Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Hibbs, Anna Maria; Johnson, Nathan L.; Rosen, Carol L.; Kirchner, H. Lester; Martin, Richard; Storfer-Isser, Amy; Redline, Susan

doi:10.1016/j.jpeds.2008.01.040

« Previous Next »The Journal of Pediatrics
Volume 153, Issue 2 , Pages 176-182, August 2008

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Anna Maria Hibbs, MD, MSCE
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
- Reprint requests: Anna Maria Hibbs, MD, MSCE, Division of Neonatology, Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Suite 3100, Cleveland, OH 44106-6010.
Nathan L. Johnson, MS
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
Carol L. Rosen, MD
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
H. Lester Kirchner, PhD
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
- Geisinger Center for Health Research, Danville, PA.
Richard Martin, MD
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
Amy Storfer-Isser, MS
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
Susan Redline, MD, MPH
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH

Received 19 June 2007; received in revised form 9 November 2007; accepted 30 January 2008. published online 31 March 2008.

Objectives

Previously published data from the Cleveland Children's Sleep and Health Study demonstrated that preterm infants are especially vulnerable both to sleep disordered breathing (SDB) and its neurocognitive sequelae at age 8 to 11 years. In this analysis, we aimed to identify the components of the neonatal medical history associated with childhood SDB among children born prematurely.

Study design

This analysis focuses on the 383 children in the population-based cohort from the Cleveland Children's Sleep and Health Study who were born <37 weeks gestational age and who had technically acceptable sleep studies performed at ages 8 to 11 years (92% of all preterm children). Logistic regression was used to evaluate the associations between candidate perinatal and neonatal risk factors and the presence of childhood SDB by sleep study.

Results

Twenty-eight preterm children (7.3%) met the definition for SDB at age 8 to 11 years. Having a single mother and mild maternal preeclampsia were strongly associated with SDB in unadjusted and race-adjusted models. Unadjusted analyses also identified xanthine use and cardiopulmonary resuscitation or intubation in the delivery room as potential risk-factors for SDB. We did not find a significant link between traditional markers of severity of neonatal illness—such as gestational age, birth weight, intraventricular hemorrhage, bronchopulmonary dysplasia, or duration of ventilation—and childhood SDB at school age.

Conclusions

These results represent a first step in identifying prenatal and neonatal characteristics that place preterm infants at higher risk for childhood SDB. The strong association between mild preeclampsia and childhood SDB underscores the importance of research aimed at understanding in utero risk factors for neurorespiratory development.

Abbreviations: AHI, Apnea hypopnea index, BMI, Body mass index, BPD, Bronchopulmonary dysplasia, CCSHS, Cleveland Children's Sleep and Health Study, GA, Gestational age, NICU, Neonatal intensive care unit, RDS, Respiratory distress syndrome, SDB, Sleep disordered breathing, SGA, Small for gestational age