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\begin{document}

\title{Associations of PM 2.5 exposure with emergency department visits and
readmissions among preterm infants with bronchopulmonary dysplasia}



\author[1]{Timothy Nelin}%
\author[1]{Joshua Radack}%
\author[1]{Nancy Yang}%
\author[1]{Scott A. Lorch}%
\author[1]{Sara B. DeMauro}%
\author[1]{Nic Bamat}%
\author[1]{Erik A. Jensen}%
\author[1]{Kathleen Gibbs}%
\author[1]{Daria Murosko}%
\author[1]{Kristan A. Scott}%
\author[1]{Nicolas P. Novick Goldstein}%
\author[2]{Allan C. Just}%
\author[1]{Heather H. Burris}%
\affil[1]{The Children's Hospital of Philadelphia Division of Neonatology}%
\affil[2]{Brown University Department of Epidemiology}%


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  \date{March 15, 2025}


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\begin{abstract}
\textbf{Objectives:} To quantify the association of ambient air
pollution (particulate matter, PM \textsubscript{2.5}) exposure with
medically attended acute respiratory illness among infants with
bronchopulmonary dysplasia (BPD). \textbf{Study Design:} Single center,
retrospective cohort study of preterm infants with BPD in Metropolitan
Philadelphia. Multivariable logistic regression quantified associations
of annual mean PM \textsubscript{2.5} exposure (per \selectlanguage{greek}μ\selectlanguage{english}g/m
\textsuperscript{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. \textbf{Results:} Of the 378 infants included
in the analysis, 189 were non-Hispanic Black and 235 were publicly
insured. Census block PM \textsubscript{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 \selectlanguage{greek}µ\selectlanguage{english}g/m
\textsuperscript{3} higher annual PM \textsubscript{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).
\textbf{Conclusions:} Cumulative PM \textsubscript{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.%
\end{abstract}%



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\textbf{Hosted file}

\verb`PMBPDManuscript.4.25.24.WithTableFigures.docx`  available at \url{https://authorea.com/users/808702/articles/1209026-associations-of-pm-2-5-exposure-with-emergency-department-visits-and-readmissions-among-preterm-infants-with-bronchopulmonary-dysplasia}

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