Neonatal Course Research Articles

Maternal features at time of preterm prelabor rupture of membranes and short-term neonatal outcomes

Objective The objective of this study was to assess if maternal and obstetric characteristics other than gestational age at the time of rupture impact short-term neonatal outcomes. Methods This is a retrospective observational study from a single tertiary care referral center. This study reviewed women with a singleton pregnancy complicated by preterm prelabor rupture of membranes over a 3-year period from May of 2014 through May of 2017. Maternal characteristics and short term neonatal outcomes were collected. Results We identified 210 pregnancies complicated by preterm prelabor rupture of membranes. Eighteen of these patients had rupture of membranes prior to viability. Of the maternal characteristics at time of admission studied, gestational age at rupture and race influenced short term neonatal outcomes. Women who identified as race other than white had neonates with lower rates of intubation than neonates born to white patients. Gestational age at rupture significantly influenced the neonatal intensive care unit length of stay. Each additional week gained before rupture occurred was associated with a 17.1% decrease in length of stay. Maternal age, gravidity, parity, body mass index, single deepest pocket, and amniotic fluid index did not influence short term neonatal outcomes. Conclusions Gestational age at rupture of membranes is the most predictive factor associated with short term neonatal outcomes. Race may also influence short term neonatal outcomes. Other maternal characteristics do not seem to influence short term neonatal outcomes. This information can assist with patient counseling on admission for preterm prelabor rupture of membranes and expected neonatal course.

What risk factors for sudden infant death syndrome are preterm and term medically complex infants exposed to at home?

Risk factors for sudden infant death syndrome include premature birth, maternal smoking, prone or side sleeping position, sleeping with blankets, sharing a sleeping surface with an adult, and sleeping without an adult in the room. In this study, we compare parents' responses on sleep patterns in premature and term infants with medical complexity. Parents of children enrolled in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab were phoned monthly regarding their child's health status until the end of each respiratory syncytial virus season. Baseline data were obtained on patient demographics, medical history, and neonatal course. Responses on adherence to safe sleep recommendations were recorded as part of the assessment. A total of 2,526 preterms and 670 term infants with medical complexity were enrolled. Statistically significant differences were found in maternal smoking rates between the two groups: 13.3% (preterm); 9.3% (term) infants (χ 2=8.1, df=1, P=0.004) and with respect to toys in the crib: 12.3% (term) versus 5.8% preterms (χ 2=24.5, df=1, P<0.0005). Preterm infants were also significantly more likely to be placed prone to sleep (8.8%), compared with term infants (3.3%), (χ 2=18.1, df=1, P<0.0005). All the infants in this study had frequent medical contacts. There is a greater prevalence of some risk factors for sudden infant death syndrome in preterm infants compared to term infants with medical complexity. Specific educational interventions for vulnerable infants may be necessary.

Cerebral and peripheral muscle oxygenation and perfusion: Course in moderate and late preterm neonates during the first day after birth.

To investigate the ratio of cerebral tissue oxygenation index (cTOI) to peripheral muscle tissue oxygenation index (pTOI) measured by near-infrared spectroscopy (NIRS) in cardio-circulatory stable preterm neonates without signs of inflammation/infection on the first day after birth. Observational study analysing secondary outcome parameters of the 'Avoiding Hypotension in Preterm Neonates (AHIP)' trial (ClinicalTrials.gov identifier: NCT01910467). Preterm neonates, who had cTOI and pTOI measurements during 24 h after birth, were included. In each neonate the mean of the cTOI/pTOI-ratio, cTOI, pTOI and routine monitoring parameters were calculated for each hour and for the 24-h measuring period. Courses of all measured parameters were analysed. Eighty-seven stable preterm neonates (33.1 [32.1-34.1] weeks of gestation) were included. The mean value over the 24-h measuring period for the cTOI/pTOI-ratio was 0.96 ± 0.02, for cTOI 70.1 ± 1.4 and for pTOI 73.4 ± 0.9. Routine monitoring parameters were in the normal ranges over 24 h. The courses of the cTOI/pTOI-ratio and cTOI showed significantly lower values from hour 5 to 15 compared to the first hours after birth. Heart rate decreased significantly over time, whereas mean arterial blood pressure increased significantly. pTOI, arterial oxygen saturation and body temperature showed no significant change over time. We are the first to report on cTOI/pTOI-ratios for cardio-circulatory stable preterm neonates over a 24-h period after birth, showing significantly lower values from hour 5 to 15 compared to the first hours after birth.

