Early childhood respiratory morbidity and antibiotic use in ex-preterm infants: a primary care population-based cohort study

Abstract

Background Globally, bronchopulmonary dysplasia (BPD) continues to increase in preterm infants. Recent studies exploring subsequent early childhood respiratory morbidity have been small or focused on hospital admissions. Primary aim Examine early childhood rates of primary care consultations for respiratory tract infections (RTI), lower respiratory tract infections (LRTI), wheeze and antibiotic prescriptions (Abx Px) in ex-preterm and term children. Secondary aim: examine differences between preterm infants discharged home with or without oxygen. Methods Retrospective cohort study using linked electronic primary care and hospital databases of children born between 1997 and 2014. We included 253 677 eligible children, with 1666 born preterm Results Ex-preterm infants had higher rates of morbidity across all respiratory outcomes. After adjusting for confounders, aIRRs for RTI (1.37, 95% CI 1.33–1.42), LRTI (2.79, 95% CI 2.59–3.01), wheeze (3.05, 95% CI 2.64–3.52) and Abx Px (1.49, 95% CI 1.44–1.55) were higher for ex-preterm infants. Ex-preterm infants discharged home on oxygen had significantly greater morbidity across all respiratory diagnoses and Abx Px compared to those without home oxygen. The highest rates of respiratory morbidity were observed in children from the most deprived socioeconomic groups. Conclusion Ex-preterm infants, particularly those with BPD requiring home oxygen, have significant respiratory morbidity and antibiotic prescriptions in early childhood. With the increasing prevalence of BPD, further research should focus on strategies to reduce the burden of respiratory morbidity in these high-risk infants after hospital discharge.