Julie L Fierro1, Molly Passarella2, Scott A Lorch3. 1. Division of Pulmonology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: fierroj@email.chop.edu. 2. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, Philadelphia, PA. 3. Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Center for Perinatal and Pediatric Health Disparities Research, The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute of Health Economics, The Wharton School, The University of Pennsylvania, Philadelphia, PA.
Abstract
OBJECTIVES: To determine if premature infants without bronchopulmonary dysplasia (BPD) are at similar risk for developing pulmonary morbidity as compared with those with BPD and if there are differences in management of care. STUDY DESIGN: We retrospectively abstracted information from our electronic medical record from January 1, 2006, to December 31, 2015, for primary care patients born at <30 weeks of gestation (n = 811). Multivariate models determined the impact of BPD on a diagnosis of respiratory disease, respiratory medications, subspecialty visits, and emergency department use or hospitalizations after adjusting for gestational age, sex, insurance type, and race. RESULTS: Infants with BPD were more likely to be diagnosed with asthma than those without BPD (75% vs 60%; OR, 1.8; 95% CI, 1.27-2.54), but not all respiratory conditions (OR, 1.56; 95% CI, 0.7-3.51), and were more likely to be referred to a pulmonologist (relative risk, 5.98; 95% CI, 4.1-8.74). Infants with BPD were more likely to be hospitalized for respiratory conditions than those without BPD (50% vs 30%; relative risk, 2.44; 95% CI, 1.73-3.45). CONCLUSIONS: Although infants with BPD were more likely to have a diagnosis of asthma and be readmitted for respiratory conditions, 60% of infants without BPD were also diagnosed with asthma and 30% were readmitted. There were significant differences in the management of patients, including time to pulmonary referral and prescription rates for inhaled corticosteroids. Practitioners should consider all patients born prematurely at high risk for respiratory morbidity.
OBJECTIVES: To determine if premature infants without bronchopulmonary dysplasia (BPD) are at similar risk for developing pulmonary morbidity as compared with those with BPD and if there are differences in management of care. STUDY DESIGN: We retrospectively abstracted information from our electronic medical record from January 1, 2006, to December 31, 2015, for primary care patients born at <30 weeks of gestation (n = 811). Multivariate models determined the impact of BPD on a diagnosis of respiratory disease, respiratory medications, subspecialty visits, and emergency department use or hospitalizations after adjusting for gestational age, sex, insurance type, and race. RESULTS:Infants with BPD were more likely to be diagnosed with asthma than those without BPD (75% vs 60%; OR, 1.8; 95% CI, 1.27-2.54), but not all respiratory conditions (OR, 1.56; 95% CI, 0.7-3.51), and were more likely to be referred to a pulmonologist (relative risk, 5.98; 95% CI, 4.1-8.74). Infants with BPD were more likely to be hospitalized for respiratory conditions than those without BPD (50% vs 30%; relative risk, 2.44; 95% CI, 1.73-3.45). CONCLUSIONS: Although infants with BPD were more likely to have a diagnosis of asthma and be readmitted for respiratory conditions, 60% of infants without BPD were also diagnosed with asthma and 30% were readmitted. There were significant differences in the management of patients, including time to pulmonary referral and prescription rates for inhaled corticosteroids. Practitioners should consider all patients born prematurely at high risk for respiratory morbidity.
Authors: A Ioana Cristea; Clement L Ren; Reshma Amin; Laurie C Eldredge; Jonathan C Levin; Parevi P Majmudar; Anne E May; Rebecca S Rose; Michael C Tracy; Karen F Watters; Julian Allen; Eric D Austin; Mary E Cataletto; Joseph M Collaco; Robert J Fleck; Andrew Gelfand; Don Hayes; Marcus H Jones; Sheila S Kun; Erica W Mandell; Sharon A McGrath-Morrow; Howard B Panitch; Rizwana Popatia; Lawrence M Rhein; Alejandro Teper; Jason C Woods; Narayan Iyer; Christopher D Baker Journal: Am J Respir Crit Care Med Date: 2021-12-15 Impact factor: 21.405