Increased Risk of Recurrent Acute Respiratory Infections in Children with Congenital Heart Disease: A Prospective Cohort Study

Abstract

BACKGROUND: There is a lack of local data about recurrent acute respiratory infections in children with congenital heart disease (CHD). This study aims to investigate the incidence and recurrence of acute respiratory infection (ARI) in left-to-right shunt CHD.METHODS: This prospective cohort study investigated children with left-to-right shunt CHD, aged three months to five years, at Dr. Cipto Mangunkusumo Hospital between September 2012 and April 2013. Age and sex-matched participants without CHD were recruited as reference. The occurrence of ARI was observed for six months. Acyanotic CHD patients from 2015 to 2019 were also evaluated to determine the proportion of ARI among this population.RESULTS: A total of 100 subjects were enrolled in the study, 50 in the CHD group and 50 in the non-CHD group, six of whom were later excluded. The monthly incidence of ARI in the CHD group ranged between 40-60% (p=0.027). Subjects with CHD had a cumulative increased risk of 10% for acquiring ARI (RR=1.1; 95% CI=1.02-1.2, p=0.027). The proportion of subjects with a high recurrence of ARI was also higher in the CHD compared to the non-CHD group (67% vs. 30 %, p<0.001). The mean frequency of and median duration of ARI episodes was also higher in CHD compared to the non-CHD group, 3 vs. 1.5 episodes (p<0.001), and 7 vs. 5 days, respectively.CONCLUSION: Children with CHD are at an increased risk of ARI, with more episodes and longer duration compared to children without CHD.KEYWORDS: non-cyanotic CHD, left-to-right shunt, acute respiratory infections

Incidence of Respiratory Tract Infection in Children with Cyanotic and Acyanotic Congenital Heart Disease: A Comparative Study

“…Furthermore, minimal levels of testosterone play a role in inflammation process, mainly due to influenza infection. 2,9,12 Malnutrition is caused by several things. Increased needs due to clinical symptoms and co-infections such as RTI and other complications with an adequate number of calories due to shortness of breath and dysphagia are aggravated by other comorbidities.…”

“…It is in contrast with the results of previous studies which proved that the common case was VSD. 2,7 Pulmonary edema easily happened in ASD patients. 17 It will trigger the emergence of RTI.…”

“…This is in line with previous studies which showed that the trend of the incidence of lower RTI was found to be increasing in children with a history of CHD. 2,7 Physiologically, respiratory tracts and organs such as the nasopharynx, oropharynx, and lungs are non-sterile organs that contain secrets and mix easily with microorganisms from outside the body and other organs, hence the colonies are easy to form. The colonization will cause symptoms if there is a worsening of individual conditions, an increasing number of pathogens, and poor environmental conditions.…”

“…Patient with CHD has a 2-fold risk of recurrent RTI within 1 month. 2 CHD is the most common congenital disease, at least each year there are 32,000-40,000 cases in Indonesia. 3 The imbalance between the need and distribution of oxygenated blood due to chronic CHD and environmental exposures such as weather and high virulence of pathogens that cause RTI will increase the body's susceptibility to RTI.…”

“…6 Previous studies explained that RTI is more common in children with acyanotic CHD, particularly the ventricular septal defect (VSD) subtype. 2,7 The potential risk of RTI in a patient with all types of CHD was not clearly identified. Therefore, this study aimed to compare RTI incidence and hospitalization time of patients with cyanotic and acyanotic CHD and observe the risk factors in patients based on age, gender, nutrition, and immunization data.…”