Associations between gestational age at birth and infection-related hospital admission rates during childhood in England: Population-based record linkage study.
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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DOI：
10.1371/journal.pone.0257341
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Quigley MA
中科院分区：
文献类型：
--
作者：
Coathup V;Carson C;Kurinczuk JJ;Macfarlane AJ;Boyle E;Johnson S;Petrou S;Quigley MA
早产儿（<37周妊娠）比足月儿有更高的感染相关发病风险。然而，很少有大规模的，以人群为基础的研究调查了整个胎龄范围内儿童感染的风险。本研究的目的是探讨出生时胎龄与10岁以下感染相关住院之间的关系，感染相关住院率在整个儿童期如何变化，以及出生时小于胎龄（SGA）是否改变了这种关系。使用基于人群的记录关联队列研究设计，使用确定性算法将出生登记、出生通知和住院联系起来。研究人群包括2005年1月至2006年12月在英格兰NHS医院发生的所有活产、单胎分娩（n = 1，018，136）。主要结局是从出生到10岁、死亡或研究结束（2015年3月）的所有感染相关住院患者。次要结局是感染相关住院的类型，分为几大类。使用广义估计方程估计每个胎龄类别的校正率比（aRR）及其95%置信区间（CI）（<28、28-29、30-31、32、33、34、35、36、37、38、39、40、41和42周），并按入院时的年龄重复模型（<1、1-2、3-4、5-6和7-10岁）。模型中包含了一个相互作用项，以检验SGA状态是否改变了胎龄和感染相关住院之间的关系。年龄与整个儿童期感染相关的住院率密切相关。虽然这种关系随着时间的推移而减弱，但在7-10岁时，妊娠40周前出生的人仍然明显高于40周出生的人。出生小于28周的儿童的aRR为6.53（5.91-7.22）在婴儿期，下降到3.16（2.50-3.99），与40周出生的婴儿相比;而38周出生的婴儿期和7-10岁的aRR分别为1.24（1.21-1.27）和1.18（1.13-1.23）。SGA状态改变了胎龄的影响（交互作用P<0.0001），在小于28周和SGA出生的儿童中发生率最高。最后，研究结果表明，与孕龄的关联因感染亚组而异。虽然上呼吸道感染是该队列中儿童经历的最常见的感染类型，但下呼吸道感染（LRTI）（<28周，aRR = 10.61（9.55-11.79））和侵袭性细菌感染（<28周，aRR = 6.02（4.56-7.95））与出生时的胎龄最密切相关。在发生的LRTI中，毛细支气管炎（<28周，aRR = 11.86（10.20-13.80））和肺炎（<28周，aRR = 9.49（7.95-11.32））是最常见的原因。出生时的生育年龄与儿童时期感染相关的住院率密切相关，即使是早出生几周的儿童在7-10岁时也有较高的风险。临床亚组之间的强度与胎龄的关系存在差异。有效的感染预防战略应包括重点减少幼儿期LRTI的数量和严重程度。
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. 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. 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.
影响因子：
2.9
作者：
Datta-Nemdharry P;Dattani N;Macfarlane AJ
通讯作者：
Macfarlane AJ