94 - Country-level Differences in Prevalence of Respiratory Health Sequelae and Healthcare Use at 5 years in Children Born Very Preterm

Publication Number: 3090.94

Birte Staude, University Medical Center Ulm, Ulm, Baden-Wurttemberg, Germany; Anna-Veera Seppänen, INSERM U1153, Université Paris Cité, Paris, Ile-de-France, France; Adrien M. Aubert, Université Paris Cité and INSERM, Paris, Ile-de-France, France; Jennifer Zeitlin, Inserm, Paris, Ile-de-France, France; Michael Zemlin, Saarland University, Homburg, Saarland, Germany; Harald Ehrhardt, University Medical Center Ulm, 89075, Baden-Wurttemberg, Germany; Erol Tutdibi, Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg / Saar, Saarland, Germany; Nasenien Nourkami-Tutdibi, Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Saarland, Germany

Background: Respiratory health sequelae (RHS), including recurrent cough and wheeze episodes and restrictions in lung function are consequences of very premature (VPT, < 32 weeks' gestation) birth. With the continuing increase in premature births, this is leading to an increasing burden not only for affected individuals but also healthcare systems.

Objective: Our aim was to evaluate country-level differences in prevalence of RHS and healthcare use in infants with RHS.

Design/Methods: We used data from the prospective population-based EPICE/SHIPS cohort, including children born VPT in 19 regions of 11 European countries. All children with completed follow-up by parental questionnaires at 5 years of age were included. RHS were defined as a declared diagnosis of asthma, other breathing concerns, or use of equipment for RHS like oxygen or inhalers. Visits to a respiratory specialist were counted if the parents declared at least one visit within the past year. Inverse probability weighting was used to account for loss to follow-up. Missing data was imputed by multiple imputation by chained equations.

Results: Out of 3635 eligible children, RHS was present in 784 (21.0%) at age 5. Of these, 71.0% had a reported asthma diagnosis. RHS prevalence differed between countries (8.5% - 35.7%, Figure 1), as did the proportion of children with RHS who had seen a respiratory specialist within the past year (7.5% - 55.2%, Figure 2). Only 0.7%-18.0% of children without RHS had seen a respiratory specialist (Figure 3).

Conclusion(s): RHS pose an important long-term problem for the health of children born VPT, with more than every fifth child being affected. The wide variations in prevalence of RHS between countries suggest room for improvement by optimizing management factors. This could include perinatal management to avoid lung injury as well as targeted follow-up care and prevention of further harm e.g. due to smoke exposure. Future research should focus on identifying children at risk for RHS early on as well as improving the access to specialized care settings. A better understanding of the healthcare use in affected and non-affected children could help distribute healthcare resources more efficiently.

Figure 1. Country prevalence of respiratory health sequelae at 5 years of age.
n = number of infants with follow-up in participating regions of each country; % = proportion of respiratory health sequelae weighted for loss to follow-up; risk ratios and 95% confidence intervals (RR[95%CI]) are presented before and after adjustment for perinatal factors.

Figure 2. Proportion of children with respiratory health sequelae who have seen a respiratory health specialist within the last year.
n = number of infants with respiratory health sequelae in participating regions of each country; % = proportion of respiratory health sequelae weighted for loss to follow-up; risk ratios and 95% confidence intervals (RR[95%CI]) are presented before and after adjustment for perinatal factors.

Figure 3. Proportion of children without respiratory health sequelae who have seen a respiratory health specialist within the last year.
n = number of infants without respiratory health sequelae in participating regions of each country; % = proportion of respiratory health sequelae weighted for loss to follow-up; risk ratios and 95% confidence intervals (RR[95%CI]) are presented before and after adjustment for perinatal factors.