Projects

Over the last three decades the prevalence of premature birth has risen due to changing demographics, higher mean age of pregnant mothers and a progressive use of reproductive medicine. Due to technological advances, improved care has further risen prevalence rates of very premature birth (<32 weeks of complete gestation). Surviving children are susceptible to severe neonatal morbidity that leads to long-term medical and social sequelae, often including respiratory disease. Lung injury due to immaturity, artificial ventilation, oxygen therapy and other factors can result in a wide range of pulmonary conditions. Respiratory limitations often extend beyond the neonatal period, and in some cases even into adulthood.

Despite several studies assessing the respiratory consequences of prematurity, there is significant variation in observed long-term pulmonary outcomes of premature birth. Most of these studies included heterogenous populations, frequently relatively small and selected samples and only a few studies assessed predictors of prematurity-related pulmonary sequelae. Studies that focused specifically on premature samples and with exhaustive perinatal care characterization covering different periods of standard treatment regimens over the last decade are scarce and cannot explain respiratory morbidity associated with prematurity. In addition, type of treatment and treatment burden for children and their parents are poorly studied and previous research is often limited to studies addressing the effects of steroids on the improvement of respiratory symptoms. So far, there is no report of other medications, no description of dosage, no treatment history, and no information of other treatment modalities. Thus, there is a clear lack of information on treatment of respiratory symptoms of premature children, response to treatment, and in particular how this affects children and their parents in respect to the disease and treatment burden.

In this study we aim to overcome some of the limitations of previous studies on the topic and perform a complete characterization of respiratory symptoms in survivors of very premature birth, using data of the larger Zurich area collected by the population-based registry of children born at preterm, the Swiss Neonatal Network & Follow-Up Group (SwissNeoNet). Specifically, we aim:
1) to assess the prevalence, type and severity of respiratory symptoms in children born <32 completed weeks of gestation between 2006 and 2019 in comparison to their siblings born at full-term;
2) to characterize the treatment and treatment burden of children and parents for respiratory symptoms;
3) to determine whether treatment of respiratory symptoms is related to respiratory improvement and
4) to assess the neonatal and sociodemographic predictors of respiratory symptoms in survivors of very preterm birth.

This is a cross-sectional observational study using an electronic survey.

Project lead: Susi Kriemler-Wiget
Funding: Lunge Zürich and additional support by the European Respiratory Society (ERS Long-Term Research Fellowship 2020)

One of the public health measures to contain the Sars-CoV-2 outbreak and with major impact at national and international level was the closure of schools. It is believed that school closures are effective in forcing parents to work from home, thereby severely limiting work-related contacts, and in significantly reducing children's activities and contacts. However, school closures have a significant impact - for example, they can lead to economic damage to parents through the need for parental childcare. The transfer of childcare responsibilities to at-risk grandparents, as well as the loss of education in socially disadvantaged families and social isolation of children, can also have far-reaching consequences. There is no data available on the implementation of school-based social distance measures during the corona pandemic or any other epidemic that has occurred in recent years. It is therefore far from clear how effective school closures are compared to other social distance measures and how much they contribute to transmission control. Another question that arises in this context is what the percentage of children in Switzerland who have undergone SARS-CoV-2 infection is. International research results show that the percentage is very low, ranging from 1% for small children to 6% for older children (http://www.corona-data.ch/). These figures do not give any indication of the actual seroprevalence (rate of infection) of SARS-CoV-2, as the tests were restricted to risk groups and persons with symptoms. Furthermore, the indications for the tests were not uniform and were handled heterogeneously. It is therefore not known whether children are less frequently infected or simply less symptomatic. Even though children and adolescents are less likely to develop severe SARS-CoV-2 than adults, there may be severe courses with immunological shock and even deaths. Knowledge about 1. the population-related seroprevalence of SARS-CoV-2 in young people, 2. the transmission routes from and among children and adolescents and teachers in schools, 3. the asymptomatic infection rate in adolescents, 4. the chance of long-term immunity or reinfection (in children and adults) and 5. the influence of school opening and protective measures on the temporal spread of the virus in children is almost completely lacking. Knowledge from a population-based cohort of children and adolescents in schools over time would help to answer these critical questions. The results would inform policy-makers on how young people should be treated during the pandemic, especially in schools, but also on the severity of social distancing measures towards their parents and grandparents.

For further information please visit the project pageand CIAO CORONA on Youtube
The study details are published here: CIAO CORONA publications
Download lecture (in german) (PDF, 949 KB)
 
Output: First Results (Mediarelease, PDF) (PDF, 144 KB)

Project lead: Susi Kriemler