Addressing Perinatal Mental Health Risk within a Fetal Care Center.

Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.

Improved ventilation in premature babies after transcatheter versus surgical closure of patent ductus arteriosus

AimsPatent ductus arteriosus (PDA) is common in preterm infants and can contribute to morbidity and mortality. We aimed to compare results and outcome of transcatheter closure using the Amplatzer Piccolo Occluder versus surgical closure in 2 matched groups of preterm infants weighing <3000 g. Methods and resultsA total of 147 babies from three tertiary centres were retrospectively analysed. Sixty-four babies undergoing catheter closure were compared with 83 matched surgical cases. Patent ductus arteriosus closure was successful in all cases. During neonatal unit course, mortality was 6.3% (n = 4) after catheterization and 12% (n = 10) after surgery (p = 0.24). Median duration of mechanical ventilation was shorter after catheterisation than after surgery (3 vs 5 days, p = 0.035). Before 4 weeks of age the difference between transcatheter and surgical closure for mechanical ventilation was even more pronounced (3 vs 9 days, p = 0.022). Additionally, when catheterisation was performed before 4 weeks, babies were discharged home earlier as compared to those who underwent closure later in life (39+1 vs. 42+1 weeks, p = 0.021). Such difference was not found in the surgical group. ConclusionsTranscatheter closure of patent ductus arteriosus is safe, effective and is associated with shorter mechanical ventilation than after surgery. Hospital stay might be shorter when performed earlier in life.

Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester

Abstract Objectives Umbilical cord varix is an abnormal dilatation of the umbilical vein. There are two types of umbilical venous varix, of which the free-loop type is extremely rare, and the prognosis and etiology are unclear. In this report, we present a case of a significantly enlarged varix in the free loop of the umbilical cord found in the second trimester. Case presentation Cesarean section was performed at 28 weeks’ gestation due to enlargement of the varix and rapidly increased umbilical venous velocity at the outlet of the varix. Neonatal blood tests revealed anemia and high concentrations of D-dimer, and they were considered to be due to clot formation inside the umbilical cord venous varix. The neonate received blood transfusion but other neonatal course was generally favorable. Thrombus formation in the enlarged varix was due to the constriction of the umbilical cord. Conclusions This case showed that the assessment of umbilical venous flow velocity can be used for estimating the constriction of the umbilical vein and for determining the timing of delivery.

Neonatal brain ultrasound training for beginners: Could a head phantom be useful?

The traditional method of teaching the technique of neonatal brain ultrasonography is based upon the interaction between the practitioner and the neonate under the supervision of a tutor. This approach has disadvantages in that it may result in a longer imaging examination and the patient may become agitated. As demand for ultrasound services escalates and departments get busier, this often means that the trainee and supervisor are under pressure to work rapidly. Such environments are common but not conducive to the development of adequate skills and competencies. A neonatal head phantom used as part of a dedicated study day could help the beginner to learn basic elements of the ultrasound examination within a safe stress-free environment. It offers the opportunity to repeat the examination as often as the trainee wishes without time pressures and the distraction of a moving and potentially very sick baby. The aim of this study is to evaluate the efficacy of a commercial phantom as a means for the practitioner to acquire the fundamental principles of neonatal brain ultrasound. A total of 17 participants attending a one day neonatal ultrasound course aimed at beginners were invited to complete a short two-part questionnaire that assessed their perceived improvement in scanning ability before and after using a commercially available head phantom. Of the 14 returned questionnaires, the overall perceived understanding, ability and confidence improved and anxiety levels about the procedure fell. The median pre-training score was 9.0 compared with the median post-training score of 12.0 (P = 0.005, Wilcoxon signed-rank test). At least 79% (up to 86%) of participants valued their experience with the phantom and would recommend the course to colleagues. Furthermore, about two-thirds reported that they would like to have additional practise with the phantom. Preliminary data from this study suggest that beginners found the head phantom useful for mastering some of the early skills required for neonatal brain ultrasound examinations, which in turn improved their confidence and reduced anxiety.

