Hospital Admissions and Gestational Age at Birth: 18 Years of Follow Up in Western Australia

Claudia Slimings; Kristjana Einarsdóttir; Ravisha Srinivasjois; Helen Leonard

doi:10.1111/ppe.12155

Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study

BMJ ◽

10.1136/bmj.l1346 ◽

2019 ◽

pp. l1346 ◽

Cited By ~ 48

Author(s):

Casey Crump ◽

Jan Sundquist ◽

Marilyn A Winkleby ◽

Kristina Sundquist

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Environmental Factors ◽

Gestational Age ◽

Early Term ◽

Extremely Preterm ◽

National Cohort ◽

Gestational Age At Birth ◽

Age At Birth

Abstract Objective To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. Design National cohort study. Setting Sweden. Participants 4 186 615 singleton live births in Sweden during 1973-2014. Exposures Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. Main outcome measures CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. Results 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.

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Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)

BMJ ◽

10.1136/bmj.m4075 ◽

2020 ◽

pp. m4075

Author(s):

Victoria Coathup ◽

Elaine Boyle ◽

Claire Carson ◽

Samantha Johnson ◽

Jennifer J Kurinzcuk ◽

...

Keyword(s):

Hospital Admission ◽

Gestational Age ◽

Record Linkage ◽

Hospital Admissions ◽

Population Based ◽

Admission Rates ◽

Adjusted Rate ◽

Gestational Age At Birth ◽

Adjusted Rate Ratio ◽

Age At Birth

AbstractObjectiveTo examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.DesignPopulation based, record linkage, cohort study in England.SettingNHS hospitals in England, United Kingdom.Participants1 018 136 live, singleton births in NHS hospitals in England between January 2005 and December 2006.Main outcome measuresPrimary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization’s first international classification of diseases, version 10 (ICD-10) code within each hospital admission record.Results1 315 338 admissions occurred between 1 January 2005 and 31 March 2015, and 831 729 (63%) were emergency admissions. 525 039 (52%) of 1 018 136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks’ gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.ConclusionsThe association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.

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

PLoS ONE ◽

10.1371/journal.pone.0257341 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257341

Author(s):

Victoria Coathup ◽

Claire Carson ◽

Jennifer J. Kurinczuk ◽

Alison J. Macfarlane ◽

Elaine Boyle ◽

...

Keyword(s):

Hospital Admission ◽

Gestational Age ◽

Respiratory Tract Infections ◽

Hospital Admissions ◽

Population Based ◽

Admission Rates ◽

Tract Infections ◽

Gestational Age At Birth ◽

The Relationship ◽

Age At Birth

Background 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. Methods and findings 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. Conclusions 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.

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Association of Gestational Age at Birth with Reasons for Subsequent Hospitalisation: 18 Years of Follow-Up in a Western Australian Population Study

PLoS ONE ◽

10.1371/journal.pone.0130535 ◽

2015 ◽

Vol 10 (6) ◽

pp. e0130535 ◽

Cited By ~ 18

Author(s):

Ravisha Srinivasjois ◽

Claudia Slimings ◽

Kristjana Einarsdóttir ◽

David Burgner ◽

Helen Leonard

Keyword(s):

Population Study ◽

Gestational Age ◽

Australian Population ◽

Gestational Age At Birth ◽

Western Australian ◽

Age At Birth

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Changes in Caesarean Delivery Rates in Western Australia from 1995 to 2010 by Gestational Age at Birth

Paediatric and Perinatal Epidemiology ◽

10.1111/ppe.12202 ◽

2015 ◽

Vol 29 (4) ◽

pp. 290-298 ◽

Cited By ~ 4

Author(s):

Kristjana Einarsdóttir ◽

Stephen Ball ◽

Gavin Pereira ◽

Christopher Griffin ◽

Peter Jacoby ◽

...

Keyword(s):

Western Australia ◽

Gestational Age ◽

Caesarean Delivery ◽

Gestational Age At Birth ◽

Age At Birth

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Preterm birth and the risk of chronic disease multimorbidity in adolescence and early adulthood: A population-based cohort study

PLoS ONE ◽

10.1371/journal.pone.0261952 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261952

Author(s):

Katriina Heikkilä ◽

Anna Pulakka ◽

Johanna Metsälä ◽

Suvi Alenius ◽

Petteri Hovi ◽

...

