Very preterm infants are babies born alive before 32 weeks of pregnancy are completed. These babies, and those weighing less than 1500g at birth, are at risk of long-term lung damage. This is called chronic lung disease and can cause problems such as asthma and severe lung disease in adulthood. Advances in technology have led to improvements in care for these infants, and therefore many more are now surviving. This has increased the number of cases of chronic lung disease seen in childhood and adulthood, and changed the nature and severity of the illness. There has been little research looking at the additional healthcare requirements (e.g. hospitalisation, GP visits) these children have and whether these have changed over time. It is important to understand these additional healthcare requirements in a recent group of ex-preterm infants as this will help us counsel parents about long-term problems as well as help care for these children. We aim to study this using a large database of healthcare records from GP and hospital care, and see if there are differences between children severely affected compared to those mildly affected and compared to children of normal birth weight who were not premature.
In recent decades advances in neonatal intensive care, such as the introduction of antenatal corticosteroid treatment, surfactant administration and improved respiratory support, have led to improvements in the survival of very premature and low birth weight infants. However, chronic lung disease (CLD) remains a major complication of prematurity and low birth weight, and is associated with many short, medium and long-term morbidities, and increased mortality. Despite the growing number of premature and very low birth weight (VLBW) babies surviving into childhood, there are relatively few recent, nationally-representative studies of health outcomes and use of healthcare resources in this group. Using data collected from CPRD and HES, we propose to use repeated cross-sectional analyses to study the prevalence of VLBW and preterm infants discharged on home oxygen and a retrospective cohort study to identify the medium and long-term morbidities (measures of respiratory health, measures of growth) and healthcare resources used (primary and secondary care consultations, inpatient stays, prescriptions) by this cohort in comparison to preterm and VLBW infants without home oxygen and term infants with normal birthweights. This information will provide an understanding of mechanisms, evolution, and consequences of lung disease in these preterm infants, and is essential in developing prevention strategies as well as in the management of these infants in the neonatal period and beyond.
Health Outcomes to be Measured:
Part 1. Need for home oxygen Part 2 . Respiratory outcomes:. Episodes of respiratory tract infection Laboratory tests for infection Diagnosis of asthma; Diagnosis of atopy Length of time oxygen required Other health outcomes: . Measures of growth Healthcare resource use:. Primary care consultation rate overall and for specific conditions such as wheeze and asthma Hospital outpatient consultation rate overall and for a respiratory condition; Hospital inpatient admission rate overall and with a respiratory condition as the primary diagnosis; Number of hospital inpatient bed days and days requiring intensive care; Antibiotic prescriptions in primary care; Prescriptions for respiratory medications in primary care.
CPRD Mother-Baby Link;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation