Hospital admissions for lower respiratory tract infections after early-, late-, and post-term birth.

BACKGROUND: Recent data suggest that early-term births are associated with later respiratory morbidity (LRTI), and post-term births may decrease this risk. OBJECTIVES: The objective was to determine the impact of early-term, late-term, and post-term birth on hospital admission for LRTI up to the age of seven years. Additionally, we explored maternal and perinatal factors associated with the risk of admission for LRTIs. METHODS: The association of early-term (37+0 -38+6  weeks), late-term (41+0 -41+6  weeks), and post-term (≥42 weeks) birth with hospital admissions for lower respiratory tract infections (LRTI) in comparison with infants born full-term (39+0 -40+6  weeks) was assessed and early predictors of LRTI were established. The register study included 948 695 infants born in Finland in 1991-2008. Data were analysed in four-term subgroups. Hospital admissions for bronchiolitis/bronchitis and pneumonia were collected up to 7 years of age. Adjusted Cox proportional hazards models were used to assess risk factors of LRTI admissions. RESULTS: The rates of hospital admission in the early-, full-, late-, and post-term groups were 6.7%, 5.5%, 5.1%, and 4.8% for bronchiolitis/bronchitis, and 2.8%, 2.4%, 2.3%, and 2.3% for pneumonia. Early-term birth was associated with an increased risk of admission for bronchiolitis/bronchitis (hazard ratio HR 1.21, 95% confidence interval CI 1.18, 1.23) and pneumonia (HR 1.16, 95% CI 1.12, 1.20), while late-term (HR 0.93, 95% CI 0.91, 0.95) and post-term births (HR 0.89, 95% CI 0.85, 0.93) were associated with a decreased risk of bronchiolitis/bronchitis admission compared with the full-term group. Maternal age ≤ 20 years, smoking during pregnancy, male sex, caesarean delivery, small for gestational age, 1-minute Apgar score < 4, ventilator support, and neonatal antibiotic therapy were associated with an increased risk of LRTI admission, while being firstborn, born in a level-II hospital and in the Northern region was associated with decreased risk. CONCLUSION: Early-term birth was associated with a higher risk of all LRTI admissions while late-term and post-term births were associated with lower risk of bronchiolitis/bronchitis admission. Modifiable risk factors of LRTIs were smoking during pregnancy, birth by elective caesarean delivery, neonatal ventilator support, and antibiotic therapy.

Asthma and atopic dermatitis in children born moderately and late preterm.

UNLABELLED: This national register study aimed to evaluate the need of asthma medication reimbursement and hospitalization due to asthma and atopic dermatitis up to 7 years of age in moderately preterm (MP) (32-33 weeks) and late preterm (LP) (34-36 weeks) children compared to very preterm (VP) (<32 weeks) and term (≥37 weeks) children. Altogether, 1,018,302 children born in Finland between 1991 and 2008 were assessed. The MP and LP groups received asthma medication reimbursement more frequently than term controls (8.0 and 5.7 vs. 3.8 %), but less frequently than VP children (15.4 %). Hospitalization due to asthma was more common among MP (10.6 %) and LP (7.3 %) children than term children (4.8 %) but less common than in VP children (20.1 %). Hospitalization due to atopic dermatitis was more frequent among term (5.2 %) compared to MP (4.2 %) and LP (4.7 %) children. Male sex, maternal smoking, maternal diabetes, and ventilator therapy predicted asthma medication in the MP and/or LP children. CONCLUSION: MP and LP children seem to need medication and hospitalization for asthma more often than term controls but less frequently than VP children followed by 7 years of age. Hospitalization due to atopic dermatitis becomes more common with increasing gestational age. WHAT IS KNOWN: • MP and LP infants have an increased risk for early respiratory morbidity and to asthma. • Less is known on the occurrence of atopic dermatitis in this patient group. What is New: • Medication and hospital care due to asthma were more frequent in school-aged MP and LP than in term infants. Male sex, maternal smoking, maternal diabetes and ventilator therapy predicted asthma. • Hospitalization due to atopic dermatitis became more common with increasing gestational age.

Visual and Hearing Impairments After Preterm Birth.

