Risk Of Respiratory Morbidity Research Articles

Risk factors associated with respiratory morbidity among puffed rice workers in an urban area of Davanagere city

Introduction: Occupational respiratory disease can be defined as an acute or chronic disorder that arises from the inhalation of air-borne agents in the work place. Puffed rice is a famous food item in Karnataka, which is produced in a cluster of small units. Materials and Methods: A Cross sectional study was conducted among puffed rice workers in Bashanagar, urban field practice area of SSIMS & RC, Davanagere. From January to December 2017. The study population included 550 puffed rice unit workers. Results: The prevalence of respiratory morbidity among the puffed rice workers in the present study was found to be 41.0%. Among them 51(9.2%) puffed rice workers reported Obstructive lung diseases and majority of the workers 175(31.8%) reported Restrictive pattern of lung diseases.Conclusion: The risk of Respiratory morbidity was significantly associated with Age, gender, Education, duration of the work and type of work.

540: Early term delivery: Is there a difference in neonatal respiratory morbidity by diabetes sub-type?

Type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) have been linked to biochemical evidence of delayed fetal lung maturation and neonatal respiratory morbidity in the late preterm period. We sought to compare the impact of diabetes sub-types on neonatal respiratory outcomes in the early term period. We performed a retrospective cohort study of all pregnancies complicated by T2DM or GDM from 2009-2017 and delivered in the early term period (37 0/7-38 6/7 weeks gestation) at an academic tertiary care center. Those with multiple gestations, fetal anomalies, chorioamnionitis, and receipt of antenatal corticosteroids during were excluded. The primary outcome was composite neonatal respiratory morbidity, which included respiratory distress syndrome (RDS) and neonatal respiratory support. Univariable analyses were performed to compare maternal demographics between those with T2DM and GDM. A multivariable logistic regression analysis was performed to adjust for potential confounders, including maternal age, body mass index, chronic hypertension, and race. A total of 683 patients were included in the study, 382 (56%) with GDM and 301 (44%) with T2DM. Women with GDM and T2DM had similar demographic characteristics except those with T2DM were more likely to have chronic hypertension (59% vs. 31%; p< 0.01). Women with T2DM had a significantly increased risk of both composite neonatal respiratory morbidity (aRR 1.49; 95% confidence interval 1.17-1.89) and neonatal RDS alone (aRR 1.63; 95% CI 1.15-2.30) (Table 1). There is a 1.5-fold increased risk for neonatal respiratory morbidity among infants born to women with T2DM compared GDM in the early term period.

The majority of early term elective cesarean sections can be postponed

Introduction To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 370–386 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity. Material and methods Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥370 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent. Results There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 370–386 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥390 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 370–386 weeks gestation compared to 2.4% at 390–421 weeks gestation (p < .001). Conclusion Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.

Morbidity burden of respiratory diseases attributable to ambient temperature: a case study in a subtropical city in China

BackgroundThere are significant associations between ambient temperature and respiratory disease mortality. However, few studies have assessed the morbidity burdens of various respiratory diseases that are attributable to different temperature ranges in subtropical regions.MethodsDaily outpatient visits, weather variables, and air pollution data were collected from January 2013 to August 2017 in a hospital in Dongguan city. A standard time series quasi-Poisson regression with a distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for total respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD), and asthma. Attributable fractions were then calculated to quantify disease burden relative to different temperature components. Finally, we conducted stratified analysis by age group.ResultsBoth low and high temperatures were associated with an increased risk of morbidity secondary to respiratory diseases. Compared with the optimum temperature, the accumulated relative risk (RR) during the seven lag days was 1.13 with a 95% confidence interval (CI) of 1.01–1.26 for extreme heat and 1.02 (95% CI: 0.99–1.05) for extreme cold. Heat-related respiratory morbidity risk was higher than cold-related risk for the total population, but an opposite result was observed for the elderly. About 8.4% (95% CI: 2.8–13.3%) of respiratory morbidity was attributable to non-optimal temperatures, and moderate heat was responsible for most of the excess respiratory morbidity (7.5, 95% CI: 2.4–12.2%).ConclusionsWe found that exposure to non-optimal temperatures increased the risk of respiratory morbidity in subtropical region, and moderate heat contributed to most of the temperature-related respiratory morbidities. This indicates a need for further examination of moderate, rather than extreme, heat in subtropical region.

