Preterm children with chronic respiratory disease such as bronchopulmonary dysplasia (BPD) are likely to experience greater respiratory morbidity if they attended daycare when compared with children not in daycare, according to findings of a multicenter study recently published in Journal of Pediatrics.¹

This multicenter study from the United States enrolled 341 children from nine specialty clinics across the country to examine if daycare visits had any impact on disease severity with greater utilization of healthcare services for respiratory illnesses in children aged ≤3 years. These patients had been preterm infants born before 34 weeks of gestation with BPD (71% severe) for which they needed follow-up as outpatients between 0 and 3 years of age. Data on daycare attendance, clinical features, emergency room (ER) visits and chronic respiratory symptoms was collected.

The researchers found that children with BPD who attended daycare were nearly 3 times more likely to visit the ED for acute care with an adjusted odds ratio of 2.81. They were also four times more likely to use systemic steroids with aOR of 4.23. Compared to children aged ≤3 years not in daycare, those attending daycare had higher probability of experiencing breathing problems (aOR 4.03) and activity limitations (aOR 2.66). They also needed rescue medications (aOR 7.38).

When the study subjects were analysed according to age, children aged 6-12 months (vs 12 months, 12024 months) attending daycare were found to have the most severe presentation of the disease with greater chances of hospital admissions.

This study demonstrates that preterm children diagnosed with BPD had greater likelihood of using systemic steroids, ER visits and having long-term respiratory symptoms if they attended daycare. Based on these findings, the researchers suggest daycare as a potentially modifiable risk factor to reduce the adverse outcomes in children with BPD up to 3 years of age. Hence, parents seeking daycare for their children, particularly the preschoolers, should be advised of the risks likely to be associated with daycare attendance.

Reference

1. McGrath-Morrow SA, et al. Daycare attendance is linked to increased risk of respiratory morbidities in children born preterm with bronchopulmonary dysplasia. J Pediatr. 2022 Oct;249:22-28.e1. doi: 10.1016/j.jpeds.2022.06.037.