Clinical profile and risk factors of recurrent pneumonia in children at Qena governorate, Egypt

Abstract

Background There is a scarce research study on recurrent pneumonia in children, particularly in the developing world. This study aimed to analyse the clinical characteristics, risk factors and underlying causes of recurrent pneumonia in children. Methods It was a case‐control study involved 87 children with ≥2 episodes of radiographically confirmed pneumonia in a single year or ≥3 episodes at any time with a radiographic clearing of densities between attacks. Controls were 87 age and gender‐matched children who had never suffered pneumonia. Demographic and clinical characteristics of patients and controls were compared and evaluated for the detection of possible underlying conditions that may be the incriminated risk factor of pneumonia recurrence. Results During one‐year study, 763 patients were admitted with pneumonia and 87 (11.4%) of them met the definition of recurrent pneumonia. There were 48 (55.2%) males and 39 (44.8%) females. The mean age at diagnosis of recurrent pneumonia was 7.15 ± 1.72 years. Prematurity, small birth weight and presence of respiratory distress at birth were significantly different between patients and controls. Aspiration, congenital heart disease, gastroesophageal reflux, oro‐motor incoordination, wheezing and asthma were significant risk factors for recurrent pneumonia. Conclusion Our study showed that 11.40% of children with pneumonia had recurrent form and that most of them had an underlying illness. The most common detected risk factors for recurrent pneumonia were rural residence, low socioeconomic standard, over‐crowding, prematurity and presence of respiratory distress at birth. Aspiration, congenital heart diseases, wheezing and asthma were found to be the main underlying illnesses associated with pneumonia recurrences.

Underlying causes and outcomes of recurrent pneumonia in hospitalized children

“…Underlying diseases were previously identified in 69%-92.4% of children with RP in different settings, which was similar to our results. [4][5][6][7][8][9][10][11]13 In accordance with most of these studies, we identified recurrent aspiration as the most common underlying condition. However, we found a higher prevalence of PID, BPD, and PCD and a lower prevalence of aspiration and asthma, compared with data from a study performed 20 years ago at a tertiary care pediatric hospital in Canada.…”

“…Among 551 patients, 90.6% were younger than 6 years of age; 66.4% were male; and 18.6% were born premature. The median age at first episode of pneumonia was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) months, and the median age at diagnosis of RP was 14 (8-37) months (Table 1). Overall, 483 (87.7%) patients were identified as having at least one underlying disorder, and the proportions of prematurity and low birth weight were significantly higher in patients with underlying diseases.…”

“…Recurrent pneumonia (RP) is defined as two episodes of pneumonia in 1 year or three episodes over any timeframe 3 . RP occurs in 8%–11% of children with pneumonia, and it may lead to severe respiratory sequelae such as bronchiectasis 4–8 …”

“…A limited number of studies indicated that underlying diseases were identified in 69%–92% of patients with RP, including recurrent aspiration, immunodeficiency, and congenital heart disease (CHD); and distinct variations were found across studies with respect to the prevalence of the most common causes. In addition, these aforementioned studies largely focused on the distribution of the underlying diseases, with few comprising detailed clinical characteristics and clinical outcomes 4–11 …”

“…In addition, these aforementioned studies largely focused on the distribution of the underlying diseases, with few comprising detailed clinical characteristics and clinical outcomes. [4][5][6][7][8][9][10][11] A recent study from Italy showed that the most common underlying conditions in children with RP were genetic diseases, including primary immunodeficiency (PID), cystic fibrosis (CF), and primary ciliary dyskinesia (PCD). 11 For children with genetic diseases, early diagnosis is crucial to reduce morbidity and to improve prognosis.…”