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Prospective study of risk factors for healthcare utilisation and RSV infection in prematurely born infants

Presented at the Neonatal Society 2004 Summer Meeting (programme).

Broughton S1, Roberts A1, Fox G2, Zuckerman M3, Greenough A1

1 Department of Child Health, Guy's King's and St Thomas' Medical School, Kings College Hospital, Denmark Hill, London SE5 9RS
2 Department of Child Health, Guy's, King's and St Thomas' Medical School, St Thomas' Hospital, Lambeth Palace Rd, London SE1 7EH
3 Department of Microbiology, Guy's King's and St Thomas' Medical School, Kings College Hospital, Denmark Hill, London SE5 9RS

Background: Prematurely born infants frequently require readmission or GP contacts following NICU discharge, data from retrospective studies suggests this may be increased following RSV infection.

Aims: In a prospective study to determine risk factors for healthcare utilisation and RSV infection in babies born prematurely.

Methods: Babies born < 32 weeks of gestation were recruited if they were born within six months of the onset of the RSV season. Following discharge from the neonatal unit, data were collected regarding subsequent healthcare utilisation; the number and length of hospital admissions and GP consultations. The parents were asked to contact a member of the research team if their baby had signs of a lower respiratory tract infection (LRTI). In addition, all parents were contacted on a fortnightly basis by the research team. If either contact indicated the baby had a LRTI, a member of the research team visited the baby at home or at hospital and a nasopharyngeal aspirate (NPA) was obtained. Healthcare utilisation and RSV infection were then related to demographic, social and neonatal data to identify risk factors. Ethical approval was obtained from the ethics committee and consent was obtained from the parent.

Results: 119 babies (median gestational age 29, range 23-31 weeks) were recruited. 86 of the babies had signs of LRTI on 149 occasions and NPAs were obtained. Thirty-eight (32 % of 119) were RSV positive on 41 occasions. In addition 8 babies were positive for influenza and five for parainfluenza. Regression analysis demonstrated that risk factors increasing for hospital admission were RSV infection (odds ratio (OR) 3.21 (95% confidence intervals 1.29-8.01)) and parental smoking (OR 3.59 (1.34-9.66)). Risk factors for hospital length of stay were gestation out of oxygen (p<0.001), parental smoking (p=0.012) and RSV infection (p=0.022). Antenatal infection was protective (p=0.049). The only risk factor identified for GP consultations was RSV infection (p<0.001). Risk factors identified for RSV infection were smoking in pregnancy (OR 3.59 (1.05-9.66)), being male (OR 2.62 1.05-6.50)) and the number of siblings (OR 1.65 (1.12-2.14)) and antenatal infection was protective (OR 0.35 (0.12-0.97)).

Conclusion: RSV infection does increase healthcare utilisation in prematurely born infants. These results further emphasise the need to counsel women against smoking during and after pregnancy.

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