Moderate hot rather than extreme hot is mainly responsible for temperature-related excess outpatient visits for respiratory diseases

TPS 661: Climate change: temperature effects 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Much evidence has revealed that there are significant associations between ambient temperature and human health. However, few studies have assessed the health burden of respiratory disease attributed to different temperature ranges in subtropical region. Methods: Daily outpatient visits, weather variables and air pollution data were collected from January 2013 to July 2017 in a hospital of Dongguan city. A standard time series quasi-Poisson regression with distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD) and asthma. Attributable risks were then calculated to quantify the disease burdens from different temperature components. Finally, a stratified analysis by age groups was conducted. Results: Both low and high temperature were associated with an increased risk of morbidity of respiratory diseases. Compared with the optimum temperature, the accumulative relative risk (RR) during 7 lag days was 1.13 with 95% confidence interval (CI) 1.01 to 1.26 for extreme hot, and 1.02 (95%CI: 0.99 to 1.05) for extreme cold. Respiratory morbidity risk for young population mainly caused by hot weather, but a reverse J-shaped was observed for the elderly. About 8.4% (95%CI: 2.8% to 13.3%) of respiratory morbidity was attributed to non-optimal temperature. Out of them, moderate hot was responsible for the major part of excess respiratory visits, accounting for 7.5% (95% CI: 2.4% to 12.2%) of respiratory morbidity. Conclusions: We found that moderate hot contributed most of excess respiratory outpatient visits caused by ambient temperature exposure in subtropical region, which indicates more attention should be paid to this temperature range rather than extreme temperature in subtropical regions.

Personal carbon monoxide exposure, respiratory symptoms, and the potentially modifying roles of sex and HIV infection in rural Uganda: a cohort study

BackgroundMost of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive.MethodsFrom September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus.ResultsTwo hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7–27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1–10.0) but not men (AOR 1.3, 95%CI 0.4–4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01–6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1–14.4) participants.ConclusionsIn a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.

A retrospective claims analysis of hospital length of stay, readmissions, and costs through 1 year corrected age among extremely preterm infants with and without chronic respiratory morbidity and bronchopulmonary dysplasia

Background: Infants born extremely preterm are at high risk for developing chronic respiratory morbidity (CRM). Bronchopulmonary pulmonary dysplasia (BPD) can be an early indicator of CRM. Objective: We evaluated the prevalence of CRM among extremely preterm infants, and compared initial hospitalization length of stay (LOS), hospital readmissions, and healthcare costs among infants with and without CRM, and infants with and without BPD. Design/methods: This was a retrospective analysis of the US Truven MarketScan claims database. Included infants were born ≤28 weeks gestational age (GA) and admitted to a neonatal intensive care unit, January 2009-June 2016. We excluded infants with death …

Prematurity as an Independent Risk Factor for the Development of Pulmonary Disease

