite advances in neonatal intensive care, babies admitted to Neonatal Intensive Care Units (NICU) suffer from adverse outcomes. We aim to describe the longer-term respiratory infectious morbidity of infants discharged from NICU using state-wide population-based linked data in Western Australia.
Study Design:
We used probabilistically linked population-based administrative data to analyse respiratory infection morbidity in a cohort of 23,784 infants admitted to the sole tertiary NICU, born 2002-2013 with follow up to 2015. We analysed incidence rates of secondary care episodes (emergency department presentations and hospitalisations) by acute respiratory infection (ARI) diagnosis, age, gestational age and presence of chronic lung disease (CLD). Poisson regression was used to investigate the differences in rates of ARI hospital admission between gestational age groups and those with CLD, after adjusting for age at hospital admission.
Results:
From 177,367 child-years at risk (i.e., time that a child could experience an ARI outcome), the overall ARI hospitalisation rate for infants and children aged 0-8 years was 71.4/1000 (95% confidence interval, CI: 70.1, 72.6), with the highest rates in infants aged 0-5 months (242.9/1000). For ARI presentations to emergency departments, equivalent rates were 114/1000 (95% CI: 112.4, 115.5) and 337.6/1000, respectively. Bronchiolitis was the most common diagnosis among both types of secondary care, followed by upper respiratory tract infections. Extremely preterm infants (< 28 weeks gestation at birth) were 6.5 (95% CI: 6.0, 7.0) times more likely and those with CLD were 5.0 (95% CI: 4.7, 5.4) times more likely to be subsequently admitted for ARI than those in NICU who were not preterm or had CLD after adjusting for age at hospital admission.
Conclusions:
There is an ongoing burden of ARI in children who graduate from the NICU, especially those born extremely preterm, that persists into early childhood. Early life interventions to prevent respiratory infections in these children and understanding the lifelong impact of early ARI on later lung health are urgent priorities.
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