Abstract
BackgroundAdvances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP). The aim of this study was to investigate hospitalisation rates and respiratory morbidity from five to 11 years of age in a prospective national cohort of EP children born in the surfactant era.MethodsThis was a national prospective cohort study of all children born in Norway during 1999 and 2000 with gestational age (GA) < 28 weeks or birth weight < 1000 grams, and of individually matched term-born controls recruited for a regional subsample. Data on hospital admissions, respiratory symptoms, and use of asthma medication was obtained by parental questionnaires at 11 years of age.ResultsQuestionnaires were returned for 232/372 (62%) EP-born and 57/61 (93%) regional term-born controls. Throughout the study period, 67 (29%) EP-born and seven (13%) term-born controls were admitted to hospital (odds ratio (OR) 2.90, 95% confidence interval (CI): 1.25, 6.72). Admissions were mainly due to surgical procedures, with only 12% due to respiratory causes, and were not influenced by neonatal bronchopulmonary dysplasia (BPD) or low GA(≤ 25 weeks). Respiratory symptoms, asthma and use of asthma medication tended to be more common for EP-born, significantly so for medication use and wheeze on exercise. Neonatal BPD was a risk factor for medication use, but not for current wheeze. In multivariate regression models, home oxygen after discharge (OR 4.84, 95% CI: 1.38, 17.06) and parental asthma (OR 4.38, 95% CI: 1.69, 11.38) predicted current asthma, but neither BPD nor low GA were associated with respiratory symptoms at 11 years of age.ConclusionsHospitalisation rates five to 11 years after EP birth were low, but twice those of term-born controls, and unrelated to neonatal BPD and low GA. Respiratory causes were rare. Respiratory complaints were more common in children born EP, but the burden of symptoms had declined since early childhood.
Highlights
Advances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP)
Risk factors for admissions to hospital and for having current asthma were assessed with binary logistic regression, and results expressed as odds ratios (OR) with 95% confidence intervals (95% CI)
The median gestational age (GA), proportion of mothers with higher education, and proportion of infants who received surfactant and had bronchopulmonary dysplasia (BPD) were higher among the participants, while proportions of mothers who smoked during pregnancy or had chorioamnionitis, and of boys, retinopathy of prematurity or major neurosensory disability at five years of age were lower
Summary
Advances in perinatal care have markedly increased the prospects of survival for infants born extremely preterm (EP). Since the early 1990s increasing numbers of infants born extremely preterm (EP) in high-income countries have survived [1, 2] Birth at this stage of pregnancy interrupts important developmental processes, and requires gas exchange to take place in foetal lungs, often leading to the syndrome of bronchopulmonary dysplasia (BPD) [3]. Skromme et al BMC Pediatrics (2018) 18:102 knowledge on health issues among EP-born survivors exposed to the advanced treatment facilities of the late 1990s and 2000s. Such data are of interest to a growing part of health care professionals, administrators, politicians, the EP-born individuals themselves and their families
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