To determine if premature infants without bronchopulmonary dysplasia (BPD) are at similar risk for developing pulmonary morbidity as compared with those with BPD and if there are differences in management of care. We retrospectively abstracted information from our electronic medical record from January 1, 2006, to December 31, 2015, for primary care patients born at <30weeks of gestation (n=811). Multivariate models determined the impact of BPD on a diagnosis of respiratory disease, respiratory medications, subspecialty visits, and emergency department use or hospitalizations after adjusting for gestational age, sex, insurance type, and race. Infants with BPD were more likely to be diagnosed with asthma than those without BPD (75% vs 60%; OR, 1.8; 95% CI, 1.27-2.54), but not all respiratory conditions (OR, 1.56; 95% CI, 0.7-3.51), and were more likely to be referred to a pulmonologist (relative risk, 5.98; 95% CI, 4.1-8.74). Infants with BPD were more likely to be hospitalized for respiratory conditions than those without BPD (50% vs 30%; relative risk, 2.44; 95% CI, 1.73-3.45). Although infants with BPD were more likely to have a diagnosis of asthma and be readmitted for respiratory conditions, 60% of infants without BPD were also diagnosed with asthma and 30% were readmitted. There were significant differences in the management of patients, including time to pulmonary referral and prescription rates for inhaled corticosteroids. Practitioners should consider all patients born prematurely at high risk for respiratory morbidity.

Neonatal Outcomes of Elective Early-term Births After Demonstrated Fetal Lung Maturity

(Am J Obstet Gynecol. 2018;219:296.e1–296.e8) Positive fetal lung maturity testing is associated with a decrease in the risk of respiratory neonatal morbidity in preterm and early-term neonates, compared with neonates who do not undergo testing. However, several studies suggest that respiratory outcomes, among others, are worse even after fetal lung maturity has been demonstrated in early-term neonates, compared with full-term neonates. This has led to a decline in fetal lung maturity testing. This study aimed to estimate the frequency and risks of adverse neonatal outcomes with early-term birth after positive fetal lung maturity testing compared with full-term birth in the absence of indications for early delivery.

Respiratory morbidity in late preterm twin infants.

Antenatal corticosteroids have been shown to decrease neonatal respiratory morbidity in singleton pregnancies when given during the late-preterm period (340/7-366/7 weeks). Whether these findings also apply to late-preterm twins, who account for approximately one-third of infants born at 340/7-356/7 weeks, is currently unclear. The answer to this question depends, in part, on whether the risk of respiratory morbidity among late-preterm twin infants is similar to that observed in late-preterm singletons. We aimed to assess the rate of respiratory morbidity among late-preterm twin infants using a secondary analysis of prospectively collected data from a large international multicenter trial, and to compare that rate with previous studies that used the same definition of respiratory morbidity. This was a secondary analysis of the twin birth study. In the current study, we limited the analysis to women who gave birth during the late preterm period. The primary outcomes were the same primary composite respiratory morbidity variables that were used in the randomized controlled trial of Gyamfi-Bannerman et al., on the administration of betamethasone during the late preterm period in singletons (ALPS trial). The risk of respiratory morbidity among late preterm twins was stratified by gestational week at birth. A total of 1163 women who gave birth to 2324 late preterm twin infants met the inclusion criteria. The rates of respiratory morbidity and severe respiratory morbidity were 16.5% and 8.9%, respectively. The risk of respiratory morbidity was highly dependent on gestational week at birth, being more than fourfold for infants born at 340/7-346/7 weeks (aOR 4.30, 95%-CI 3.01-6.14) and more than twofold for infants born at 350/7-356/7 weeks (aOR 2.12, 95%-CI 1.51-2.98) compared with infants born at 360/7-366/7 weeks. The rate of respiratory morbidity and the theoretical number of women needed to be treated with betamethasone to prevent a single case of respiratory morbidity in the current study were similar to those reported in the APLS trial (16.5% vs. 14.4%, p = 0.103, and NNT 31 vs. 34, respectively). The risk-benefit ratio of betamethasone with regard to neonatal respiratory morbidity in women with twins at risk of late-preterm birth is expected to be similar to that observed in singletons.

