Day care attendance ups risk for complications in preterm children with bronchopulmonary dysplasia

Day care attendance in the first 3 years of life was linked to increased risk for lung complications among preterm-born children who were diagnosed with bronchopulmonary dysplasia, according to findings published in Journal of Pediatrics.

“Exposure to daycare is a leading cause of recurrent respiratory tract infections in young

children worldwide,” Sharon A. McGrath-Morrow, MD, MBA, associate chief of the division of pulmonary and sleep medicine and leader of the Post-preemie Lung Disease Clinic at the Children’s Hospital of Philadelphia and University of Pennsylvania, and colleagues wrote. “Additionally, preterm infants and children with [bronchopulmonary dysplasia] can display inappropriate immune responses to respiratory viruses, such as [respiratory syncytial virus] and rhinovirus, often resulting in increased respiratory morbidities.”

Researchers collected data on day care attendance and clinical outcomes for 341 children recruited from nine bronchopulmonary dysplasia specialty clinics in the U.S. All children were former preterm infants born at less than 34 weeks gestation and were diagnosed with bronchopulmonary dysplasia (71% severe) and required outpatient follow-up at age 0 to 3 years.

Day care attendance varied from 3.3% to 34.9% (P = .002); 18.8% of all children reported to have attended day care on at least one clinic visit before 3 years of age.

Compared with those who did not attend day care, children with bronchopulmonary dysplasia who attended day care had a higher likelihood of ED visits (adjusted OR = 2.81; 95% CI, 1.26-6.31; P = .012) and systemic steroid use (aOR = 4.23; 95% CI, 1.66-10.76; P = .002). Children who attended day care up to age 3 years also had a higher likelihood of reporting trouble breathing (aOR = 4.03; 95% CI, 1.73-9.38; P = .001), activity limitations (aOR = 2.66; 95% CI, 1.37-5.17; P = .004) and use of rescue medications (aOR = 7.38; 95% CI, 2.9-18.77; P < .001) compared with children who did not attend day care.

Researchers reported a higher likelihood of hospital admissions (P = .018), systemic steroid use (P = .007) and activity limitations (P = .001) among children who attended day care at age 6 to 12 months compared with children who did not.

According to the researchers, future studies are required to define best practices for mitigating risks identified in this study that were associated with day care attendance.

“Recognizing that families may choose to seek childcare outside the home for a variety of reasons ... providers should advise families with infants and young children with bronchopulmonary dysplasia about the potential risks of day care attendance, particularly prior to 1 year of age,” the researchers wrote.

Reference:

• CHOP-led study finds day care linked to increased complications in preterm children with chronic lung disease. Published July 26, 2022. Accessed July 27, 2022.