OBJECTIVES: Our aim was to determine and compare the incidences of sensory impairments among very preterm (VP) (<32 + 0/7 weeks), moderately preterm (MP) (32 + 0/7-33 + 6/7 weeks), late preterm (LP) (34 + 0/7-36 + 6/7 weeks), and term infants (≥37 weeks) and to establish risk factors of neurosensory disabilities. METHODS: This national register study included all live-born infants in Finland between 1991 and 2008. Infants who died before the age of 1 year, who had any major congenital anomaly, or had missing data were excluded (n = 21 007; 2.0%). A total of 1 018 256 infants were analyzed. Incidences of hearing loss, visual disturbances or blindness, other ophthalmologic disorders, and retinopathy of prematurity were determined for gestational age (GA) groups. Risk factors of hearing loss and visual disturbances or blindness were analyzed. RESULTS: The incidences of sensory impairments decreased with advancing GA at birth (P < .001). The most prominent factors associated with increased risks of hearing loss and visual impairment were intracranial hemorrhage and convulsions. VP (odds ratio [OR] 2.34; 95% confidence interval [CI] 1.75-3.14) and LP (OR 1.26; 95% CI 1.04-1.52) births were associated with an increased risk of hearing loss, and VP (OR 1.94; 95% CI 1.55-2.44), MP (OR 1.42; 95% CI 1.11-1.80), and LP (OR 1.31; 95% CI 1.16-1.49) births predicted an increased risk of visual impairment. CONCLUSIONS: Incidences of sensory impairment decreased with increasing GA at birth. The most prominent risk factors predictive of sensory disabilities were intracranial hemorrhage and convulsions. VP and LP births were associated with an increased risk of hearing loss, and VP, MP, and LP births were associated with an increased risk of visual impairment.

Hospital admissions for lower respiratory tract infections in children born moderately/late preterm.

OBJECTIVE: To evaluate the frequency and predictors of hospital admissions for lower respiratory tract infections (LRTIs) in moderately preterm (MP, 32+0 to 33+6 weeks) and late preterm (LP, 34+0 to 36+6 weeks) infants compared to term (T ≥37 weeks) and very preterm (VP, <32+0 weeks) infants. STUDY DESIGN: This national register-based study covered all infants born in Finland in 1991-2008. Data on 1 018 256 infants were analyzed in four gestational age-based groups: VP (n = 6329), MP (n = 6796), LP (n = 39 928), and T (n = 965 203) groups. Data on hospital admissions due to bronchiolitis/bronchitis and pneumonia were collected up to the age of 7 years. RESULTS: Hospital admissions for LRTIs were more common in the MP and LP groups than in the T group but less frequent than in the VP group: bronchiolitis/bronchitis (VP 24.4%, MP 13.9%, LP 9.5%, and T 5.6%) and pneumonia (VP 8.8%, MP 4.5%, LP 3.3%, and T 2.4%). Compared to the term group, MP and LP birth predicted bronchiolitis/bronchitis (MP OR 1.89; 95%CI 1.75-2.03, LP 1.51; 1.45-1.56) and pneumonia (MP 1.49; 1.32-1.67, LP 1.25; 1.18-1.33) admissions. Statistically significant risk factors for LRTIs included maternal smoking, cesarean section, male sex, admission to a neonatal unit and ventilator therapy. In addition, being first-born, being born SGA and neonatal antibiotic therapy were associated with bronchiolitis/bronchitis. CONCLUSIONS: MP and LP births, in addition to VP birth, have a significant impact on respiratory infectious morbidity and the need of hospital admissions for LRTIs.

Asthma and atopic dermatitis after early-, late-, and post-term birth.

