Study should inform future health provision for premature youngsters

A new study has found that children born preterm spend an average of two days admitted to hospital between going home from neonatal care and their second birthday. 

The study, led by the University of Leicester, was funded by the National Institute for Health and Care Research (NIHR), and supported by the charity for sick and preterm babies, Bliss.

It found that typically, youngsters born early need increased care, but until now the impact on healthcare services wasn’t clear.

Now the study, which included 39,413 babies born in England and Wales before 32 weeks gestation between 2013 and 2018, has gathered data to highlight just that. 

The results by neonatal researchers at the University have just been published in JAMA Network Open.

Figures showed that 26,498 children (67.2%) of those included in the study had at least one hospital admission after being discharged home from their neonatal unit. Most of these admissions were short, so that on average, children spent two calendar days in hospital before their second birthday. 

The majority of the admissions were for respiratory illness such as bronchiolitis, which can require admission for oxygen or other respiratory support, or to help with feeding and hydration. However, the most preterm children, and those with long-term complications of prematurity such as chronic lung disease and brain injury, spent more time in hospital, estimated up to 40 days.

Dr Tim van Hasselt is a neonatal intensive care doctor at University Hospitals of Leicester, and clinical lecturer in the University’s School of Healthcare and led the study.

He said: “We set out to examine the associations between hospitalisation and neonatal health problems and it’s clear that for preterm youngsters and their parents, more could be done to see if we can lower the number of hospitalisations, whether by advising parents about preventative care in the home or ensuring preterm babies and their families have access to healthcare including follow-up when they go home.

“We’re very pleased that premature babies will now be protected from RSV (respiratory syncytial virus) thanks to the roll out of vaccinations announced recently by NHS England. This common lung infection can be extremely dangerous to preterm babies and children and a dose of the drug nirsevimab should make a huge difference to the numbers needing hospital treatment.”

Around 30,000 children in the UK under five need hospital care because of the virus. The drug will be delivered via injection to around 7,000 preterm babies per year by neonatal teams.

Dr Van Hasselt added: “While the NICE Guidance on Developmental follow-up of children and young people born preterm does not specifically discuss unplanned hospital admissions and respiratory infections, preterm birth before 32 weeks is recognised as a risk factor in NICE guidance on Bronchiolitis in children: diagnosis and management, which includes recommendations for advising parents.

“We recommend that families of preterm babies are directed to the excellent online resources from Bliss, the charity for babies born premature or sick, which includes advice on ‘How can I help my baby avoid infections’ such as handwashing, avoiding people who are unwell, and smoke-free environments.

“We hope this study can assist future discussions around neonatal discharge and provision of services for vulnerable children.”