Association of platelet count with all-cause mortality and risk of cardiovascular and respiratory morbidity in stable COPD

BackgroundPlatelet count is a prognostic indicator in the general population and elderly. Thrombocytosis during acute exacerbation of COPD (AECOPD) has been associated with mortality; however, the relationship between platelet count and mortality in stable COPD is unknown.MethodsWe performed post hoc secondary analysis on a subsample of 1797 patients in the Study to Understand Mortality and Morbidity in COPD (SUMMIT) who had blood samples drawn at baseline. Participants were current or former smokers, 40–80 years old with moderate COPD and history or increased risk of cardiovascular (CV) disease. The primary outcome was on and post-treatment all-cause mortality. Secondary outcomes included first-on-treatment moderate/severe AECOPD and on-treatment CV composite event (CV death, myocardial infarction, stroke, unstable angina and transient ischemic attack). Multivariable Cox proportional hazards models were used to investigate study endpoint associations with platelet count quintile grouping, continuous platelet count utilizing two-term fractional polynomials, and categories of low, normal and high platelet count (< 150, ≥150 to < 300, ≥300 × 109/L).ResultsPatients were followed for 2.3 ± 0.9 years for vital status and 1.6 ± 1.1 years for morbidity endpoints during which 105 (5.8%) died, 651 (36.2%) experienced AECOPD (159 with severe AECOPD) and 86 (4.8%) experienced a CV event. A U-shaped association between platelet count and all-cause mortality was observed. Compared to the third quintile group (Q3) of platelet count, risk of death was increased in the lowest quintile group (Q1; hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 0.93–3.23) and highest quintile group (Q5; HR: 1.66; 95%CI: 0.89–3.10), though point estimates were imprecise. Using clinical cutoffs, compared with normal platelet counts (≥150 to < 300 × 109/L), risk of all-cause mortality was nominally increased among patients with thrombocytopenia (HR: 1.46; 95%CI: 0.81–2.64) and high platelet count (HR: 1.66; 95%CI: 0.96–2.86). Compared with Q3, CV events were nominally increased for Q5 (HR: 1.71; 95%CI: 0.83–3.49) and Q1 (HR: 1.41; 95%CI: 0.70, 2.85). There was no association between platelet count and AECOPD.ConclusionsIn stable COPD platelet count demonstrated a U-shaped association with increased risk of 3-year all-cause mortality, though a platelet count level above or below which risk of mortality was increased could not be definitively identified.Trial registrationClinicalTrials.gov NCT01313676.

Impact of Maternal Obesity on Outcomes in Late Preterm Prelabor Rupture of Membranes [11L

INTRODUCTION: Morbidity associated with preterm prelabor rupture of membranes (PPROM) is primarily related to infectious complications and gestational age at delivery. Obesity is a known risk factor for adverse pregnancy outcomes. There is no data on the impact of obesity on outcomes in pregnancies with PPROM after 34 weeks. METHODS: Secondary analysis of a multicenter retrospective cohort study of singletons with PPROM from January 2011-April 2017. Women with a delivery BMI of ≥30 kg/m2 (obese) were compared to women with a delivery BMI of &lt;30 kg/m2 (non-obese). Pregnancies were also stratified based on hospital delivery policies of expectant management (EM) until 35 weeks versus immediate delivery (ID) ≥34 weeks. The primary outcome was neonatal ventilation. Univariate and general estimating equations models were used with p&lt;0.05 level of significance. RESULTS: 259 mother-infant dyads were included and 122 (47%) women were obese. Pregnancies complicated by obesity had increased need for neonatal ventilation as compared to non-obese pregnancies (15.4% in obese versus 8.2% in non-obese, adjusted p&lt;0.001). Obesity was also associated with increased neonatal supplemental oxygen administration, surfactant administration and neonatal antibiotic use &gt;72 hours. However, when stratified by delivery practice and obesity only neonatal antibiotic use &gt;72 hours was significantly lower in obese pregnancies with ID (5.9%) as compared to obese pregnancies with EM (25.0%, p=0.004). CONCLUSION: Pregnancies complicated by PPROM and obesity have an increased risk for neonatal respiratory and infectious morbidity. These findings suggest that obesity and delivery timing impact perinatal outcomes in pregnancies with late PPROM.