OBJECTIVE: To assess the incidence and risk factors of asthma and atopic dermatitis by seven years of age after early-term (ET) (37+0 -38+6 weeks), full-term (FT) (39+0 -40+6 weeks), late-term (LT) (41+0 -41+6 weeks), and especially post-term (PT) (≥42 weeks) birth. METHODS: Altogether, 965 203 infants born between 1991 and 2008 in Finland were investigated in ET, FT, LT, and PT groups. Data on asthma medication reimbursement and hospital visits for atopic dermatitis were retrieved from national health databases. RESULTS: The frequencies of asthma medication reimbursement in the ET, FT, LT, and PT groups were 4.5%, 3.7%, 3.3%, and 3.2%, respectively. Hospital visits due to atopic dermatitis were most common after PT birth. Compared with FT births, ET births were associated with an increased risk of asthma (adjusted odds ratio (aOR), 95% confidence interval (CI) 1.20, 1.17-1.23), while LT (aOR, 95%CI 0.91, 0.89-0.93) births and PT (aOR, 95%CI 0.87, 0.83-0.92) births decreased this risk. PT birth (aOR, 95%CI 1.06, 1.01-1.10) predicted atopic dermatitis. From a population point of view, the most relevant risk factors for asthma were male sex, ET birth, smoking during pregnancy and birth by elective cesarean section, and for atopic dermatitis male sex, first delivery, birth in a level II hospital and birth by cesarean section. CONCLUSIONS: Early-term birth was a predictor of asthma, and PT birth was associated with atopic dermatitis. Counseling against smoking and following strict indications for planned ET deliveries and cesarean sections may be means to reduce the risk of later asthma.

The incidence and risk factors of epilepsy in children born preterm: A nationwide register study.

OBJECTIVES: The aim was to compare the incidence of epilepsy between very preterm (VP) (<32+0 weeks), moderately preterm (MP) (32+0-33+6 weeks), late preterm (LP) (34+0-36+6 weeks) and term infants (≥37 weeks) and to establish and compare risk factors of epilepsy in these groups. METHODS: The national register study included all live born infants in Finland in 1991-2008. Excluding infants with missing gestational age, a total of 1,033,349 infants were included in the analysis and they were analyzed in four subgroups (VP, MP, LP and term) and three time periods (1991-1995, 1996-2001 and 2002-2008). RESULTS: 5611 (0.54%) children with epilepsy were diagnosed. The incidence of epilepsy was 2.53% in the VP, 1.08% in the MP, 0.75% in the LP and 0.51% in the term group. Intracranial hemorrhage (OR 3.48; 95% CI 2.47-4.89) and convulsions in the neonatal period (OR 13.4; 95% CI 10.2-17.6) were associated with an increased risk of epilepsy. Compared to the term group, preterm birth (VP OR 4.59; 95% CI 3.79-5.57, MP 1.97; 1.48-2.63, LP 1.44; 1.25-1.68) was associated with an increased risk of epilepsy after adjusting for maternal, pregnancy, delivery and sex variables. CONCLUSIONS: The incidence of epilepsy decreased by advancing gestational age at birth and preterm birth predicted an increased risk of epilepsy in childhood. Intracranial hemorrhage and neonatal convulsions were strongly associated with an increased risk of epilepsy.

Cerebral palsy among children born moderately and late preterm.

OBJECTIVE: To compare the incidence of and risk factors for cerebral palsy (CP) in moderately preterm (MP) (32(+0)-33(+6) weeks) and late preterm (LP) (34(+0)-36(+6) weeks) infants with those in very preterm (VP) (<32(+0) weeks) and term infants (≥37 weeks). METHODS: The national register study included all live-born infants in Finland from 1991 to 2008. Infants who died before the age of 1 year, had any major congenital anomaly, or had missing data were excluded. A total of 1 018 302 infants were included in the analysis and they were analyzed in 4 subgroups (VP, MP, LP, and term) and 3 time periods (1991-1995, 1996-2001, and 2002-2008). RESULTS: By the age of 7 years, 2242 children with CP were diagnosed (0.2%). CP incidence was 8.7% in the VP, 2.4% in the MP, 0.6% in the LP, and 0.1% in the term group. The risk of CP was highest in the study period 1991-1995 in all groups. Factors predictive of an increased CP risk in the MP and LP groups included resuscitation at birth (odds ratio 1.60; 95% CI 1.01-2.53 and 1.78; 1.09-2.90), antibiotic treatment during the first hospitalization (1.63; 1.08-2.45 and 1.67; 1.13-2.44), 1-minute Apgar score <7 (1.70; 1.15-2.52 and 1.80; 1.21-2.67) and intracranial hemorrhage (7.18; 3.60-14.3 and 12.8; 5.58-29.2). CONCLUSIONS: The incidence of CP is higher in LP and MP infants compared with term infants. There is a nonlinear decrease in incidence over time and with increasing gestational age.