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Early childhood respiratory morbidity and antibiotic use in ex-preterm infants: A primary care population-based cohort study

Tan, Shin; Szatkowski, Lisa; Moreton, William; Fiaschi, Linda; McKeever, Tricia; Gibson, Jack; Sharkey, Don


Shin Tan

William Moreton

Senior Research Fellow in Ehealth

Professor of Epidemiology and Medical Statistics

Jack Gibson

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Professor of Neonatal Medicine and Technologies


Background Globally, bronchopulmonary dysplasia (BPD) continues to increase in preterm infants. Recent studies exploring subsequent early childhood respiratory morbidity have been small or focused on hospital admissions.

Primary aim Examine early childhood rates of primary care consultations for respiratory tract infections (RTI), lower respiratory tract infections (LRTI), wheeze and antibiotic prescriptions (Abx Px) in ex-preterm and term children. Secondary aim: examine differences between preterm infants discharged home with or without oxygen.
Methods Retrospective cohort study using linked electronic primary care and hospital databases of children born between 1997 and 2014. We included 253 677 eligible children, with 1666 born preterm [less than] 32 weeks' gestation, followed up from primary care registration to age 5 years. Adjusted incidence rate ratios (aIRR) were calculated.

Results Ex-preterm infants had higher rates of morbidity across all respiratory outcomes. After adjusting for confounders, aIRRs for RTI (1.37, 95% CI 1.33–1.42), LRTI (2.79, 95% CI 2.59–3.01), wheeze (3.05, 95% CI 2.64–3.52) and Abx Px (1.49, 95% CI 1.44–1.55) were higher for ex-preterm infants. Ex-preterm infants discharged home on oxygen had significantly greater morbidity across all respiratory diagnoses and Abx Px compared to those without home oxygen. The highest rates of respiratory morbidity were observed in children from the most deprived socioeconomic groups.

Conclusion Ex-preterm infants, particularly those with BPD requiring home oxygen, have significant respiratory morbidity and antibiotic prescriptions in early childhood. With the increasing prevalence of BPD, further research should focus on strategies to reduce the burden of respiratory morbidity in these high-risk infants after hospital discharge.


Tan, S., Szatkowski, L., Moreton, W., Fiaschi, L., McKeever, T., Gibson, J., & Sharkey, D. (2020). Early childhood respiratory morbidity and antibiotic use in ex-preterm infants: A primary care population-based cohort study. European Respiratory Journal, 56(1),

Journal Article Type Article
Acceptance Date Apr 8, 2020
Online Publication Date May 4, 2020
Publication Date Jul 1, 2020
Deposit Date May 14, 2020
Publicly Available Date May 5, 2021
Journal European Respiratory Journal
Print ISSN 0903-1936
Electronic ISSN 1399-3003
Publisher European Respiratory Society
Peer Reviewed Peer Reviewed
Volume 56
Issue 1
Article Number 2000202
Keywords Pulmonary and Respiratory Medicine
Public URL
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Additional Information This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication.


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