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October 4, 2010

Recurrent Wheezing in the Third Year of Life Among Children Born at 32 Weeks' Gestation or Later: Relationship to Laboratory-Confirmed, Medically Attended Infection With Respiratory Syncytial Virus During the First Year of Life

Author Affiliations

Author Affiliations: Division of Research, Systems Research Initiative and Perinatal Research Unit, Kaiser Permanente Medical Care Program, Oakland, California (Drs Escobar and Kipnis and Mss Ragins and Li); Department of Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California (Dr Escobar and Mss Ragins and Li); Department of Pediatrics, Kaiser Permanente Medical Center, Daly City, California (Dr Prager); MedImmune LLC, Gaithersburg, Maryland (Dr Masaquel); and Department of Management Information and Analysis, Kaiser Foundation Health Plan Inc, Oakland, California (Dr Kipnis).

Arch Pediatr Adolesc Med. 2010;164(10):915-922. doi:10.1001/archpediatrics.2010.177

Objective  To quantify the relationship between recurrent wheezing (RW) in the third year of life and respiratory syncytial virus (RSV) infection, prematurity, and neonatal oxygen exposure.

Design  Retrospective cohort study linking inpatient, outpatient, and laboratory databases for cohort assembly and logistic regression analysis.

Setting  Integrated health care delivery system in Northern California.

Participants  A total of 71 102 children born from 1996 to 2002 at 32 weeks' gestational age or later who were health plan members for 9 or more months in their first and third years.

Main Exposures  Laboratory-confirmed, medically attended RSV infection during first year and supplemental oxygen during birth hospitalization.

Outcome Measures  Recurrent wheezing, quantified through outpatient visits, inpatient hospital stays, and asthma prescriptions.

Results  The rate of RW in the third year of life was 16.23% among premature infants with RSV and 6.22% among those without RSV. The risk of RW increased among infants who had an RSV outpatient encounter (adjusted odds ratio [AOR], 2.07; 95% CI, 1.61-2.67), uncomplicated RSV hospitalization (AOR, 4.66; 95% CI, 3.55-6.12), or prolonged RSV hospitalization (AOR, 3.42; 95% CI, 2.01-5.82) compared with infants without RSV encounters. Gestational age of 34 to 36 weeks was associated with increased risk of RW (AOR, 1.23; 95% CI 1.07-1.41) compared with 38 to 40 weeks, while a gestational age of 41 weeks or more was protective (AOR, 0.90; 95% CI, 0.81-0.99). Supplemental oxygen exposure was associated with increased risk at all levels.

Conclusion  Laboratory-confirmed, medically attended RSV infection, prematurity, and exposure to supplemental oxygen during the neonatal period have independent associations with the development of RW in the third year of life.