Respiratory morbidity, atopy and asthma at school age in preterm infants aged 32-35weeks.

Little is known about respiratory morbidity and asthma risk in preterm infants (PTIs) with a gestational age (GA) over 32weeks. This was a prospective study carried out from birth to 7-8years, comparing two groups: (a) PTIs (GAs 32weeks + 1day to 35weeks + 0days, without comorbidities) and (b) full-term infants (FTIs; GA ≥ 37weeks). Risk and protective factors for bronchiolitis and asthma were identified. A total of 232 children (116/group) were included. Sixty-six (56.9%) PTIs and 43 (37.1%) FTIs presented bronchiolitis (p = 0.002). Recurrent wheezing was 52 (44.8%) on PTIs versus 36 (31.0%) on FTIs (p = 0.03). Asthma at school aged was 27 (23.3%) on PTIs and 8 (6.9%) on FTIs (p = 0.020). Asthma risk factors were only detected in group A.Conclusion: PTIs had a higher prevalence of bronchiolitis, recurrent wheezing and asthma; risk factors for asthma are the following: older siblings, allergic father, atopic dermatitis and antibiotic treatment in the first 3years of life and prematurity itself, which also acted as protective factor for atopic dermatitis. What is known: • In recent decades, there has been a significant increase in the birth of premature babies and consequently, also in the pathologies secondary to the prematurity: a greater number of complications and disorders related to the development and maturation of many organs and systems, especially the respiratory system. Several studies, especially in full-term infants and very preterm infants, have tried to elucidate the risk factors that may influence the development of persistent or chronic respiratory problems such asasthma, but little is known about the aetiology of these disorders in the late or moderate preterm infants. Inthis group of children, the role played by certain factors (early use of antibiotics, chorioamnionitis, smokeexposure, paternal asthma, etc.) on late respiratory morbidity, or asthma, is inconclusive. • Moderate-to-late preterm infants are more predisposed to developing recurrent wheezing/asthma and should adopt control measures. What is new: • Our work provides data related to little-understood aspects of respiratory diseases in this group of late or moderate preterm infants (gestational age between 32 weeks plus 1 day and 35 weeks plus 0 days), by monitoring their evolution from birth to 7-8 years of age, compared with another group of full-term newborns. We aimed to establish the prevalence of bronchiolitis and recurrent wheezing in these children during their first years of life. • The prevalence of school-aged asthma and the risk factors for contracting it were also investigated.

Fetal umbilical, cerebral and pulmonary blood flow patterns in relation to lung function and asthma in childhood. The Generation R Study.

BackgroundFetal growth restriction is associated with higher risks of childhood respiratory morbidity. Fetal blood flow adaptations might contribute to these associations. We examined the associations of fetal umbilical, cerebral, and pulmonary blood flow with wheezing patterns, lung function, and asthma in childhood.MethodsIn a population‐based prospective cohort study among 903 children, we measured fetal umbilical, cerebral, and pulmonary blood flow by pulsed‐wave Doppler at a median gestational age of 30.3 (95% range 28.8‐32.3) weeks. We obtained information about wheezing patterns until the age of 6 years by questionnaires. Lung function was measured by spirometry and information about current asthma was obtained by questionnaire at the age of 10 years.ResultsResults showed a non‐significant relationship between a higher umbilical artery pulsatility index (PI) and umbilical artery PI/cerebral artery PI ratio, indicating fetal blood flow redistribution at the expense of the trunk, with higher risks of early wheezing (OR [95% CI]: 2.07 (0.70‐6.10) and 2.74 (0.60, 12.62) per unit increase, respectively). A higher pulmonary artery time velocity integral, indicating higher pulmonary vascular resistance, was associated with a higher risk of late/persistent wheezing (Z‐score 1.14 [1.01‐1.29]). A higher middle cerebral artery PI was associated with a higher FEV1/FVC (Z‐score [95% CI]: 0.21 [0.01‐0.42]). Results did not materially change after additional adjustment for birth and growth characteristics.ConclusionThird‐trimester fetal blood flow patterns might be related to childhood respiratory health. These findings should be considered as hypothesis generating and need further replication.

