Early childhood respiratory morbidity according to gestational age at birth: A nationwide cohort study

Background: Preterm birth survivors are at risk for short- and long-term respiratory morbidity. This includes increased rates of chronic obstructive pulmonary disease and infectious morbidity. Previous studies showed increased utilization of healthcare services throughout early childhood. However, only a few large-scale studies showed the effect on respiratory morbidity throughout the full spectrum of gestational age at birth. The aim of this study was to show the healthcare burden associated with prematurity, in a large nationwide cohort. Study design: Data regarding gestational age at birth, month and year of birth, and infant sex were gathered for all 1,762,149 infants born in Israel between January 1, 2010, and December 31, 2019. Rates of hospitalization, length of hospitalization, and emergency department visits were calculated per 1000 live births and stratified by gestational age. Poisson regression was constructed to adjust for infant sex, year and month of birth. Results: Preterm birth occurred in 6.43 % of deliveries (n = 109,405). A negative association was found between gestational age at birth and respiratory morbidity. As gestational age at birth advances, rates of respiratory hospitalization decrease, and length of hospitalization shortens. This association continues even after full term is reached. Conclusion: The short- and long-term effect of preterm birth poses a significant burden on healthcare systems globally, not only at birth or in infancy, but well into early childhood. These results are a call for action to stakeholders and professional organizations to increase efforts in preventing and treating preterm and early term labor.