Problems and thoughts in the application of neonatal resuscitation technology in rural primary hospitals

Neonatal resuscitation project to rural grass-roots development is different from urban promotion and application, need to adjust appropriate strategies and measures. Correct understanding of the effectiveness of resuscitation technology can improve the compliance of rural grass-roots promotion and application. According to Renewal of International Neonatal Resuscitation Course and China′s Implementation Opinions, we should make the training of recovery teams as an important goal of long-term management, And adhere to case one preparation, one monitoring, one week one review. Rural grass-roots units should innovate and popularize application methods according to local conditions. It is suggested that the training system for neonatal resuscitation and post-resuscitation treatment should be gradually established in county (city) areas. Key words: Neonatal resuscitation; Asphyxia; Rural areas; Basic level; Training

Assessment of educational performance of nurses in neonatal intensive care unit from parents' perspective.

INTRODUCTION:One of the key elements in family-centered care is educating parents with hospitalized infant at intensive care unit. Education is a fundamental role of nursing at intensive care units to satisfy parents and accelerate disease progression that eventually reduces hospital re-admission.MATERIALS AND METHODS:This was a cross-sectional study conducted in 2018, and the study population was admitted infants (n = 90) in the neonatal intensive care unit (NICU) of Shahid Beheshti University of Medical Sciences hospitals. We used a questionnaire including sociodemographic characteristics and performance of nurses in educating parents. Nurses’ performance was assessed in five major areas composed of family-centered care, delivering cares according to individualized needs, education on equipment, basic needs of infants, and finally, nutritional education. All statistical analyses were conducted using SPSS version 22. The data were analyzed using t-test, ANOVA, and nonparametric tests.RESULTS:Findings from the current study indicated that nurses performed their educational role weakly (37% of standard level). We also found that nurses who participated in neonatal educational courses had better performance compared to their counterparts. The results showed that year of experiences working as a clinical nurse was significantly associated (P < 0.05) with performing standard education.CONCLUSION:Our findings indicated that nurses performed their educational role weakly which might be due to staff shortage, heavy workload, and lack of time for educating parents. Therefore, it is necessary to improve the quality of education among nurses working at the NICUs and provide the necessary standards and indicators to evaluate this important task.

A survey of emergency medical services personnel who attended the neonatal cardio-pulmonary resuscitation training course

A survey of emergency medical services personnel who attended the neonatal cardio-pulmonary resuscitation training course

Juvenile onset parkinsonism-dystonia syndrome: A novel mutation in the SLC6A3 gene

The differential diagnosis for genetic dystonia parkinsonism is broad. Juvenile onset parkinsonism-dystonia, also known as dopamine transporter deficiency syndrome (DTDS), is an autosomal recessive disorder with variable neurological manifestations and age of onset. We describe DTDS with a novel mutation. Case report We identified a 19-year-old male, who presented with history of juvenile-onset parkinsonism. He had a normal birth and neonatal course with normal developmental milestones. Cognitive, motor and speech were reported to be normal in the first decade of life. At 10–11 years of age, the patient started to have tremor and progressive parkinsonian symptoms. He additionally starts to have speech difficulties. The parents are consanguineous, but there is no family history of movement disorders, Parkinson’s disease or other psychiatric illness. Other siblings (brother and sister) are unaffected. Neurological examination revealed loss of speech to single words, rigidity, generalized bradykinesia, dystonia with dystonic tremor. Gene analysis showed a novel homozygous mutation in SLC6A3 gene (g.1394863c > G) with both parents and siblings having a heterozygous mutation in the same gene. •DTDS is a rare disorder that should be considered in the differential diagnosis of genetic parkinsonism of juvenile-onset. Affected individuals show hyperkinesia with orolingual and limb dyskinesia, dystonia, and chorea with parkinsonian features.•Atypical onset in adolescence or adulthood has been described.•SLC6A3 encodes the dopamine transporter (DAT) that is expressed predominantly within the substantia nigra and in the midbrain, which has a crucial role in mediating reuptake and homeostasis of dopamine.