Neonatal respiratory status predicts longitudinal respiratory health outcomes in preterm infants.

To examine the relationship between neonatal respiratory status and longitudinal respiratory health outcomes in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 109 VLBW preterm infants were prospectively assessed for respiratory status using the Toce clinical and radiographic scoring method on a postnatal day 28, and severity of bronchopulmonary dysplasia (BPD) at 36-weeks postmenstrual age (PMA), respiratory morbidity within 1 year of corrected age (CA), pulmonary function test, and six-minute walk test at 4 years of age. A high Toce clinical score on day 28 was associated with the occurrence of respiratory morbidity within 1 year of CA and poor pulmonary function and functional exercise performance at 4 years of age in VLBW preterm infants (all P < 0.05). BPD at 36-weeks PMA was associated with an increased risk of respiratory morbidity within 1 year of CA and its negative impact on pulmonary function and functional exercise performance at 4 years of age was most pronounced in the severe form (all P < 0.05). Early assessments of neonatal respiratory status including Toce clinical score and the severity of BPD are valid to identify VLBW preterm infants who are at risk of adverse longitudinal respiratory health outcomes.

Evaluation of the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean

Background: Compared with vaginal delivery, early-term cesarean section (CS) is associated with an increased risk of neonatal respiratory morbidity. Given the role of steroids in lung maturation in preterm labor, few studies have investigated their effects on early-term delivery. Therefore, this study aimed to investigate the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean (37–38 weeks and 6 d).Methods: This randomized clinical trial was conducted in Mahdieh Hospital in Tehran in 2017. Women with single pregnancy who were candidates for planned elective CS in 37–38 weeks and 6 d of gestation were randomly assigned to either betamethasone group (intramuscular injection of 12 mg of betamethasone in two doses with an interval of 24 h from the 37th week of gestation) or control group (routine treatment). Then, neonatal respiratory morbidities, hospitalization in NICU, and its cause and duration were recorded and compared between the two groups.Results: Of all, 16 neonates (7%) suffered from one or more respiratory morbidities, and there was no significant difference between the betamethasone and control groups (six cases (6%) and 10 cases (9%), respectively, p = .299). There was also no significant difference between betamethasone and control groups in terms of the frequency of respiratory morbidities at the gestational age of 37 and 38 weeks (p > .05). Grunting, retraction, or nasal flaring was the most common respiratory morbidity that was observed in 13 neonates (6%). We observed the need for CPAP in three neonates (1%), respiratory distress syndrome (RDS) in three neonates (1%), transient tachypnea of the newborn (TTN) in two neonates (1%), need for resuscitation at birth in one neonate (0.5%), and apnea in one neonate (0.5%). There was no significant difference between the two groups in terms of respiratory morbidities (p > .05). A total of 17 neonates (8%) were admitted to NICU; the number of neonates admitted to NICU was significantly lower in betamethasone group than in the control group (three neonates (7.2%) and 14 neonates (12.7%), respectively, p = .005). Respiratory distress in 11 neonates (5%), sepsis in two neonates (1%), and other cases in four neonates (2%) were the main reasons for NICU admission. The prevalence of respiratory distress, as a cause for admission, was significantly lower in the betamethasone group (p = .005).Conclusion: The findings of this study showed that intramuscular injection of 12 mg of betamethasone in two doses, with an interval of 24 h, after 37 weeks of gestation in women undergoing early-term CS did not have a significant effect on respiratory morbidities in neonates. However, it decreased the frequency of admission to NICU, especially admission due to respiratory distress; it could indicate that the respiratory morbidities were less severe in betamethasone group than in the control group.

