Outpatient Respiratory Outcomes in Extremely Preterm Children During the First 3 Years of Life.

Abstract

Rationale: Extremely preterm infants are at highest risk for developing bronchopulmonary dysplasia (BPD). This study aimed to examine the relationship between gestational age and respiratory outcomes in children with BPD in the outpatient setting.

Methods: Data were collected from 1025 preterm children with BPD recruited from outpatient bronchopulmonary (BPD) clinics at Johns Hopkins and Children's Hospital of Philadelphia (CHOP). Extremely preterm children (22-24 and 25-27 weeks gestation) were compared to a reference group of very preterm children (28-32 weeks gestation). Data were analyzed using Χ² tests, t-tests, and ANOVA tests.

Results: Infants born at < 25 weeks gestation were more likely to have severe BPD (71.9%), be discharged on supplemental oxygen (50.7%), have public insurance, and self-report as Black (60.4%) compared to those born > 25 weeks. In the outpatient setting, extremely preterm children (22-24 weeks gestation) had a higher likelihood of activity limitation (OR 1.72) compared to very preterm infants. Hispanic children, regardless of gestational age, were more likely to have sick visits (OR 2.09) and a hospital admission (OR 2.15) compared to non-Hispanic children. Children with public insurance had a higher likelihood of ED visits (OR 1.48), hospital admissions (OR 1.49), systemic steroid use (OR 1.39), nighttime respiratory symptoms (OR 1.66), and activity limitations (OR 1.61) compared to privately insured children.

Conclusions: After initial hospital discharge, extremely preterm children (22-24 weeks gestation) have a higher likelihood of activity limitation. However, other factors including race/ethnicity and public insurance are more likely driving outpatient respiratory outcomes regardless of gestational age.