Asthma and lower airway disease
Early-term birth is a risk factor for wheezing in childhood: A cross-sectional population study

https://doi.org/10.1016/j.jaci.2015.05.005Get rights and content

Background

Early term–born (37-38 weeks' gestation) infants have increased respiratory morbidity during the neonatal period compared with full term–born (39-42 weeks' gestation) infants, but longer-term respiratory morbidity remains unclear.

Objective

We assessed whether early term–born children have greater respiratory symptoms and health care use in childhood compared with full term–born children.

Methods

We surveyed 1- to 10-year-old term-born children (n = 13,361). Questionnaires assessed respiratory outcomes with additional data gathered from national health databases.

Results

Of 2,845 eligible participants, 545 were early term–born and 2,300 were full term–born. Early term–born children had higher rates of admission to the neonatal unit (odds ratio [OR], 1.7; 95% CI, 1.2-2.5) and admission to the hospital during their first year of life (OR, 1.6; 95% CI, 1.2-2.1). Forty-eight percent of early term–born children less than 5 years old reported wheeze ever compared with 39% of full term–born children (OR, 1.5; 95% CI, 1.1-1.9), and 26% versus 17% reported recent wheezing (OR, 1.7; 95% CI, 1.3-2.4). Early term–born children older than 5 years reported higher rates of wheeze ever (OR, 1.4; 95% CI, 1.05-1.8) and recent wheezing over the last 12 months than full-term control subjects (OR, 1.4; 95% CI, 1.02-2.0). Increased rates of respiratory symptoms in early term–born children persisted when family history of atopy and delivery by means of cesarean sections were included in logistic regression models.

Conclusion

Early term–born children had significantly increased respiratory morbidity and use of health care services when compared with full term–born children, even when stratified by mode of delivery and family history of atopy.

Section snippets

Respiratory and Neurological Outcomes of Children born Preterm Study

We conducted a cross-sectional population-based study of children in Wales to explore the association between gestational age at birth and the risk of respiratory illness, hospital admissions, and other health-related outcomes in the first 10 years of life. In brief, we invited 13,361 preterm-born children and 13,361 term-born matched control subjects in 2013, with birth dates from January 1, 2003, to December 31, 2011, to complete a survey on respiratory and neurological health-based outcomes.

Characteristics of responders

From 13,361 term-born children invited to take part, 2,845 (21.3%) were included in the analyses after exclusion of 6 respondents. Responders had similar characteristics to nonresponders except for higher WIMD scores (Table I, Table II and see Tables E1 and E2 in this article's Online Repository at www.jacionline.org). Comparing early term–born children (both age groups) with full term–born control subjects did not show a statistically significant difference for sex, age, WIMD score, ethnicity,

Discussion

The aim of this cross-sectional study was to collect data on respiratory-related outcomes for children who were born early or full term. Our results show that early term–born children up to 10 years of age had up to 70% greater risk of respiratory symptoms and up to 50% greater inhaler use than similarly aged term-born children. Early term–born children aged 5 years or greater also had increased risk of chest infections and antibiotic use when compared with those born at full term. The risk of

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    Supported in part by Mason Medical Research Foundation and CYPRN.

    Disclosure of potential conflict of interest: M. O. Edwards has received research support from the Mason Medical Research Foundation and the Children and Young People's Research Network (CYPRN Wales) and has received travel support from CYPRN Wales. S. Kotecha has consultant arrangements with VoluSense Norway and has received research support from the Medical Research Council, the European Union Framework Programme 7, and the Welsh government. The rest of the authors declare that they have no relevant conflicts of interest.

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