Antifungal Drugs for Invasive Candida Infections (ICI) in Neonates: Future Perspectives.

Fungal infections may complicate the neonatal clinical course, and the spectrum of therapies for their treatment in the perinatal period is limited. Polyenes, Azoles and Echinocandins represent the three classes of antifungal drugs commonly used in the neonatal period. The present review provides an overview about the most recent therapeutic strategies for the treatment of fungal infections in neonates.

Elevated C-reactive protein in umbilical cord blood: Neonatal case review.

C-reactive protein (CRP) has limited placental transportability. Relying on CRP level in umbilical cord blood alone is an inaccurate way to predict early onset neonatal sepsis, and we retrospectively reviewed the clinical courses of neonates with elevated CRP in umbilical cord blood. This study was a retrospective case review of neonates with elevated CRP in umbilical cord blood (>0.5mg/dL) in the Nara Prefecture General Medical Center, Nara, Japan between February 2013 and August 2017. We investigated the association of maternal and neonatal factors with neonatal clinical course. Then, we compared the cases of neonates with and without elevated CRP in umbilical cord blood. The subjects consisted of a total of 22 neonates with elevated CRP in umbilical cord blood and 344 neonates without elevated CRP in umbilical cord blood. Of the 22 neonates with elevated CRP, 18 had some symptoms of sepsis at birth, but the symptoms of 85% of the symptomatic patients resolved ≤24h after birth. Two neonates with elevated CRP in umbilical cord blood had bacteremia, and they had poor prognoses. Elevated CRP in umbilical cord blood was associated with length of antimicrobials (P = 0.021), immature/total neutrophil ratio (P = 0.017), and pathological chorioamnionitis (CAM; P = 0.028) on multivariable logistic regression analysis. Elevated CRP in umbilical cord blood was associated with pathological CAM. Most symptoms of sepsis resolved <24h after birth.

Estimation of early life endogenous surfactant pool and CPAP failure in preterm neonates with RDS

BackgroundIt is not known if the endogenous surfactant pool available early in life is associated with the RDS clinical course in preterm neonates treated with CPAP. We aim to clarify the clinical factors affecting surfactant pool in preterm neonates and study its association with CPAP failure.MethodsProspective, pragmatic, blind, cohort study. Gastric aspirates were obtained (within the first 6 h of life and before the first feeding) from 125 preterm neonates with RDS. Surfactant pool was measured by postnatal automated lamellar body count based on impedancemetry, without any pre-analytical treatment. A formal respiratory care protocol based on European guidelines was applied. Clinical data and perinatal risk factors influencing RDS severity or lamellar body count were real-time recorded. Investigators performing lamellar body count were blind to the clinical data and LBC was not used in clinical practice.ResultsMultivariate analysis showed gestational age to be the only factor significantly associated with lamellar body count (standardized β:0.233;p = 0.023). Lamellar body count was significantly higher in neonates with CPAP success (43.500 [23.750–93.750]bodies/μL), than in those failing CPAP (20.500 [12.250–49.750] bodies/μL;p = 0.0003).LBC had a moderate reliability to detect CPAP failure (AUC: 0.703 (0.615–0.781);p < 0.0001; best cut-off: ≤30,000 bodies/μL). Upon adjustment for possible confounders, neither lamellar body count, nor its interaction factor with gestational age resulted associated with CPAP failure.ConclusionsEarly postnatal lamellar body count on gastric aspirates in CPAP-treated preterm neonates with RDS is significantly influenced only by gestational age. Lamellar bodies are not associated with CPAP failure. Thus, the endogenous surfactant pool available early in life only has a moderate reliability to predict CPAP failure.

Neurological diseases in pregnancy.

