Respiratory Morbidity of Late-Preterm Vs Intrauterine Growth Retarded Infants at School Age
Condition: Intrauterine Growth Restriction; Preterm Birth
MeSH terms: Premature Birth; Fetal Growth Retardation
Study type: Observational

Summary: 
      Background: It is increasingly recognized that late preterm infants have increased
      respiratory morbidity in the neonatal period as well as decreased lung function in later
      life. Also, in-utero growth retardation (IUGR) and low birth weight are associated with
      increased respiratory morbidity beginning from infancy, throughout childhood and into
      adulthood. However, very few studies have assessed long term respiratory consequences of late
      preterm birth in comparison with IUGR.

      Aim: To determine respiratory morbidity of late-preterm vs infants with IUGR at school age
      Study Design: Participants included late-preterm AGA infants (34-36, 6/7 weeks), IUGR infants
      (term/preterm) and term AGA infants born between 2004 and 2008 were included in this study
      and assessed for respiratory morbidity at school age. To assess the impact of late-preterm
      birth compared with IUGR and term gestation on respiratory morbidity by using a validated
      questionnaire. Wheezing, infectious respiratory morbidity and physician-diagnosed asthma
      panels were evaluated.
    

Detailed description: 
      Our study is a cross-sectional study in which the school-age respiratory morbidity of
      newborns with late preterm and IUGR birth history who were followed and treated by Trakya
      University Faculty of Medicine, Department of Pediatrics, Division of Neonatology between
      January 2006 and December 2008 were evaluated.

      A total number of 160 children were included in the study. Children who admitted to the
      Neonatal intensive care unit and/or those who were born at the obstetrics unit and followed
      up with their mothers between January 2006 - December 2008 and reevaluated at school age (5-7
      years old) during the study, were divided into two main groups: Late preterm AGA infants:
      according to the new BALLARD scoring system (5) gestational age was 34-36 6/7 and those who
      were at the 10-90th percentile according to the Fenton growth curves (6) (Group 1). Newborns
      with IUGR: term or preterm infants below 10th percentile according to the values calculated
      according to Fenton growth curves (6) (Group 2). In addition to these groups, preterm IUGR
      infants (<32 weeks of gestation) (Group 2a), and an equal number of preterm AGA infants (<32
      weeks of gestation) (Group 3), late preterm (between 34-36 6/7 gestational weeks) IUGR
      infants (Group 2b) were divided into subgroups. And, the healthy term (gestation week 38-42
      weeks), AGA newborns, who born between January 2006 and December 2008, were included in the
      study as a control group (Group 4) (Figure 1). The presence of major anomalies, patients who
      did not come to the school-age assessment or and rejected the informed consent form were
      excluded from the study.

      Early (perinatal-neonatal), natal and postnatal period data were recorded from the hospital
      database system and patient file. The morbidities observed during the follow-up of the
      newborns, the duration of hospitalization, needed of oxygen, surfactant administration,
      positive pressure ventilation requirement, and need for mechanical ventilation support and
      duration were noted from patient file records. During the study, the study and control group
      cases who were at school age and had perinatal parameters as defined above were contacted by
      phone and invited to the outpatient clinic. Anthropometric measurements of all patients were
      taken (Tartımsan brand, TBS model, scale with serial number 1212430 and height meter).
      Demographic information, socioeconomic level, mother/father education level, mother's smoking
      status and medical history were questioned, and physical examinations of the patients were
      performed. The validated Turkish forms of ATS-DLD-78-C (7) and ISAAC questionnaires (8) were
      tested on 10 randomly selected patients by 2 different investigators to evaluate their
      intelligibility for screening respiratory diseases. The questionnaires were applied
      separately to both mother and father and after comparing the answers, it was decided that the
      questions were understandable. After the physical examination, the questionnaire forms were
      filled in face-to-face by the research doctor who did not know the patients' medical history
      (M.C.U).

      Responses to the survey questions include; the presence of wheezing/wheezing in the chest
      independent of having a cold, presence of wheezing in the chest day/night, presence of two or
      more wheezing episodes causing shortness of breath, the need of using medication during
      wheezing attacks causing shortness of breath, one or more of the presence of wheezing
      episodes after exercise or playing games "Respiratory morbidity 1 included wheezing panel",
      presence of hospitalization due to severe respiratory infection under 2 years of age, having
      had more than 1 previous bronchiolitis/bronchitis/pneumonia or two or three of them, more
      than 3 days in the last 3 years of chest disease, cough/sputum attacks lasting at least for a
      week or longer, sputum, breast fullness, cough present for more than 3 months of the year
      "Respiratory morbidity 2 included previous infectious respiratory morbidity panel", presence
      of physician -diagnosed asthma history, current asthma, and the presence of a history of
      being followed up with a diagnosis of asthma "Respiratory morbidity 3 physician -diagnosed
      asthma panel" (9-13).
    

Intervention name(s): ATS-DLD-78-C and ISAAC questionnaires
Intervention type(s): Other
Intervention description(s): Early, natal and postnatal period data were recorded from the hospital database system and patient file. The morbidities observed during the follow-up of the newborns, the duration of hospitalization, needed of oxygen, surfactant administration, positive pressure ventilation requirement, and need for mechanical ventilation support and duration were noted from patient file records. Anthropometric measurements of all patients were taken. Demographic information, socioeconomic level, mother/father education level, mother's smoking status and medical history were questioned, and physical examinations of the patients were performed. were performed for screening respiratory diseases. After the physical examination, the validated Turkish forms of ATS-DLD-78-C and ISAAC questionnaires were filled in face-to-face by the research doctor who did not know the patients' medical history
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        A total number of 160 children were included in the study. Children who admitted to the
        Neonatal intensive care unit and/or those who were born at the obstetrics unit and followed
        up with their mothers between January 2006 - December 2008 and reevaluated at school age
        (5-7 years old) during the study, were divided into two main groups: Late preterm AGA
        infants: according to the new BALLARD scoring system gestational age was 34-36 6/7 and
        those who were at the 10-90th percentile according to the Fenton growth curves. Newborns
        with IUGR: term or preterm infants below 10th percentile according to the values calculated
        according to Fenton growth curves. And, the healthy term (gestation week 38-42 weeks), AGA
        newborns, who born between January 2006 and December 2008, were included in the study as a
        control group
      
Keywords: Premature Birth; Late preterm; Fetal Growth Retardation; Asthma; School-age