Population-Attributable Risk of Risk Factors for Recurrent Wheezing in Moderate Preterm Infants During the First Year of Life

• Published in: Paediatric and perinatal epidemiology Vol. 30; no. 4; pp. 376 - 385
• Main Authors: Blanken, Maarten O., Korsten, Koos, Achten, Niek B., Tamminga, Saskia, Nibbelke, Elisabeth E., Sanders, Elisabeth A.M., Smit, Henriette A., Groenwold, Rolf H.H., Bont, Louis
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-07-2016; Wiley Subscription Services, Inc
• Subjects: Babies; Bronchiolitis - economics; Bronchiolitis - epidemiology; Bronchiolitis - physiopathology; Child, Preschool; Cost-Benefit Analysis; day-care attendance; Female; Follow-Up Studies; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - economics; Infant, Premature, Diseases - epidemiology; Infant, Premature, Diseases - etiology; Infant, Premature, Diseases - physiopathology; Male; moderate preterm infants; Pediatrics; population-attributable risk; Premature birth; Prospective Studies; Quality of Life; Recurrence; recurrent wheezing; Respiratory diseases; Respiratory Sounds - physiopathology; Respiratory syncytial virus; Respiratory Syncytial Virus Infections - economics; Respiratory Syncytial Virus Infections - epidemiology; Respiratory Syncytial Virus Infections - physiopathology; Respiratory therapy; Risk Factors; United States - epidemiology; population-attributable risk; moderate preterm infants; day-care attendance; recurrent wheezing; respiratory syncytial virus
• ISSN: 0269-5022; 1365-3016
• DOI: 10.1111/ppe.12295

Background
Recurrent wheezing in young infants has a high prevalence, influences quality of life, and generates substantial health care costs. We previously showed that respiratory syncytial virus infection is an important mechanism of recurrent wheezing in moderate preterm infants. We aimed to provide population‐attributable risks (PAR) of risk factors for recurrent wheezing during the first year of life in otherwise healthy moderate preterm infants.
Methods
RISK is a multicentre prospective birth cohort study of 4424 moderate preterm infants born at 32–35 weeks gestation. We estimated PAR of risk factors for recurrent wheezing, which was defined as three or more parent‐reported wheezing episodes during the first year of life.
Results
We evaluated 3952 (89%) children at 1 year of age, of whom 705 infants (18%) developed recurrent wheezing. Fourteen variables were independently associated with recurrent wheezing. Hospitalisation for respiratory syncytial virus bronchiolitis had a strong relationship with recurrent wheezing (RR 2.6; 95% confidence interval, CI, 2.2, 3.1), but a relative modest PAR (8%; 95% CI 6, 11%) which can be explained by a low prevalence (13%). Day‐care attendance showed a strong relationship with recurrent wheezing (RR 1.9; 95% CI 1.7, 2.2) and the highest PAR (32%; 95% CI 23, 37%) due to a high prevalence (67%). The combined adjusted PAR for the 14 risk factors associated with recurrent wheezing was 49% (95% CI 46, 52%).
Conclusions
In moderate preterm infants, day‐care attendance has the largest PAR for recurrent wheezing. Trial evidence is needed to determine the potential benefit of delayed day‐care attendance in this population.