Little Lungs May Struggle When Born a Little Early

Respiratory conditions in babies requiring hospitalization linked to pregnancy week of birth

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) It's already understood that babies born very early are at a higher risk for respiratory problems. Yet even being a week or two early might increase this risk slightly.

A recent study found that a child's likelihood of needing hospitalization for a respiratory condition increased the earlier the child was born.

Children born even a week or two before a complete full term pregnancy, at 40 to 42 weeks, saw very small increases in their risk of respiratory conditions in their first five years of life.

Common respiratory conditions requiring emergency hospitalization included acute upper or lower respiratory tract infections, acute bronchiolitis, influenza, pneumonia and asthma.

Babies born very underweight were also a little more likely to experience a respiratory condition requiring hospitalization than non-underweight babies.

Yet breastfed babies were a little less likely to experience these conditions than non-breastfed babies.

"Attend all prenatal appointments."

This study, led by Shantini Paranjothy, PhD, of the Institute of Primary Care and Public Health at the Cardiff University School of Medicine in the United Kingdom, aimed to find out whether the week babies were born affected their risk of having respiratory problems requiring hospitalization.

The researchers examined the medical records of 318,613 babies born between May 1998 and December 2008 in Wales.

Approximately 18 percent of these babies required at least one emergency admission to the hospital for respiratory conditions before they were 5 years old.

One of the most common respiratory conditions requiring hospitalization was acute upper respiratory tract infection, occurring in 16,475, or 45 percent, of the admissions.

The other common respiratory condition requiring emergency hospitalization was acute bronchiolitis, occurring in 16,172, or 44 percent, of the admissions.

Other conditions requiring hospitalization included influenza, pneumonia, acute lower respiratory tract infections and asthma.

Among babies born before 33 weeks of pregnancy, 42 babies out of every 100 in a single year would require emergency hospitalization for respiratory issues during their first year of life.

Among babies born between 40 and 42 weeks of pregnancy (full term), only 10 babies out of every 100 in a year would require emergency hospitalization for respiratory issues during their first year of life.

The researchers found that a child's likelihood of requiring emergency admission to the hospital for a respiratory issue any time before they were 5 years old became greater the earlier they were born when they were born before the 40th week of pregnancy.

For example, even babies born at 39 weeks — considered full term but still a week shy of a complete term pregnancy — had a 10 percent greater risk of requiring hospitalization for respiratory conditions.

Andre Hall, MD, an OBGYN at Birth and Women's Care, PA in Fayetteville, NC, noted that it is important not to rush the arrival of a baby into the world.

"We have become a 'microwave' society where we expect what we want, when we want it. Unfortunately, this has also carried over into our expectations for the deliveries of babies," Dr. Hall said.

"It is commonly known that it is possible for obstetricians to induce labor, hence allowing babies to be born before their due date," he said. "As a result, patients and their families regularly request induction of labor early for a host of reasons ranging from a husband who is about to deploy to other family members 'needing' to coordinate their travel plans in order to come for the delivery."

But even when these requests may seem valid, they may not take into consideration what is best for the baby, Dr. Hall said.

"Comments by patients such as 'my other baby was born several weeks early and he is fine' are often made in an attempt to justify their request for induction," he said.

But, Dr. Hall said, the American College of Obstetricians and Gynecologists (ACOG) is very clear on this point: Inductions prior to 39 weeks should not be done without a clear medical indication.

"Each day prior to 39 weeks that a baby is born, the rate of respiratory compromise increases," he said. "It is not appropriate to risk the health of a baby for often what is the convenience of the family."

Meanwhile, the researchers also found a very small increased risk for respiratory issues requiring emergency hospitalization among babies who were "small for gestational age."

Small for gestational age means weighing in the lowest 10th percentile for the pregnancy week when the baby was born.

Babies who were small for gestational age were 7 percent more likely than non-underweight babies to require emergency admission to the hospital for respiratory conditions.

Other factors that appeared to increase a child's risk of having a respiratory condition requiring hospitalization were having been born by cesarean section, having been in the neonatal intensive care unit, having a younger mother and living in areas with fewer social resources.

Breastfeeding slightly decreased a baby's risk of hospitalization due to a respiratory condition.

This study was published November 18 in the journal Pediatrics. The authors declared no conflicts of interest.

The research was funded by the National Institute for Social Care and Health Research and the UK Centre for the Improvement of Population Health through E-records Research (CIPHER).

CIPHER receives support from Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scotland), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council, the National Institute for Health Research, the National Institute for Social Care and Health Research (Wales) and the Wellcome Trust.

Review Date: 
November 17, 2013
Last Updated:
November 18, 2013