Respiratory Morbidity in Late Preterm and Term Babies Born by Elective Caesarean Section.

This study sought to determine the incidence and severity of respiratory morbidity among late preterm and term babies born by elective Caesarean section (CS) in London, Ontario. A retrospective chart review was conducted of all elective CSs performed at or beyond 360 weeks gestation from June 2010 to June 2014 at London Health Sciences Centre and St. Joseph's Health Care (Canadian Task Force Classification II-2). The main indications for elective CS were previous CS (59.3%) and malpresentation (24.2%). The majority of elective CSs were performed at 38 weeks (34.1%) and 39 weeks (40.1%). Although only 3.7% of babies born by elective CS were found to have respiratory morbidity, 85% of these babies were admitted to the neonatal intensive care unit (NICU), and 15% required additional observation through a triage period. The relative risk of respiratory morbidity with elective CS at ≤386 weeks compared with ≥390 weeks was 2.14 (P = 0.0110). Only 3.5% of patients received antenatal steroids. There was an increased level of intervention among the babies admitted to the NICU for respiratory morbidity; 47.8%, 19.6%, 60.8%, and 15.25% required oxygen supplement, bag and mask, continuous positive airway pressure, and intubation with mechanical ventilation, respectively. The risk of respiratory morbidity was significantly higher following elective CS before 39 weeks gestation. This resulted in increased length of stay and increased requirements for intravenous lines, blood draws, and exposure to antibiotics. This study provides further evidence that uncomplicated elective CS should be performed at ≥39 weeks, and interventions, such as preoperative antenatal steroid administration, may be considered if elective CS is medically indicated before 39 weeks.

Apgar score and long-term respiratory morbidity of the offspring: a population-based cohort study with up to 18years of follow-up.

The objective of this study is to investigate whether a significant association exists between low 5-min Apgar scores (< 7) and respiratory morbidity of the offspring. A population-based cohort analysis was performed comparing subtypes of respiratory morbidity leading to hospitalizations among children (up to age 18years) stratified by their 5min Apgar scores. Data were collected from two databases of a regional tertiary center. All singleton deliveries occurring between 1991 and 2014 were included in the analysis. A Kaplan-Meier survival curve was constructed to compare cumulative respiratory-related hospitalization incidence and a Cox proportional hazards model to control for confounders. Deliveries (238,622) met the inclusion criteria. Low 5-min Apgar scores were recorded in 742 (0.3%) newborns. Incidence of respiratory hospitalizations was higher among the low 5min Apgar score group (7.3 vs. 4.8% in the normal [≥ 7] 5min Apgar score group; OR = 1.5, 95%CI 1.2-2.0, p = 0.003). Association remained significant in the Cox model (aHR = 1.4, 95%CI 1.1-1.9, p = 0.01). Incidence of respiratory-related hospitalizations in preterm born offspring was higher among the low vs. the normal 5min Apgar score groups (13.4 vs. 7.2%, OR = 2.0, 95%CI 1.2-3.1 , p = 0.008). Association remained significant in the multivariable analysis (aHR = 1.6, 95%CI 1.1-2.5, p = 0.03). The survival curves demonstrated significantly higher cumulative respiratory morbidity in the low Agar score group for the entire cohort and for the preterm born subgroup.Conclusion: Newborns, of any gestational age, with low 5min Apgar scores appear to be at an increased risk for pediatric respiratory morbidity. What is Known: • Apgar score is a method for assessment of the medical condition of a newborn, and of the need for medical intervention and/or resuscitation. Studies assesing the correlation between low Apgar score and short or long term outcomes report a sgnificant correlation with different outcomes including neurological development and more. As two of its five components (color and respiratory effort) are utilizing the respiratory status, low Apgar scoreis associated with a higher risk for immedisate respiratory morbidity. What is New: • Low Apgar score increases the chances for several long-term respiratory-related morbidities, independent of gestational age and other obstetrical circumstances.

