Respiratory morbidity in preschool and school-age children born very preterm and its association with parents' health-related quality of life and family functioning

Abstract

The purpose of this study is to describe the prevalence and severity of respiratory symptoms in children born very preterm and to assess their association with parents' health-related quality of life (HRQoL) and family functioning. We conducted a cross-sectional study and recruited children born less than 32 weeks' gestation between January 2006 and December 2019, in the greater Zurich area, Switzerland. Between May and December 2021, parents were invited to complete an online survey for their preterm child and for a control term born (≥ 37 weeks' gestation) sibling aged 1 to 18 years. We used a validated questionnaire to assess respiratory symptoms and the Pediatrics Quality of Life Family Impact Module (PedsQL FIM) to assess parents' HRQoL and family functioning. The survey was completed for 616 very preterm children (99 with bronchopulmonary dysplasia (BPD)) and 180 controls. Girls made up 45% (46% in controls) of the sample, and 63% (60% in controls) of participants were aged 6 to 18 years (school-age). Very preterm children reported a higher risk of respiratory symptoms than controls, especially preschoolers and those with moderate-to-severe BPD. Parents of children with "mild" and "moderate-severe" respiratory symptoms had on average -3.9 (95%CI: -6.6 to -1.1) and -8.2 (-11.2 to -5.2) lower PedsQL FIM total score, respectively, than parents of children with no symptoms. The same pattern was observed after stratifying by age categories. Conclusions: Our study suggests that respiratory morbidity in very preterm children has a negative impact on parents' HRQoL and family functioning, even beyond the first years of life. What is Known: • The burden of respiratory morbidity associated with very premature birth is high and last far beyond the neonatal period. • Respiratory morbidity contributes to lower health-related quality of life (HRQoL) in parents of very preterm children in early infancy. What is New: • Respiratory morbidity in very preterm children has a negative impact on parents' HRQoL and family functioning beyond the first years of life. • Parents of very preterm children with moderate and severe respiratory symptoms are the ones who report lower scores, both for preschool and school-age children.

Keywords: Children; Family functioning; Health-related quality of life; Parents; Premature birth; Respiratory symptoms.

Fig. 1

Combined variable for respiratory symptoms, stratified by age and BPD categories. Group comparisons were tested using Fisher’s exact test: preschool-age children, p-value = 0.007; school-age children, p-value = 0.284. Abbreviations: BPD, bronchopulmonary dysplasia; C, controls; VP no BPD, very preterm with no-to-mild BPD; VP BPD, very preterm with moderate-to-severe BPD

Fig. 2

Adjusted associations between respiratory symptoms in very preterm children and parents’ HRQoL and family functioning. Models were adjusted for child’s sex, gestational age category, presence of chronic diseases, number of siblings, parents’ nationality, educational level, smoking status, family history of atopy, and for who filled in the survey. Abbreviations: CI, confidence interval; HRQoL, health-related quality of life; Mod-sev, moderate-severe