To summarize recent research findings and current concepts related to care of neurologic diseases in pregnancy and the risks of pregnancy to the mother-infant dyad. Recent publications related to best practices for neurologic care, risks of pregnancy, rate of relapse during and after pregnancy, as well as medication safety in pregnancy and lactation for more commonly used neurologic medications are reviewed. Data continues to grow that women with neurologic conditions can experience pregnancy with minimal risks. Additionally, as more data is being published on medication safety in pregnancy and lactation, most medical therapy is now thought to be compatible, improving symptoms and care for women with neurologic conditions who require pharmacologic treatment. However, data remains limited from clinical trials and from more objective studies. Researchers continue to clarify the impact of pregnancy on the course of chronic neurologic diseases such as multiple sclerosis, myasthenia gravis, epilepsy, migraine, and cerebral aneurysms as well as the impact of these diseases on antepartum, labor and delivery, and postpartum management and neonatal course. Acute neurological conditions with pregnancy-associated risk such as stroke, posterior reversible encephalopathy syndrome, and cerebral venous sinus thrombosis are increasingly studied to determine individuals who are most vulnerable to these serious complications. Many neurological diseases coexist with pregnancy. Recent research indicates a good prognosis for both mother and neonate. Although research related to neurologic disease in pregnancy is growing, it remains an area that deserves further focus to guide evidence-based care. With advances in research on therapeutic options, some women can achieve a safe pregnancy in the setting of chronic neurological disease. VIDEO ABSTRACT: http://links.lww.com/COOG/A45.

Cervical lymphatic malformations: Prenatal characteristics and ex utero intrapartum treatment

The ex utero intrapartum treatment (EXIT) is utilized to transition fetuses with prenatally diagnosed airway obstruction to postnatal life. We describe the unique clinical course, diagnosis, treatment, and outcomes of patients with cervical lymphatic malformation (CLM) managed with EXIT. Review of fetuses with diagnosed CLM was delivered by EXIT (2001-2018) in a tertiary referral fetal center. Outcomes included survival, tracheostomy at discharge, neonatal course after delivery, and pulmonary hypoplasia. Data are reported as median [range] and rate (%). Out of 45 patients delivered by EXIT, 10 were delivered for CLM: seven had polyhydramnios, one had nonimmune hydrops, five delivered preterm, and three were emergency EXITs. The EXIT time and estimated blood loss were 125minutes (95, 158) and 900mL (500, 1500), respectively. Airway was secured in all. There was one neonatal death (day 8) with prematurity, sepsis, and pulmonary hypoplasia. Three out of nine were discharged with a tracheostomy. In CLM, close monitoring for structural neck involvement and development of polyhydramnios are important and may be an indication for EXIT as the optimal delivery mode. An experienced multidisciplinary team is a key factor for an effective approach to the obstructed airway in CLM.

Delayed resolution of retinopathy of prematurity

To compare the characteristics of infants whose retinopathy of prematurity (ROP) resolves in <50weeks with those of infants whose ROP resolves in >50weeks' postmenstrual age (PMA) in order to identify which infants are at risk for delayed resolution and to evaluate whether severe ROP developed after 50weeks' PMA. The medical records of infants screened for ROP from January 2008 to December 2016 at a tertiary care facility were reviewed retrospectively. Infants without follow-up prior to ROP resolution or complete retinal vascularization and those with retinal detachment were excluded. Delayed resolution of ROP was defined as presence of immature retinal vasculature at ≥50weeks' PMA. The birth characteristics, neonatal complications, and ROP characteristics of infants with and without delayed resolution were compared. A total of 996 infants were included, of whom 136 (13.6%) showed delayed resolution. Increasing severity of ROP (higher stage, lower zone, plus/pre-plus disease) and type 2 ROP was associated with delayed resolution (P<0.05). Other variables associated with delayed resolution included <28weeks gestational age, ≤3rd percentile birth weight, positive blood culture sepsis, necrotizing enterocolitis, intraventricular hemorrhage, and bronchopulmonary dysplasia (P<0.05). No infants developed type 1 after 50weeks' PMA. After a prolonged follow-up course consistent with AAP guidelines, a single patient in our study cohort was treated at 81weeks' PMA for persistent type 2 ROP. In our cohort, delayed resolution of ROP was more likely in infants with more severe ROP or a complex neonatal course. No patient with delayed resolution developed type 1 ROP after 50weeks' PMA, supporting AAP guidelines.

