title: Day care increases the risk of respiratory morbidity in chronic lung disease of prematurity.
abstract: OBJECTIVE
  Infants and children with chronic lung disease of prematurity (CLDP) are at increased risk for morbidity and mortality from respiratory viral infections. Exposure to respiratory viruses may be increased in the day care environment. The risk of respiratory morbidity from day care attendance in the CLDP population is unknown. We therefore sought to determine if day care attendance is a significant risk factor for increased respiratory morbidity and symptoms in infants and children with CLDP.
  
  
  METHODS
  Between January 2008 and October 2009, parents of infants and children with CLDP were surveyed. Information on perinatal history, sociodemographic information, day care attendance, and indicators of respiratory morbidity, including emergency department (ED) visits, hospitalizations, systemic corticosteroid use, antibiotic use, and respiratory symptoms, was collected on children<3 years of age. Logistic regression models were constructed to examine associations between exposure to day care and respiratory morbidities.
  
  
  RESULTS
  Data were collected from 111 patients with CLDP. The average gestational age was 26.2±2.0 weeks. Day care attendance was associated with significantly higher adjusted odds for ED visits (odds ratio [OR]: 3.74 [95% confidence interval (CI): 1.41-9.91]; P<.008), systemic corticosteroid use (OR: 2.22 [CI: 1.10-4.49]; P<.026), antibiotic use (OR: 2.40 [CI: 1.08-5.30]; P<.031), and days with trouble breathing (OR: 2.72 [CI: 1.30-5.69]; P<.008). Although there was an increased OR for hospitalization (OR: 3.22 [CI: 0.97-10.72]; P<.057), this did not reach statistical significance.
  
  
  CONCLUSIONS
  We found that day care attendance is associated with increased respiratory morbidities in young children with CLDP. Physicians should consider screening for and educating caregivers about the risks of day care attendance by young children with CLDP.
authors.affiliation: Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Suite 3029, 200 N Wolfe St, Baltimore, MD 21287-2533, USA. smgrath@jhmi.edu
authors.forename: Sharon A
authors.initials: SA
authors.lastname: McGrath-Morrow
authors.forename: Grace
authors.initials: G
authors.lastname: Lee
authors.forename: Beth H
authors.initials: BH
authors.lastname: Stewart
authors.forename: Brian M
authors.initials: BM
authors.lastname: McGinley
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lefton-Greif
authors.forename: Sande O
authors.initials: SO
authors.lastname: Okelo
authors.forename: J Michael
authors.initials: JM
authors.lastname: Collaco
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000628:therapy*; D002656:Child Day Care Centers; D002908:Chronic Disease; D003428:Cross Infection / Q000635:transmission; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000628:therapy*; D008297:Male; D016156:Respiratory Tract Fistula / Q000209:etiology*; D012141:Respiratory Tract Infections / Q000635:transmission; D012307:Risk Factors