Keyword(s):

Chronic Disease ◽

Preterm Birth ◽

Gestational Age ◽

Early Adulthood ◽

Full Term ◽

The Life Course ◽

Gestational Age At Birth ◽

Age At Birth

Background People who were born prematurely have high risks of many individual diseases and conditions in the early part of the life course. However, our knowledge of the burden of multiple diseases (multimorbidity) among prematurely born individuals is limited. We aimed to investigate the risk and patterns of chronic disease multimorbidity in adolescence and early adulthood among individuals born across the spectrum of gestational ages, comparing preterm and full-term born individuals. Methods and findings We used individual-level data from linked nationwide registers to examine the associations of gestational age at birth with specialised healthcare records of ≥2 chronic diseases (multimorbidity) in adolescence (age 10–17 years) and early adulthood (age 18–30 years). Our study population comprised 951,116 individuals (50.2% females) born alive in Finland between 1st January 1987 and 31st December 2006, inclusive. All individuals were followed from age 10 years to the onset of multimorbidity, emigration, death, or 31 December 2016 (up to age 30 years). We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for multimorbidity using flexible parametric survival models. During 6,417,903 person-years at risk (median follow-up: 7.9 years), 11,919 individuals (1.3%) had multimorbidity in adolescence (18.6 per 10,000 person-years). During 3,967,419 person-years at risk (median follow-up: 6.2 years), 15,664 individuals (1.7%) had multimorbidity in early adulthood (39.5 per 10,000 person-years). Adjusted HRs for adolescent multimorbidity, comparing preterm to full-term born individuals, were 1.29 (95% CI: 1.22 to 1.36) and 1.26 (95% CI: 1.18 to 1.35) in females and males, respectively. The associations of preterm birth with early adult multimorbidity were less marked, with the adjusted HRs indicating 1.18-fold risk in females (95% CI: 1.12 to 1.24) and 1.10-fold risk in males (95% CI: 1.04 to 1.17). We observed a consistent dose-response relationship between earlier gestational age at birth and increasing risks of both multimorbidity outcomes. Compared to full-term born males, those born at 37–38 weeks (early term) had a 1.06-fold risk of multimorbidity in adolescence (95% CI: 0.98 to 1.14) and this risk increased in a graded manner up to 6.85-fold (95% CI: 5.39 to 8.71) in those born at 23–27 weeks (extremely premature), independently of covariates. Among females, the same risks ranged from 1.16-fold (95% CI: 1.09 to 1.23) among those born at 37–38 weeks to 5.65-fold (95% CI: 4.45 to 7.18) among those born at 23–27 weeks. The corresponding risks of early adult multimorbidity were similar in direction but less marked in magnitude, with little difference in risks between males and females born at 36–37 weeks but up to 3-fold risks observed among those born at 23–27 weeks. Conclusions Our findings indicate that an earlier gestational age at birth is associated with increased risks of chronic disease multimorbidity in the early part of the life course. There are currently no clinical guidelines for follow-up of prematurely born individuals beyond childhood, but these observations suggest that information on gestational age would be a useful characteristic to include in a medical history when assessing the risk of multiple chronic diseases in adolescent and young adult patients.

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Abnormal Pulmonary Outcomes in Premature Infants: Prediction From Oxygen Requirement in the Neonatal Period

PEDIATRICS ◽

10.1542/peds.82.4.527 ◽

1988 ◽

Vol 82 (4) ◽

pp. 527-532 ◽

Cited By ~ 4

Author(s):

Andrew T. Shennan ◽

Michael S. Dunn ◽

Ame Ohlsson ◽

Kathryn Lennox ◽

Elizabeth M. Hoskins

Keyword(s):

Positive Predictive Value ◽

Gestational Age ◽

Predictive Value ◽

Neonatal Period ◽

Oxygen Requirement ◽

Normal Outcome ◽

Oxygen Requirements ◽

Gestational Age At Birth ◽

Age At Birth

The follow-up records of 605 infants with birth weights of less than 1,500 g, with data available for 2 years after birth, were examined for evidence of abnormal pulmonary signs or symptoms. A total of 119 infants were identified and the neonatal oxygen requirements of these infants were compared with those of 486 infants who had normal pulmonary function. A requirement for oxygen at 28 days of life had a positive predictive value for abnormal pulmonary findings at the time of follow-up of only 38%, whereas 31% of those with normal pulmonary findings at the time of follow-up were still receiving oxygen at this age. The need for oxygen at 28 days was a good predictor of abnormal findings in infants of ≥3O weeks' gestational age at birth but became increasingly less useful as gestational age decreased It was found that, irrespective of gestational age at birth, the ment for additional oxygen at 36 weeks' corrected postnatal gestational age was a better predictor of abnormal outcome, increasing the positive predictive value to 63%. The prediction of a normal outcome remained 90% for infants not receiving oxygen at this corrected gestational age.

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