Black Race Is Associated with a Lower Risk of Bronchopulmonary Dysplasia

To use a large current prospective cohort of infants <29 weeks to compare bronchopulmonary dysplasia (BPD) rates in black and white infants. The Prematurity and Respiratory Outcome Program (PROP) enrolled 835 infants born in 2011-2013 at <29 weeks of gestation; 728 black or white infants survived to 36 weeks postmenstrual age (PMA). Logistic regression was used to compare BPD outcomes (defined as supplemental oxygen requirement at 36 weeks PMA) between the races, adjusted for gestational age (GA), antenatal steroid use, intubation at birth, and surfactant use at birth. Of 707 black or white infants with available BPD outcomes, BPD was lower in black infants (38% vs 45%), even though they were of significantly lower GA. At every GA, BPD was more common in white infants. The aOR for BPD was 0.60 (95% CI, 0.42-0.85; P = .004) for black infants compared with white infants after adjusting for GA. Despite the lower rate of BPD, black infants had a higher rate of first-year post-prematurity respiratory disease (black, 79%; white, 63%). In this large cohort of recently born preterm infants at <29 weeks GA, compared with white infants, black infants had a lower risk of BPD but an increased risk of persistent respiratory morbidity.

544: Neonatal morbidity in preterm infants stratified by gestational week of delivery

To explore the effect of gestational age at delivery on the risk for neonatal morbidity following preterm birth (PTB) <37 weeks. A retrospective cohort study of all live singleton preterm neonates born <37 weeks’ gestation (2010-2016). Deliveries <24 weeks’ gestation or stillbirths were excluded. Short-term morbidity included respiratory (RDS, TTN, Bronchopulmonary dysplasia, meconium aspiration syndrome) or CNS (Encephalopathy, IVH, seizures, PVL) adverse outcome. Total morbidity included all previously mentioned complications. 1. Of 69,625 neonates who were delivered during the study period, 3,468 (4.9%) were preterm and met inclusion criteria. The mean(SD) and median (IQR) GA and birthweight were 34.4±2.3 and 35 (34-36) weeks, and 2,430.0±581.7 and 2,430 (2,050-2,740) grams, respectively. The rate of cesarean delivery was 42.3% in our cohort. 2. The overall rate of neonatal morbidity in our cohort was 17.9% for respiratory morbidity, 2.9% of CNS morbidity (IVH rate of 2.7%), 2.7% of NEC and 20.8% of total neonatal morbidity. The rate of neonatal morbidity was inversely related to GA at delivery (Figure). 3. In multivariable logistic regression analysis controlling for maternal hypertensive disorders, diabetes, labor induction, mode of delivery, meconium, birthweight (BW) centile, small for gestational age, neonate gender and gestational age at delivery, the risk for respiratory and CNS morbidity decreased in 21.9-39.8% for every 1 week of pregnancy prolongation (Table). 4. Factors which were significantly associated with adverse neonatal morbidity were maternal hypertensive disorders OR(95%CI) 1.34 (1.02-1.77), male gender 1.45(1.20-177), induction of labor 1.58 (1.18-2.10) and gestational week 0.62 (0.59-0.65). Interestingly, mode of delivery was not associated with adverse outcome. Additionally, as compared to appropriate for gestational age neonates (BW between 10th and 90th centiles), SGA (<10th centile) was significantly associated with decreased risk for total adverse outcome 0.69 (0.49-0.98) whereas LGA (>90th centile) was associated with increased respiratory morbidity 2.0 (1.17-3.43). In preterm neonates, the risk for respiratory and CNS morbidity was inversely related to GA at delivery with SGA being associated with lower risk for complications. The results can be used for risk assessment and consultations in PTBs.View Large Image Figure ViewerDownload Hi-res image Download (PPT)