Daycare Attendance is Linked to Increased Risk of Respiratory Morbidities in Children Born Preterm with Bronchopulmonary Dysplasia

J Pediatr. 2022 Oct;249:22-28.e1. doi: 10.1016/j.jpeds.2022.06.037. Epub 2022 Jul 5.


Objectives: To test the hypothesis that daycare attendance among children with bronchopulmonary dysplasia (BPD) is associated with increased chronic respiratory symptoms and/or greater health care use for respiratory illnesses during the first 3 years of life.

Study design: Daycare attendance and clinical outcomes were obtained via standardized instruments for 341 subjects recruited from 9 BPD specialty clinics in the US. All subjects were former infants born preterm (<34 weeks) with BPD (71% severe) requiring outpatient follow-up between 0 and 3 years of age. Mixed logistic regression models were used to test for associations.

Results: Children with BPD attending daycare were more likely to have emergency department visits and systemic steroid usage. Children in daycare up to 3 years of age also were more likely to report trouble breathing, having activity limitations, and using rescue medications when compared with children not in daycare. More severe manifestations were found in children attending daycare between 6 and 12 months of chronological age.

Conclusions: In this study, children born preterm with BPD who attend daycare were more likely to visit the emergency department, use systemic steroids, and have chronic respiratory symptoms compared with children not in daycare, indicating that daycare may be a potential modifiable risk factor to minimize respiratory morbidities in children with BPD during the preschool years.

Keywords: bronchopulmonary dysplasia; daycare; rehospitalizations; respiratory morbidities.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bronchopulmonary Dysplasia* / complications
  • Bronchopulmonary Dysplasia* / epidemiology
  • Child
  • Child Day Care Centers
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Morbidity
  • Steroids / therapeutic use


  • Steroids