Preterm Birth and Risk of Health Service Use, Morbidity, and Medication Needs at 5 Years
Notice bibliographique
Résumé
Importance: Neonatal intensive care has advanced over recent decades, yet premature birth remains associated with increased neonatal mortality and morbidity. Objective: To describe health service use, morbidity, and medication needs up to age 5 years in a contemporary cohort of children born preterm. Design, Setting, and Participants: This population-based cohort study was conducted in British Columbia (BC), Canada, using health service and pharmacy data linked using provincial administrative databases. Data for a sample of 465 338 children born at 22 to 44 weeks' gestational age (GA) in BC from April 2004 to December 2014 were available. After exclusions for missing information on GA or birth weight, incomplete linkage, or loss of registration, the cohort included 448 819 children (96.5%), with 420 309 (93.6%) having complete 5-year follow-up until 2019. Data were analyzed from May 2023 to April 2025. Exposures: GA at birth, grouped into 8 categories: 22 to 24, 25 to 27, 28 to 30, 31 to 33, 34 to 36, 37 to 38, 39 to 41 weeks (reference), and 42 to 44 weeks. Main Outcomes and Measures: Health service use (hospitalizations and outpatient visits), morbidity (combined inpatient and outpatient diagnoses), and medication needs (outpatient prescriptions). Results: Of 448 819 children (mean [SD] age at follow-up, 4.8 [0.69]; 230 351 [51.3%] male), 42 080 (9.4%) were born before 37 weeks. Hospitalization rates within 5 years were higher for children born earlier compared to 39 to 41 weeks: 22 to 24 weeks (risk ratio [RR], 6.37; 95% CI, 5.62-7.22; risk difference [RD], 464.35 per 1000 patients; 95% CI, 395.62-533.08), 25 to 27 weeks (RR, 4.52; 95% CI, 4.15-4.92; RD, 304.21; 95% CI, 271.42-336.99), 28 to 30 weeks (RR, 2.70; 95% CI, 2.49-2.93; RD, 146.9; 95% CI, 128.01-165.78), 31 to 33 weeks (RR, 1.91; 95% CI, 1.81-2.03; RD, 79.08; 95% CI, 69.56-88.61), 34 to 36 weeks (RR, 1.53; 95% CI, 1.49-1.58; RD, 46.03; 95% CI, 42.13-49.92), and 37-38 weeks (RR, 1.16; 95% CI, 1.14-1.18; RD, 13.84; 95% CI, 11.9-15.78). Earlier GA was associated with increased outpatient visits by age 5 years. Children born preterm exhibited higher rates of respiratory (RR, 1.33; 95% CI, 1.30-1.37 to RR, 3.96; 95% CI, 3.30-4.70), endocrine (RR, 1.13; 95% CI, 1.09-1.18 to RR, 2.37; 95% CI, 1.65-3.27), gastrointestinal (RR, 1.26; 95% CI, 1.11-1.43 to RR, 6.36; 95% CI, 3.05-11.49), kidney (RR, 1.17; 95% CI, 1.08-1.26 to RR, 3.39; 95% CI, 1.86-5.59), neurodevelopmental (RR, 1.60; 95% CI, 1.55-1.66 to RR, 8.04; 95% CI, 6.78-9.44), and sleep (RR, 1.35; 95% CI, 1.21-1.51 to RR, 3.39; 95% CI, 1.34-6.87) disorders. Children born preterm were more likely to receive outpatient antibiotics, bronchodilators, corticosteroids, diuretics, and thyroid hormones. Conclusions and Relevance: In this population-based cohort study, despite neonatal care advancements, children born preterm required more health care resources and faced greater health challenges in their first 5 years.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».