Childcare attendance during the first three years of life is linked to increased lung complications in children born prematurely and diagnosed with a form of chronic lung disease, according to new research led by the Children’s Hospital of Philadelphia ( CHOP).
The multicenter study, which drew data from nine specialty centers in the United States, found that preterm children with bronchopulmonary dysplasia (BPD) attending daycare were more likely to visit the emergency department, use systemic steroids, and have chronic respiratory symptoms compared to non-daycare children. The findings were published in The Journal of Pediatrics.
Premature children born with BPD have a short window to improve their lung function trajectory, so we are always looking for ways to minimize exposures in early childhood to prevent lung function problems in adulthood. This study shows that childcare is a modifiable risk factor that is related to poorer outcomes in preterm children with BPD.”
Sharon McGrath-Morrow, MD, MBA, lead author, 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
Several previous studies have shown an association between childcare attendance and increased risk of respiratory complications in children with very low birth weight. However, these studies focused on a single center or location and therefore the results were not generalizable to the entire population.
To better characterize the impact of daycare exposure on respiratory illness in children with BPD, researchers collected registry data from nine U.S. tertiary care centers participating in the BPD Ambulatory Collaborative Registry . Analyzing 341 former premature infants with BPD aged 0 to 3 years, the researchers collected data on daycare attendance, clinical characteristics, acute care use, and chronic respiratory symptoms.
The researchers found that preterm children with BPD who attended daycare were three times more likely to visit the emergency room and four times more likely to use systemic steroids. They also observed an increased risk of chronic respiratory symptoms among premature children who attended daycare, including breathing problems (coughing or wheezing) and increased use of rescue medications, such as inhalers. There was no difference between children who attended home daycare and those who attended center daycare.
To determine whether these effects diminished with age, the researchers stratified their data into three age groups: 6-12 months, 12-24 months, and 24-36 months. They found that the negative impacts of childcare were highest in the 6- to 12-month age group, but the data suggest that these effects may persist up to 36 months of age.
“Many families need childcare outside the home for a variety of reasons, including the employment of a carer,” McGrath-Morrow said. “Providers should counsel families with infants and toddlers with BPD about the potential risks of attending daycare, especially before one year of age, while taking into account the family’s financial needs.”
Source:
Children’s Hospital of Philadelphia
Journal reference:
McGrath-Morrow, SA, et al. (2022) Daycare attendance is associated with increased risk of respiratory morbidities in preterm infants with bronchopulmonary dysplasia. Journal of Pediatrics. doi.org/10.1016/j.jpeds.2022.06.037.