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

Coathup, Victoria; Boyle, Elaine M.; Carson, Claire; Johnson, Samantha; Kurinzcuk, Jennifer J.; Macfarlane, Alison; Petrou, Stavros; Rivero‐Arias, Oliver; Quigley, Maria A.

doi:10.1136/bmj.m4075

Cited by 40 publications

(42 citation statements)

References 45 publications

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“…The risk of hospital admission associated with gestational age decreased over time, particularly after age 2; however, an excess risk remained up to age 10, even for children born at 38 and 39 weeks’ gestation. (3)…”

Section: Neonatal Lung Diseasesmentioning

confidence: 99%

Topic Sessions

Bui¹,

Fossati²,

Challier³

et al. 2021

Pediatric Pulmonology

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Section: Neonatal Lung Diseasesmentioning

confidence: 99%

Topic Sessions

Bui¹,

Fossati²,

Challier³

et al. 2021

Pediatric Pulmonology

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“…Results from a recent population-based record linkage study that we conducted—the TIGAR study [ 10 ]—indicated that children in England who were born preterm, and even those born a few weeks before their due date, were at a higher risk of hospital admissions throughout childhood than those born at term. Whilst the relationship decreased with time, there was an excess risk that persisted up to 7 to 10 years of age.…”

Section: Introductionmentioning

confidence: 99%

“…Whilst the relationship decreased with time, there was an excess risk that persisted up to 7 to 10 years of age. The study also showed that the majority of excess admissions experienced by children born before 40 weeks’ of gestation were attributed to infections [ 10 ]. However, it remains unclear which types of infection are most strongly associated with gestational age at birth and how these relationships may change with increasing age among children born in England.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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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“…The first large study to demonstrate this, published in 2012, used a cohort of 18,818 infants and found that individuals born between 37 and 38 weeks gestational age had a higher risk of adverse health and developmental outcomes at age 3 compared to those born between 39 and 41 weeks gestational age (Boyle et al, 2012). Subsequent studies have linked other phenotypes with early term birth, including higher risks of neonatal (Murzakanova et al, 2020) and later childhood illness (Coathup et al, 2020) and less favourable neurodevelopmental outcomes in early childhood (Hua et al, 2019; Rose et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Effects of gestational age at birth on perinatal structural brain development in healthy term-born babies

Gale‐Grant

Fenn-Moltu

França

et al. 2021

Preprint

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Multiple studies have demonstrated less favourable childhood outcomes in infants born in early term (37-38 weeks gestation) compared to those born at full term (40-41 weeks gestation). While this could be due to lower birthweight and greater perinatal morbidity, gestational age at birth may also have a direct effect on the brain and subsequent neurodevelopment in term-born babies. Here we characterise structural brain correlates of gestational age at birth in healthy term-born neonates and their relationship to later neurodevelopmental outcome. We used T2 and diffusion weighted Magnetic Resonance Images acquired in the neonatal period from a cohort (n=454) of healthy babies born at term age (>37 weeks gestation) and scanned between 1 and 41 days after birth. Images were analysed using tensor based morphometry (TBM) and tract based spatial statistics (TBSS). Neurodevelopment was subsequently assessed at age 18 months using the Bayley-III Scales of Infant and Toddler Development (n=281), and the effects of gestational age at birth and related neuroimaging findings on outcome were analysed with linear regression. Infants born earlier had areas of higher relative ventricular volume, and lower relative brain volume in the basal ganglia, cerebellum and brainstem. Earlier birth was also associated with lower fractional anisotropy, higher mean, axial and radial diffusivity in major white matter tracts. Gestational age at birth was positively associated with all Bayley-III subscales at age 18 months. Linear regression models predicting outcome from gestational age at birth were significantly improved by adding neuroimaging features associated with gestational age at birth. This work adds to the growing body of evidence of the impact of early term birth and highlights the importance of considering the effect of gestational age at birth in future neuroimaging studies including term-born babies.

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

Cited by 40 publications

References 45 publications

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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

Effects of gestational age at birth on perinatal structural brain development in healthy term-born babies

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