Childhood Re-Admission Following Preterm Birth Predicts Respiratory Morbidity at 19 Years

Abstract

<b>Introduction:</b> The 2019 ERS guidelines for the long-term management of children with bronchopulmonary dysplasia (BPD) recommended monitoring for children with recurrent re-hospitalisations, based on low quality evidence. We&nbsp;investigated associations between respiratory admission during childhood (≤11 years), and respiratory morbidity in young adults born &lt;32 weeks gestation. <b>Methods:</b> Participants in the West Australian Lung Health in Prematurity (WALHIP) study,&nbsp;attended&nbsp;a lung health assessment at 16-23 years. Spirometry was performed pre- and post- 400mcg Salbutamol, and respiratory morbidity was assessed using the ISAAC questionnaire. Computed tomography (CT) images of the chest were consensus scored using the scoring system by Aukland <i>et al</i>. <b>Results:</b> 127 preterm participants (81 with BPD) were included at a mean (±SD) age of 19.3±1.4 years. 50% of preterm participants reported a previous respiratory admission (36% and 59% in those without and with BPD, respectively). Mean FEV₁/FVC was -0.61 z-scores lower in those born preterm with a respiratory admission (95% CI -0.21, -1.02, p=0.003) and this difference was greatest in those with BPD (-0.74 z-scores (95% CI -0.24, -1.24), p=0.004). Respiratory symptom burden was increased (wheeze: χ²=5.01, p=0.025; cough: χ²=5.56, p=0.018; rattle: χ²=8.93, p=0.003) and CT analysis showed increased peribronchial thickening in those with an admission (χ²=6.679: p=0.010).&nbsp;A bronchodilator response was more frequently observed in those with a respiratory admission (35% vs 17%, p=0.025). <b>Conclusion:</b> A respiratory admission during infancy or childhood should be considered a risk factor for long-term respiratory morbidity in those born preterm.