Infant respiratory infections and later respiratory hospitalisation in childhood

Abstract

Acute respiratory infections (ARI) cause significant morbidity in infancy. We sought to quantify the relationship between ARI and development of respiratory morbidity in early childhood.Population-based longitudinal hospitalisation data were linked to perinatal, birth and death records for 145 580 Western Australian children from 1997 to 2002. We conducted Cox regression with sensitivity analyses to quantify the risk of recurrent ARI in infancy for respiratory hospitalisation after the age of 3 years.ARI in infancy was significantly related to respiratory hospitalisation before (hazard ratio (HR) 3.5, 95% CI 3.1-3.8) and after (HR 3.0, 95% CI 2.6-3.4) adjusting for known risk factors including maternal smoking during pregnancy, season of birth, delivery mode and gestational age. We noted a dose response with the number and length of infant ARI hospitalisations and increasing risk with no effect modification by gestational age. Results were similar when later respiratory hospitalisations were restricted to asthma hospitalisations only.Recurrent hospitalisations for ARI in infancy significantly increase the risk of respiratory morbidity and asthma requiring hospitalisation after the age of 3 years in a dose-response fashion. The increase in relative risk is not modified by gestational age. Efforts to reduce the occurrence of infant ARI are likely to have significant public health benefits. @ERSpublications Recurrent infant acute respiratory infections: the major predictor of later hospitalisation for respiratory morbidity http://ow.ly/NVmGv

Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection

“…Our findings are consistent with the range suggested by previous studies (2,12). We found one in four children experienced a subsequent hospitalization with infection, with more than half occurring within 12 months.…”

“…We found one in four children experienced a subsequent hospitalization with infection, with more than half occurring within 12 months. Our findings are consistent with the range suggested by previous studies (2,12). Additionally, population-based data show that those hospitalized with infection in infancy have a three to four times increased risk of repeat hospitalization with infection later in childhood (12,24).…”

“…Two population-based studies from Western Australia found that among children hospitalized with infections, 36% had a repeat hospitalization for any infection before 18 years of age, and 20% had a repeat hospitalization for lower respiratory tract infection before age three (2,12). They also found lower birthweight and earlier GA were associated with an increasing number of hospitalizations with infection during childhood (2).…”

“…Age at first hospitalization was adjusted for, using penalized splines. Multivariable Cox models included adjustment for covariates previously identified in the literature as risk factors (2,4,7,8,12,19): maternal age, socioeconomic status, Australia-born mother, married or de facto relationship, parity, smoking, hypertension or diabetes during pregnancy, baby's sex, birthweight z-score (standardized by Australian national GA and sex), infection during the birth admission, neonatal length of stay z-score (standardized by GA and vaginal vs. cesarean delivery within the study population), season and year of birth. Socioeconomic status used an area-level measure assigned according to postcode of residence at the time of birth, and was created using variables for occupation, education or qualifications, and unemployment (see also Table S2).…”

Growing up with your airway microbiota: a risky business

“…Recurrent ARIs in the first year of life have been shown to be a significant risk factor for both reduced lung function at 1 year of age and hospitalisations with respiratory symptoms, particularly asthma, at 3 years of age in two large population-based studies in children in South Africa16 and Australia, respectively 17. Surprisingly, Toivonen et al 10 did not find an association with microbiota profiles and recurrent wheezing, although this may reflect the low incidence of recurrent wheezing in this cohort, and the long-term implications of this study on future lung health remain unknown.…”