Epidemiology of neonatal stroke: A population-based study.

The goal of this study was to obtain population-based data on the incidence, clinical presentation, management, imaging features, and long-term outcomes of patients with all types of neonatal stroke (NS). Full-term neonates with NS born between January 2007 and December 2013 were identified through the Nova Scotia Provincial Perinatal Follow-up Program Database. Perinatal data and neonatal course were reviewed. Neurodevelopmental outcomes were assessed at 18 and 36 months of age using standardized testing. Twenty-nine neonates with NS were identified during the study period, giving an incidence of 47 per 100,000 live births in Nova Scotia. Arterial ischemic stroke was the most common stroke type (76%), followed by neonatal hemorrhagic stroke (17%), then cerebral sinovenous thrombosis (7%). The majority of neonates presented with seizures (86%) on the first day of life (76%). At 36 months of age, 23 (79%) of the children had a normal outcome, while 3 (10%) were diagnosed with cerebral palsy (2 with neonatal arterial stroke and one with neonatal hemorrhagic stroke) and 3 (10%) had recurrent seizures (1 patient from each stroke subtype group). The incidence of NS in Nova Scotia is higher than what has been reported internationally in the literature. However, the neurodevelopmental outcomes at 3 years of age are better. Further studies are required to better understand the reasons for these findings.

Incidence and Risk Factors of Early Onset Neonatal AKI.

Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. The international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization. Twenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Those factors that were associated with a lower risk included multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors. Risk factors varied by gestational age strata. AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as "red flags" for clinicians at the initiation of the neonatal intensive care unit course.

Respiratory syncytial virus prophylaxis in infants with congenital airway anomalies compared to standard indications and complex medical disorders.

An observational study was conducted of children < 2years who received ≥ 1 dose of palivizumab in 32 Canadian institutions from 2005 to 2017. We compared respiratory illness (RIH) and respiratory syncytial virus-related hospitalization (RSVH) hazards in children with a congenital airway anomaly (CAA) versus those prophylaxed for standard indications (SI) and serious medical disorders (SMD). Data were assembled on neonatal course, demographics, palivizumab utilization and adherence, and respiratory illness events, and analyzed using ANOVA, chi-square tests and Cox proportional hazards. Twenty-five thousand three children (1219 CAA, 3538 SMD, and 20,246 SI) were enrolled. Palivizumab adherence was 74.8% overall and similar across groups. For 2054 respiratory-related events, 1724 children were hospitalized. RIH rates were 13.6% (CAA), 9.6% (SMD), and 6.0% (SI). RSVH rates were 2.4% (CAA), 1.6% (SMD), and 1.5% (SI). After adjustment for demographic and neonatal differences, children with a CAA had a significantly increased RIH and RSVH hazard relative to SI (RIH, HR = 1.6, 95% CI 1.2-2.2, p = 0.002; RSVH, HR = 2.1, 95% CI 1.0-4.4, p = 0.037) but similar to SMD (RIH, HR = 1.3, 95% CI 0.9-1.9, p = 0.190; RSVH, HR = 1.7, 95% CI 0.7-4.1, p = 0.277).Conclusion: Children with a CAA experience higher RIH risk. RSVH hazard was similar between CAA and SMD but higher for CAA compared to SI, implying that this population requires surveillance for RSV prophylaxis. What is Known: • Children with congenital airway anomalies (CAA) are at risk for respiratory tract illness and respiratory syncytial virus-related hospitalization (RSVH) with accompanying morbidity and mortality • RSV prophylaxis may be useful in children with a CAA, but is not routinely recommended What is New: • Children with a CAA had a 1.6-2.3 fold greater risk of respiratory-related hospitalization and RSVH compared to those prophylaxed for standard, approved indications and serious medical disorders. • RSVH risk in children aged < 2years with either upper or lower airway anomalies is similar. Children with a CAA require careful surveillance during the RSV season and prophylaxis may be appropriate.