Association of gestational age and growth measures at birth with infection-related admissions to hospital throughout childhood: a population-based, data-linkage study from Western Australia
Association of gestational age and growth measures at birth with infection-related admissions to hospital throughout childhood: a population-based, data-linkage study from Western Australia
复制标题
DOI：
10.1016/s1473-3099(16)00150-x
复制
发表时间：
2016-08-01
影响因子：
56.3
通讯作者：
Burgner, David P.
中科院分区：
文献类型：
--
作者：
Miller, Jessica E.;Hammond, Geoffrey C.;Burgner, David P.
研究背景胎龄缩短和出生体重低与新生儿感染风险增加有关。然而，感染的长期风险，特别是在晚期早产儿或出生体重接近正常的婴儿中，尚不清楚。我们估计是否与年龄，胎龄，出生体重，出生long.Methods的儿童在西澳大利亚州的感染相关的入院率，我们做了一个以人口为基础的，数据联动研究，使用总链接，登记数据从西澳大利亚州出生登记册的所有活产，非土著澳大利亚单胎出生记录从1980年1月1日至2010年12月31日。我们随访了从出生相关的出院到18岁、死亡或2010年底的个体，并与随后入院或死亡登记的数据相关联。根据末次月经和基于超声检查的估计来评估孕龄。我们将出生体重按500 g带分类，出生身长按5 cm带分类，并将两者的参考范围近似为第50百分位数。由于出生时的大小和胎龄密切相关，我们计算了Z评分的妊娠特异性和性别特异性出生体重，出生长度和重量指数。我们的主要结果是感染相关入院的数量和类型。我们使用多水平负二项回归来生成此类入院的率比（RR），通过国际疾病分类第9版和第10-AM版的代码进行识别。我们调整了产妇分娩年龄、出生年份、出生季节、产次、性别、5分钟Apgar评分、分娩方式、社会经济状况和支气管肺发育不良的RR。213 683名（30%）儿童发生了365 867例感染相关住院。在纳入分析的719311名儿童中，137124名（19%）有一次感染相关入院，43796名（6%）有两次，16679名（2%）有三次，16084名（2%）有四次或更多。在365867例住院患者中，诊断为上呼吸道感染的有174653例（48%），下呼吸道感染的有74297例（20%），胃肠道感染的有44755例（12%），病毒感染的有37213例（10%）。胎龄小于39-40周的孕妇，每减少一周，与预防相关的入院率增加12%（RR 1.12，95% CI 1.12-1.13），出生体重低于3000-3500 g，每减少500 g，减少19%（1.19，1.18-1.21），出生身长小于45-50 cm每减少5 cm，减少41%（1.41，1.38-1.45）。出生时年龄-特异性和性别-特异性出生体重Z评分低于第25 - 50百分位数和出生身长Z评分低于第10 - 25百分位数与感染相关入院率增加相关（例如，第1 - 5百分位数RR分别为1.15，95% CI为1.12-1.19和1.11，1.07-1.14）。体重指数Z评分低于第25 - 50百分位数也与感染相关入院率增加相关（例如，第1 - 5百分位数RR 1.08，95% CI 1.04-1.12）。胎龄41周或更大、出生体重或出生身长Z评分高于第50百分位数或重量指数Z评分在第75百分位数和第95百分位数之间，与感染相关入院率的适度降低有关。解释出生时胎龄、出生体重、和出生时间的长短持续增加了18岁之前感染相关的住院率。应优化妊娠结局，以防止在这一人群中发生感染，特别是在资源有限的环境中，次优宫内生长和中度早产很常见。
Background Reduced gestational age and low birthweight are associated with an increased risk of neonatal infections. However, the long-term risk of infection, especially in late preterm infants or those at near-normal birthweight, is unknown. We estimated whether rates of infection-related admissions to hospital for children in Western Australia were associated with age, gestational age, birthweight, and birth length.Methods We did a population-based, data-linkage study using total-linked, registry data from the Western Australia Birth Register of all liveborn, non-Indigenous Australian singleton births recorded from Jan 1, 1980, to Dec 31, 2010. We followed up individuals from birth-related hospital discharge to age 18 years, death, or end of 2010, and linked to data about subsequent admissions to hospital or death registrations. Gestational age was assessed from both the last menstrual period and from estimates based on ultrasonography. We categorised birthweight by 500 g bands and birth length by 5 cm bands, and approximated the reference ranges for both to the 50th percentile. Because size at birth and gestational age are strongly associated, we calculated Z scores for gestational-specific and sex-specific birthweight, birth length, and ponderal index. Our primary outcomes were the number and type of infection-related admissions to hospital. We used multilevel negative binomial regression to generate rate ratios (RR) for such admissions, identified by codes from the International Classification of Diseases, versions 9 and 10-AM. We adjusted the RRs for maternal age at delivery, birth year, birth season, parity, sex, 5-min Apgar score, delivery method, socioeconomic status, and bronchopulmonary dysplasia.Findings Of 719 311 liveborn singletons included in the analysis and followed up for 8 824 093 person-years, 365 867 infection-related admissions to hospital occurred for 213 683 (30%) children. Of the 719 311 children included in the analysis, 137 124 (19%) had one infection-related admission to hospital, 43 796 (6%) had two, 16 679 (2%) had three, and 16 084 (2%) had four or more. The 365 867 admissions to hospital included a diagnosis of infection of the upper respiratory tract for 174 653 (48%), the lower respiratory tract for 74 297 (20%), the gastrointestinal tract for 44 755 (12%), and a viral infection for 37 213 (10%). Infection-related rates of admissions to hospital increased by 12% for each week reduction in gestational age less than 39-40 weeks (RR 1.12, 95% CI 1.12-1.13), by 19% for each 500 g reduction in birthweight less than 3000-3500 g (1.19, 1.18-1.21), and by 41% for each 5 cm reduction in birth length less than 45-50 cm (1.41, 1.38-1.45). Gestational age-specific and sex-specific birthweight Z scores lower than the 25th to 50th percentile and birth length Z scores lower than the 10th to 25th percentile were associated with increased rates of infection-related admissions to hospital (eg, 1st-5th percentile RR 1.15, 95% CI 1.12-1.19, and 1.11, 1.07-1.14, respectively). Ponderal index Z scores lower than the 25th to 50th percentile were also associated with increased rates of infection-related admissions (eg, 1st-5th percentile RR 1.08, 95% CI 1.04-1.12). A gestational age of 41 weeks or later, a birthweight or birth length Z score above the 50th percentile, or a ponderal index Z score between the 75th and 95th percentile, were associated with modestly reduced rates of infection-related admissions to hospital.Interpretation Children who were born with reduced gestational age, birthweight, and birth length have persistently increased rates of infection-related admissions to hospital until age 18 years. Pregnancy outcomes should be optimised to prevent infection occurring in this population, especially in resource-limited settings where suboptimum intrauterine growth and moderate prematurity are common.