Dataset Information

Measuring the Severity of Respiratory Illness in the First 2 Years of Life in Preterm and Term Infants.

ABSTRACT:

Objective

To develop a valid research tool to measure infant respiratory illness severity using parent-reported symptoms.

Study design

Nose and throat swabs were collected monthly for 1 year and during respiratory illnesses for 2 years in a prospective study of term and preterm infants in the Prematurity, Respiratory Outcomes, Immune System and Microbiome study. Viral pathogens were detected using Taqman Array Cards. Parents recorded symptoms during respiratory illnesses using a Childhood Origins of Asthma (COAST) scorecard. The COAST score was validated using linear mixed effects regression modeling to evaluate associations with hospitalization and specific infections. A data-driven method was also used to compute symptom weights and derive a new score, the Infant Research Respiratory Infection Severity Score (IRRISS). Linear mixed effects regression modeling was repeated with the IRRISS illness data.

Results

From April 2013 to April 2017, 50 term, 40 late preterm, and 28 extremely low gestational age (<29 weeks of gestation) infants had 303 respiratory illness visits with viral testing and parent-reported symptoms. A range of illness severity was described with 39% of illness scores suggestive of severe disease. Both the COAST score and IRRISS were associated with respiratory syncytial virus infection and hospitalization. Gestational age and human rhinovirus infection were inversely associated with both scoring systems. The IRRISS and COAST scores were highly correlated (r = 0.93; P < .0001).

Conclusions

Using parent-reported symptoms, we validated the COAST score as a measure of respiratory illness severity in infants. The new IRRISS score performed as well as the COAST score.

SUBMITTER: Caserta MT

PROVIDER: S-EPMC6815715 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:BackgroundEarly postanal growth of preterm infants has many effects on early and late health. However, evidence on growth pattern in Chinese preterm infant population during early life is insufficient. This study aims to describe the growth trajectory, catch-up growth, and risk of overweight of preterm infants during the first 2 years of life in a Chinese community population.MethodsAll preterm infants (n = 10,624) received routine childcare in one primary maternal and child healthcare network in 8 years were included. Body weight and length/height at corrected age (CA) 40 weeks, CA 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months were extracted and converted to z-scores based on the World Health Organization (WHO) standards. According to the intrauterine growth status, infants were divided into small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA) infants. Changes of z-score were used to describe the growth velocity. Generalized estimating equation (GEE) model was used to analyze growth trajectory trends over time.ResultsBody weight and length/height were overall above the WHO standards during the first 2 years of life. Z-score increased significantly by 0.08 (95% CI: 0.06-0.10) in weight and 0.07 (95% CI: 0.04-0.09) in length/height from CA 40 weeks to 3 months and then levelled off until CA 24 months after adjustment. Almost 90% of AGA and LGA infants achieved growth targets (≥25th percentile of WHO standards), and over 85% of SGA infants achieved catch-up growth (≥10th percentile of WHO standards) before CA 24 months. However, the risk of overweight appeared during this period, with the proportion of infants with the risk of overweight being at the peak at CA 3 months (25.6% of all preterm infants and 39.4% of LGA infants). Growth trajectories of SGA showed increasing trends, but those of LGA showed decreasing trends during the first 2 years.ConclusionsBody weight and length/height of preterm infants are above the WHO standards in the Chinese community population during the first 2 years of life. Catch-up growth is accompanied by risk of overweight as early as CA 3 months. (349 words).

Project description:Lower respiratory tract infections (LRTIs) in children are common and, although often mild, a major cause of mortality and hospitalization. Recently, the respiratory microbiome has been associated with both susceptibility and severity of LRTI. In this current study, we combined respiratory microbiome, viral, and clinical data to find associations with the severity of LRTI. Nasopharyngeal aspirates of children aged one month to five years included in the STRAP study (Study to Reduce Antibiotic prescription in childhood Pneumonia), who presented at the emergency department (ED) with fever and cough or dyspnea, were sequenced with nanopore 16S-rRNA gene sequencing and subsequently analyzed with hierarchical clustering to identify respiratory microbiome profiles. Samples were also tested using a panel of 15 respiratory viruses and Mycoplasma pneumoniae, which were analyzed in two groups, according to their reported virulence. The primary outcome was hospitalization, as measure of disease severity. Nasopharyngeal samples were isolated from a total of 167 children. After quality filtering, microbiome results were available for 54 children and virology panels for 158 children. Six distinct genus-dominant microbiome profiles were identified, with Haemophilus-, Moraxella-, and Streptococcus-dominant profiles being the most prevalent. However, these profiles were not found to be significantly associated with hospitalization. At least one virus was detected in 139 (88%) children, of whom 32.4% had co-infections with multiple viruses. Viral co-infections were common for adenovirus, bocavirus, and enterovirus, and uncommon for human metapneumovirus (hMPV) and influenza A virus. The detection of enteroviruses was negatively associated with hospitalization. Virulence groups were not significantly associated with hospitalization. Our data underlines high detection rates and co-infection of viruses in children with respiratory symptoms and confirms the predominant presence of Haemophilus-, Streptococcus-, and Moraxella-dominant profiles in a symptomatic pediatric population at the ED. However, we could not assess significant associations between microbiome profiles and disease severity measures.

