Title: Gestational age and hospital admissions during childhood: population based, record linkage study in England (TIGAR study)
Author: Victoria Coathup, Elaine Boyle, Claire Carson, Samantha Johnson, Jennifer J Kurinzcuk, Alison Macfarlane, Stavros Petrou, Oliver Rivero-Arias, Maria A Quigley
Objective To examine the association between gestational age at birth and hospital admissions to age 10 years and how admission rates change throughout childhood.
Design Population based, record linkage, cohort study in England.
Setting NHS hospitals in England, United Kingdom.
Participants 1018136 live, singleton births in NHS hospitals in England between January 2005 and December 2006.
Main outcome measures Primary outcome was all inpatient hospital admissions from birth to age 10, death, or study end (March 2015); secondary outcome was the main cause of admission, which was defined as the World Health Organization’s first international classification of diseases, version 10 (ICD-10) code within each hospital admission record.
Results 1315338 admissions occurred between 1 January 2005 and 31 March 2015, and 831729 (63%) were emergency admissions. 525039 (52%) of 1018136 children were admitted to hospital at least once during the study period. Hospital admissions during childhood were strongly associated with gestational age at birth (<28, 28-29, 30-31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, and 42 weeks). In comparison with children born at full term (40 weeks’ gestation), those born extremely preterm (<28 weeks) had the highest rate of hospital admission throughout childhood (adjusted rate ratio 4.92, 95% confidence interval 4.58 to 5.30). Even children born at 38 weeks had a higher rate of hospital admission throughout childhood (1.19, 1.16 to 1.22). The association between gestational age and hospital admission decreased with increasing age (interaction P<0.001). Children born earlier than 28 weeks had an adjusted rate ratio of 6.34 (95% confidence interval 5.80 to 6.85) at age less than 1 year, declining to 3.28 (2.82 to 3.82) at ages 7-10, in comparison with those born full term; whereas in children born at 38 weeks, the adjusted rate ratios were 1.29 (1.27 to 1.31) and 1.16 (1.13 to 1.19), during infancy and ages 7-10, respectively. Infection was the main cause of excess hospital admissions at all ages, but particularly during infancy. Respiratory and gastrointestinal conditions also accounted for a large proportion of admissions during the first two years of life.
Conclusions The association between gestational age and hospital admission rates decreased with age, but an excess risk remained throughout childhood, even among children born at 38 and 39 weeks of gestation. Strategies aimed at the prevention and management of childhood infections should target children born preterm and those born a few weeks early.