Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.

<h4>Background</h4>Children born preterm (<37 completed weeks' gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gesta...

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Autores principales:	Victoria Coathup, Claire Carson, Jennifer J Kurinczuk, Alison J Macfarlane, Elaine Boyle, Samantha Johnson, Stavros Petrou, Maria A Quigley
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/eb81479172834f969cbf0c22b7b0ad4b
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id	oai:doaj.org-article:eb81479172834f969cbf0c22b7b0ad4b
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Victoria Coathup Claire Carson Jennifer J Kurinczuk Alison J Macfarlane Elaine Boyle Samantha Johnson Stavros Petrou Maria A Quigley Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
description	<h4>Background</h4>Children born preterm (<37 completed weeks' gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship.<h4>Methods and findings</h4>Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1-2, 3-4, 5-6, and 7-10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7-10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91-7.22) during infancy, declining to 3.16 (2.50-3.99) at ages 7-10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21-1.27) and 1·18 (1.13-1.23), during infancy and aged 7-10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55-11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56-7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20-13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95-11.32)) were the most common causes.<h4>Conclusions</h4>Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7-10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.
format	article
author	Victoria Coathup Claire Carson Jennifer J Kurinczuk Alison J Macfarlane Elaine Boyle Samantha Johnson Stavros Petrou Maria A Quigley
author_facet	Victoria Coathup Claire Carson Jennifer J Kurinczuk Alison J Macfarlane Elaine Boyle Samantha Johnson Stavros Petrou Maria A Quigley
author_sort	Victoria Coathup
title	Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
title_short	Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
title_full	Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
title_fullStr	Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
title_full_unstemmed	Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
title_sort	associations between gestational age at birth and infection-related hospital admission rates during childhood in england: population-based record linkage study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/eb81479172834f969cbf0c22b7b0ad4b
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spelling	oai:doaj.org-article:eb81479172834f969cbf0c22b7b0ad4b2021-12-02T20:06:11ZAssociations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.1932-620310.1371/journal.pone.0257341https://doaj.org/article/eb81479172834f969cbf0c22b7b0ad4b2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257341https://doaj.org/toc/1932-6203<h4>Background</h4>Children born preterm (<37 completed weeks' gestation) have a higher risk of infection-related morbidity than those born at term. However, few large, population-based studies have investigated the risk of infection in childhood across the full spectrum of gestational age. The objectives of this study were to explore the association between gestational age at birth and infection-related hospital admissions up to the age of 10 years, how infection-related hospital admission rates change throughout childhood, and whether being born small for gestational age (SGA) modifies this relationship.<h4>Methods and findings</h4>Using a population-based, record-linkage cohort study design, birth registrations, birth notifications and hospital admissions were linked using a deterministic algorithm. The study population included all live, singleton births occurring in NHS hospitals in England from January 2005 to December 2006 (n = 1,018,136). The primary outcome was all infection-related inpatient hospital admissions from birth to 10 years of age, death or study end (March 2015). The secondary outcome was the type of infection-related hospital admission, grouped into broad categories. Generalised estimating equations were used to estimate adjusted rate ratios (aRRs) with 95% confidence intervals (CIs) for each gestational age category (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 and 42 weeks) and the models were repeated by age at admission (<1, 1-2, 3-4, 5-6, and 7-10 years). An interaction term was included in the model to test whether SGA status modified the relationship between gestational age and infection-related hospital admissions. Gestational age was strongly associated with rates of infection-related hospital admissions throughout childhood. Whilst the relationship attenuated over time, at 7-10 years of age those born before 40 weeks gestation were still significantly higher in comparison to those born at 40 weeks. Children born <28 weeks had an aRR of 6.53 (5.91-7.22) during infancy, declining to 3.16 (2.50-3.99) at ages 7-10 years, in comparison to those born at 40 weeks; whilst in children born at 38 weeks, the aRRs were 1·24 (1.21-1.27) and 1·18 (1.13-1.23), during infancy and aged 7-10 years, respectively. SGA status modified the effect of gestational age (interaction P<0.0001), with the highest rate among the children born at <28 weeks and SGA. Finally, study findings indicated that the associations with gestational age varied by subgroup of infection. Whilst upper respiratory tract infections were the most common type of infection experienced by children in this cohort, lower respiratory tract infections (LRTIs) (<28 weeks, aRR = 10.61(9.55-11.79)) and invasive bacterial infections (<28 weeks, aRR = 6.02 (4.56-7.95)) were the most strongly associated with gestational age at birth. Of LRTIs experienced, bronchiolitis (<28 weeks, aRR = 11.86 (10.20-13.80)), and pneumonia (<28 weeks, aRR = 9.49 (7.95-11.32)) were the most common causes.<h4>Conclusions</h4>Gestational age at birth was strongly associated with rates of infection-related hospital admissions during childhood and even children born a few weeks early remained at higher risk at 7-10 years of age. There was variation between clinical subgroups in the strength of relationships with gestational age. Effective infection prevention strategies should include focus on reducing the number and severity of LRTIs during early childhood.Victoria CoathupClaire CarsonJennifer J KurinczukAlison J MacfarlaneElaine BoyleSamantha JohnsonStavros PetrouMaria A QuigleyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257341 (2021)

Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.

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