Project description:ImportancePrevious studies have focused on exposure to fine particulate matter 2.5 μm or less in diameter (PM2.5) and on birth outcome risks; however, few studies have evaluated the health consequences of PM2.5 exposure on infants during their first year of life and whether prematurity could exacerbate such risks.ObjectiveTo assess the association of PM2.5 exposure with emergency department (ED) visits during the first year of life and determine whether preterm birth status modifies the association.Design, setting, and participantsThis individual-level cohort study used data from the Study of Outcomes in Mothers and Infants cohort, which includes all live-born, singleton deliveries in California. Data from infants' health records through their first birthday were included. Participants included 2 175 180 infants born between 2014 and 2018, and complete data were included for an analytic sample of 1 983 700 (91.2%). Analysis was conducted from October 2021 to September 2022.ExposuresWeekly PM2.5 exposure at the residential ZIP code at birth was estimated from an ensemble model combining multiple machine learning algorithms and several potentially associated variables.Main outcomes and measuresMain outcomes included the first all-cause ED visit and the first infection- and respiratory-related visits separately. Hypotheses were generated after data collection and prior to analysis. Pooled logistic regression models with a discrete time approach assessed PM2.5 exposure and time to ED visits during each week of the first year of life and across the entire year. Preterm birth status, sex, and payment type for delivery were assessed as effect modifiers.ResultsOf the 1 983 700 infants, 979 038 (49.4%) were female, 966 349 (48.7%) were Hispanic, and 142 081 (7.2%) were preterm. Across the first year of life, the odds of an ED visit for any cause were greater among both preterm (AOR, 1.056; 95% CI, 1.048-1.064) and full-term (AOR, 1.051; 95% CI, 1.049-1.053) infants for each 5-μg/m3 increase in exposure to PM2.5. Elevated odds were also observed for infection-related ED visit (preterm: AOR, 1.035; 95% CI, 1.001-1.069; full-term: AOR, 1.053; 95% CI, 1.044-1.062) and first respiratory-related ED visit (preterm: AOR, 1.080; 95% CI, 1.067-1.093; full-term: AOR,1.065; 95% CI, 1.061-1.069). For both preterm and full-term infants, ages 18 to 23 weeks were associated with the greatest odds of all-cause ED visits (AORs ranged from 1.034; 95% CI, 0.976-1.094 to 1.077; 95% CI, 1.022-1.135).Conclusions and relevanceIncreasing PM2.5 exposure was associated with an increased ED visit risk for both preterm and full-term infants during the first year of life, which may have implications for interventions aimed at minimizing air pollution.

Project description:ObjectiveInfection with respiratory syncytial virus (RSV), which causes lower respiratory tract infections, is the leading cause of hospitalization among children <1 year old in the United States. Risk factors for RSV hospitalization include premature birth and younger chronologic age, along with several comorbid conditions. However, in terms of RSV hospitalization costs, premature infants are rarely studied separately from full-term infants. The objective of this study is to describe the cost and severity of RSV hospitalizations among preterm and full-term infants without chronic lung disease or other high-risk conditions.Study designThis analysis used Truven Health Market Scan Multi-State Medicaid and Commercial Claims and Encounters databases, which contain a combined 4 million births from 2003 to 2013. Infants with comorbid conditions associated with increased risk for RSV infection were excluded. Infants were classified as preterm (<29, 29-30, 31-32, 33-34 and 35-36 weeks' gestational age (wGA)) or full term based on diagnostic coding. Health-care claims during the first year of life were evaluated for RSV hospitalizations, defined as inpatient claims with a diagnosis code for RSV in any position. Costs of RSV hospitalizations were captured and reported in 2014 USD. Inpatient claims for RSV hospitalizations were evaluated for the presence of codes indicating admission to the intensive care unit (ICU), use of mechanical ventilation (MV) and length of stay. These three measures were used to describe hospital severity. Chronologic age at the time of RSV hospitalization was also captured. Data were summarized and no statistical comparisons were conducted.ResultsThere were 1?683?188 infants insured through Medicaid and 1?663?832 infants insured through commercial plans born from 1 July 2003 to 30 June 2013. Of those, 10.8 and 8.8% in each database, respectively, were born prematurely. There were 29?967 Medicaid-insured infants and 16?310 commercially insured infants with an RSV hospitalization during their first year of life. Mean first-year RSV hospitalization costs were higher for preterm infants, ranging from $8324 and $10?570 for full-term infants to $15?839 and $19?931 for preterm infants 33-34 wGA, and to $39?354 and $40?813 for preterm infants <29 wGA, among Medicaid-insured and commercially insured infants, respectively. RSV hospitalizations also tended to be more severe among preterm infants, with longer lengths of stay, a higher proportion of infants admitted to the intensive care unit (ICU) and increased use of MV compared with full-term infants. Mean costs of RSV hospitalizations with a PICU admission ranged from approximately $35?000 to $89?000. In both Medicaid and commercial groups, costs were greater for infants hospitalized at <90 days of age compared with older infants.ConclusionsInfants who were born prematurely and those hospitalized at <90 days of age have more costly and more severe RSV hospitalizations during the first year of life. These findings demonstrate important differences in the costs and severity of first-year RSV hospitalizations of premature and full-term infants. These differences are likely to be obscured in combined analysis, in which full-term infants predominate. Clinical guidelines and health-care policies relating to RSV would benefit from the availability of data obtained from separate analyses of these two infant subgroups.