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Nationwide study of respiratory-related hospitalisations and deaths in preterm children in Brazil: a registry-based
Thiago Cerqueira-Silva1,2, Pilar T V Florentino3, Aline Dos Santos Rocha3
1Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT, UK. Thiago.silva@lshtm.ac.uk.
Insights
Preterm infants face significantly higher risks of respiratory hospitalizations and deaths compared to full-term infants, especially within the first year of life. These findings highlight critical vulnerabilities in preterm newborns needing targeted health interventions.
Area of Science:
- Neonatal Health
- Pediatric Respiratory Medicine
- Global Public Health
Background:
- Preterm birth and respiratory diseases pose significant health burdens, particularly in low- and middle-income countries.
- Existing research on respiratory morbimortality in preterm infants is predominantly from high-income settings, creating a knowledge gap for other regions.
Purpose of the Study:
- To investigate the burden of respiratory-related hospitalizations and deaths among preterm children in Brazil.
- To identify periods of heightened vulnerability for respiratory complications in preterm infants.
Main Methods:
- Population-based cohort study utilizing the CIDACS Birth Cohort (2011-2018) including over 3.2 million live births.
- Preterm infants defined as born before 37 weeks gestation; respiratory outcomes analyzed in children under five.
- Statistical analysis included Ghosh-Lin models for mean ratios and Cox models for hazard ratios, with adjustments for maternal characteristics.
Main Results:
- 8.9% of births were preterm. Preterm infants had a 1.40 times higher risk of under-five respiratory hospitalization (MR=1.40, 95%CI:1.38-1.42).
- The risk of respiratory-related death was 3.94 times higher for preterm infants (HR=3.94, 95%CI:3.62-4.30).
- Highest mortality risk for preterm infants was between 28-90 days (HR=4.66, 95%CI:4.00-5.43), decreasing with age.
Conclusions:
- Preterm newborns exhibit a substantially elevated risk of respiratory illnesses compared to term infants, particularly during their first year.
- Findings underscore the critical need for tailored health strategies to mitigate risks associated with preterm birth and respiratory disease.
- Identifying specific vulnerability periods is crucial for effective public health interventions in preterm infant care.
Background:
Preterm birth and respiratory diseases disproportionately affect low-and middle-income countries. Although preterm birth is a major contributor to the burden of respiratory morbimortality in early childhood, most evidence comes from high-income settings. To address this gap, we examined respiratory-related hospitalisations and deaths among preterm children in Brazil.
Methods:
We conducted a population-based cohort study using the CIDACS Birth Cohort, which included all live births in Brazil from January 1, 2011, to November 30, 2018. Preterm infants were defined as infants born before 37 weeks of gestation. We examined respiratory-related hospital admissions and deaths in children under five. Mean ratios (MR) and 95% confidence intervals (CI) were estimated using the Ghosh-Lin model; hazard ratios (HR) were estimated using Cox models. Maternal characteristics were adjusted through inverse probability weighting, with treatment probabilities estimated via entropy balancing.
Results:
The study included 3,239,563 live births, with 288,466 (8.9%) classified as preterm. The MR for under-five respiratory hospitalisation, comparing preterm to term births, was 1.40 (95%CI:1.38-1.42), peaking at 1.68 (1.63-1.72) between 28 and 90 days, declining to approximately 1.18 (1.10-1.28) at the fourth year. For respiratory disease deaths, the under-five HR was 3.94 (3.62-4.30). Respiratory-related mortality was highest between 28-90 days of age, with an HR of 4.66 (4.00-5.43), decreasing to 1.25 (0.62-2.51) by three years of age.
Conclusion:
Preterm newborns have a higher risk of respiratory illness than full-term children, particularly in their first year. This understanding can guide health strategies to address premature birth issues by identifying important periods of vulnerability.
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