title: Cystic Fibrosis is Associated with Adverse Neonatal Outcomes in Washington State, 1996-2013.
abstract: To determine whether cystic fibrosis (CF) is associated with adverse neonatal outcomes in a recent birth cohort in the US.
  
  
  
  A retrospective matched cohort study of infants born in Washington State from 1996 to 2013 was identified through birth certificate data and linked to statewide hospital discharge data. Infants with CF were identified by hospitalization (through age 5 years) in which a CF-specific International Classification of Diseases, Ninth Revision code was recorded. "Unexposed" infants lacked CF-related International Classification of Diseases, Ninth Revision codes and were randomly selected among births, frequency-matched to "exposed" infants on birth year. Associations of CF with adverse neonatal outcomes (low birth weight [LBW], small for gestational age [SGA], preterm birth, and infant mortality) were estimated through Poisson regression. We performed extreme value imputation to address possible ascertainment bias.
  
  
  
  We identified 170 infants with CF and 3400 unexposed infants. CF was associated with increased relative risk (95% CI) of 3.5 (2.5-4.9), 1.6 (1.1-2.4), 3.0 (2.2-4.0), and 6.8 (1.7-26.5) for LBW, SGA, preterm birth, and infant death, respectively. The estimated relative risks were similar among infants born from 2006 to 2013, except SGA was no longer associated with CF diagnosis. Results were robust to extreme value imputation and exclusion of infants with meconium ileus.
  
  
  
  Observed associations of CF with LBW, preterm birth, and infant death are unlikely to be due to ascertainment bias. Further work is needed to determine how to prevent these adverse neonatal outcomes.
authors: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA. Electronic address: ramoskj@uw.edu.
authors: Kathleen J
authors: KJ
authors: Ramos
authors: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.
authors: Coralynn S
authors: CS
authors: Sack
authors: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.
authors: Kristina H
authors: KH
authors: Mitchell
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA; Department of Pediatrics, University of Washington, Seattle, WA; Seattle Children's Hospital, Seattle, WA.
authors: Christopher H
authors: CH
authors: Goss
authors: Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA; The Forsyth Institute, Cambridge, MA.
authors: Jacqueline R
authors: JR
authors: Starr
mesh_terms: D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D047928:Premature Birth / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014861:Washington
keywords: infant mortality; low birth weight; prematurity; preterm birth; small for gestational age