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Associations of PM 2.5 exposure with emergency department visits and readmissions among preterm infants with bronchopulmonary dysplasia
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  • Timothy Nelin,
  • Joshua Radack,
  • Nancy Yang,
  • Scott A. Lorch,
  • Sara B. DeMauro,
  • Nic Bamat,
  • Erik A. Jensen,
  • Kathleen Gibbs,
  • Daria Murosko,
  • Kristan A. Scott,
  • Nicolas P. Novick Goldstein,
  • Allan C. Just,
  • Heather H. Burris
Timothy Nelin
The Children's Hospital of Philadelphia Division of Neonatology

Corresponding Author:nelint@chop.edu

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Joshua Radack
The Children's Hospital of Philadelphia Division of Neonatology
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Nancy Yang
The Children's Hospital of Philadelphia Division of Neonatology
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Scott A. Lorch
The Children's Hospital of Philadelphia Division of Neonatology
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Sara B. DeMauro
The Children's Hospital of Philadelphia Division of Neonatology
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Nic Bamat
The Children's Hospital of Philadelphia Division of Neonatology
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Erik A. Jensen
The Children's Hospital of Philadelphia Division of Neonatology
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Kathleen Gibbs
The Children's Hospital of Philadelphia Division of Neonatology
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Daria Murosko
The Children's Hospital of Philadelphia Division of Neonatology
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Kristan A. Scott
The Children's Hospital of Philadelphia Division of Neonatology
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Nicolas P. Novick Goldstein
The Children's Hospital of Philadelphia Division of Neonatology
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Allan C. Just
Brown University Department of Epidemiology
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Heather H. Burris
The Children's Hospital of Philadelphia Division of Neonatology
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Abstract

Objectives: To quantify the association of ambient air pollution (particulate matter, PM 2.5) exposure with medically attended acute respiratory illness among infants with bronchopulmonary dysplasia (BPD). Study Design: Single center, retrospective cohort study of preterm infants with BPD in Metropolitan Philadelphia. Multivariable logistic regression quantified associations of annual mean PM 2.5 exposure (per μg/m 3) at the census block group level with medically attended acute respiratory illness, defined as emergency department (ED) visits or hospital readmissions within a year after first hospital discharge adjusting for age at neonatal intensive care unit (NICU) discharge, year, sex, race, insurance, BPD severity, and census tract deprivation. As a secondary analysis, we examined whether BPD severity modified the associations. Results: Of the 378 infants included in the analysis, 189 were non-Hispanic Black and 235 were publicly insured. Census block PM 2.5 level was not significantly associated with medically attended acute respiratory illnesses, ED visits, or hospital readmissions in the full study cohort. We observed significant effect modification by BPD grade; each 1 µg/m 3 higher annual PM 2.5 exposure was medically attended acute respiratory illness (aOR 1.65, 95% CI: 1.06-2.63) among infants with grade 1 BPD but not among infants with grade 3 BPD (aOR 0.83, 95% CI: 0.47-1.48) (interaction p=0.024). Conclusions: Cumulative PM 2.5 exposure in the year after NICU discharge was not significantly associated with medically attended acute respiratory illness among infants with BPD. However, infants with grade 1 BPD had significantly higher odds with higher exposures. If replicated, these findings could inform anticipatory guidance for families of these infants to avoid outdoor activities during high pollution days after NICU discharge.
24 Apr 2024Submitted to Pediatric Pulmonology
15 May 2024Reviewer(s) Assigned
08 Jun 2024Submission Checks Completed
08 Jun 2024Assigned to Editor
08 Jun 2024Reviewer(s) Assigned
24 Jun 2024Review(s) Completed, Editorial Evaluation Pending
26 Jun 2024Editorial Decision: Accept