英国牛津大学Victoria Coathup团队研究了胎龄与儿童期住院的相关性。2020年11月25日，《英国医学杂志》发表了该成果。
为了研究出生时胎龄与10岁以前住院、以及在整个儿童期住院率变化之间的相关性，研究组在英国进行了一项基于人口的队列研究。2005年1月至2006年12月，研究组在英国NHS医院中招募了1018136例单胎活产的婴儿，主要观察指标为参与者从出生至10岁、死亡或研究结束时的住院情况。
2005年1月1日至2015年3月31日，共发生1315338次住院，其中831729次（63％）是紧急住院。在研究期间，有525039名（52％）儿童至少住院一次。儿童时期住院与出生时的胎龄密切相关（<28、28-29、30-31、32、33、34、35、36、37、38、39、40、41和42周）。
与足月（妊娠40周）出生的孩子相比，极早（小于28周）出生的孩子在整个童年时期住院率最高，校正后的比率为4.92。即使是在38周出生的孩子，整个儿童时期的住院率也较高，比率为1.19。出生胎龄与住院率之间的相关性随年龄增加而降低。与足月出生的孩子相比，28周之前出生的孩子在1岁以内住院率的校正后比率为6.34，在7-10岁时下降至3.28；而在38周出生的孩子中，在婴儿期和7-10岁之间，校正后的比率分别为1.29和1.16。在所有年龄段，尤其是婴儿期，感染都是导致住院率增加的主要原因。在出生后的头两年，呼吸道和胃肠道疾病也占住院的很大比例。
研究结果表明，胎龄与住院率之间的相关性随着年龄的增长而降低，但整个儿童期仍存在较高风险，即使在妊娠38周和39周出生的儿童中亦是如此。
附：英文原文
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
Issue&Volume: 2020/11/25
Abstract:
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.
DOI: 10.1136/bmj.m4075
Source: https://www.bmj.com/content/371/bmj.m4075
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
