Long-term clinical and economic outcomes post birth hospitalization in preterm infants with neonatal respiratory distress syndrome: A real-world retrospective cohort study

Background Neonatal respiratory distress syndrome (nRDS) is a leading cause of morbidity among preterm infants. While short-term outcomes during birth hospitalization are well described, real-world evidence on long-term respiratory outcomes, healthcare resource utilization (HCRU), and economic burden following discharge remains limited. Methods This retrospective observational cohort study used linked IQVIA US Hospital Charge Data Master, Professional Fee Claims, and Longitudinal Prescription Claims databases from October 2015 to March 2024. Preterm infants (< 37 weeks’ gestation) diagnosed with nRDS between October 1, 2015, and March 31, 2022, and treated with surfactant or continuous positive airway pressure during birth hospitalization were included. Follow-up began at discharge and continued for ≥ 3 months. The outcomes included respiratory diseases during follow-up, respiratory-related HCRU, and costs standardized to 2023 USD per patient per month (PPPM). The results were reported overall and by gestational age (GA): very/extreme (< 32 weeks), moderate (32 to < 34 weeks), and late preterm (34 to < 37 weeks). Results The cohort comprised 7,532 preterm infants with nRDS; 43.6% were late preterm, 23.7% moderate preterm, and 32.3% very/extreme preterm (median follow-up: 1 year). Respiratory morbidity persisted across all GA categories: upper respiratory tract infection (URTI; 49.6%), cough (32.4%), lower respiratory tract infection (LRTI; 31.5%), and bronchiolitis (28.6%). Acute respiratory conditions, including URTI, LRTI, bronchiolitis, and cough, were more frequent among moderate and late preterm infants, whereas asthma, pulmonary hypertension, obstructive sleep apnea, pneumonia, and wheeze occurred most often in very/extreme preterm infants. Respiratory-related HCRU was common, including outpatient pharmacy use (62.2%), physician office visits (40.3%), and emergency room visits (30.8%), with similar patterns across GA subgroups. Mean respiratory-related costs were $347 PPPM overall, driven primarily by inpatient care (77.5%). Costs increased markedly with lower GA, averaging $684 PPPM in very/extreme preterm infants versus $164 PPPM in late preterm infants. Conclusions Preterm infants with nRDS experience substantial long-term respiratory morbidity and healthcare costs following discharge, even in the absence of BPD. Persistent burden across all GAs highlights the need for structured long-term respiratory follow-up and preventive strategies that extend beyond the neonatal period.