Per capita increase in hospital presentations and admissions among children since the 1990s

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Aim To determine the incidence, risk factors and health service utilisation for infection in the first 12 months of life in a population‐derived Australian pre‐birth cohort. Methods The Barwon Infant Study is a population‐derived pre‐birth cohort with antenatal recruitment (n = 1074) based in Geelong, Victoria, Australia. Infection data were collected by parent report, and general practitioner and hospital records at 1, 3, 6, 9 and 12 months of age. We calculated the incidence of infection, attendance at a health service with infection and used multiple negative binomial regression to investigate the effects of a range of exposures on incidence of infection. Results In the first 12 months of life, infections of the upper and lower respiratory tract (henceforth ‘respiratory infections’), conjunctivitis and gastroenteritis occurred at a rate of 0.35, 0.04 and 0.04 episodes per child‐month, respectively. A total of 482 (72.4%) infants attended a general practitioner with an infection and 69 (10.4%) infants attended the emergency department. Maternal antibiotic exposure in pregnancy and having older siblings were associated with respiratory infection. Childcare attendance by 12 months of age was associated with respiratory infections and gastroenteritis. Breastfeeding, even if less than 4 weeks in total, was associated with reduced respiratory infection. Conclusion Infection, especially of the respiratory tract, is a common cause of morbidity in Australian infants. Several potentially modifiable risk factors were identified, particularly for respiratory infections. Most infections were managed by general practitioners and 1 in 10 infants attended an emergency department with infection in the first year of life.

Section: Discussioncontrasting

confidence: 96%

mentioning

confidence: 99%

Burden of infection in Australian infants

Rowland

Sass

Ponsonby

et al. 2020

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“…Only 9.6% of infants with respiratory illness presented to hospital; however, a previous study at the main public hospital in the study region found that, of all children presenting to hospital, those with respiratory illness were the most likely to be admitted. 21 The study population and location share many characteristics of other large regional centres in southern Australia, 14 indicating that respiratory illnesses in infancy remain a significant resource burden and cost for all levels of Australian health care.…”

Section: Discussionmentioning

confidence: 99%

High incidence of respiratory disease in Australian infants despite low rate of maternal cigarette smoking

Gray

Ponsonby

Lin

et al. 2019

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Aim The burden of wheezing illnesses in Australian infants has not been documented since the success of initiatives to reduce maternal cigarette smoking. We aimed to determine the incidence of wheeze and related health‐care utilisation during the first year of life among a contemporary Australian birth cohort. Methods A birth cohort of 1074 infants was assembled between 2010 and 2013. Parents completed questionnaires periodically. Several non‐exclusive infant respiratory disease phenotypes were defined, including any wheeze, wheeze with shortness of breath and recurrent wheeze. Skin prick testing was performed to determine atopic wheeze. Health‐care utilisation for respiratory disease was determined from questionnaires and hospital medical records. Results Retention to 1 year was 840/1074 (83%). The incidence of any wheeze was 51.8% (95% confidence interval (CI) 48.3–55.2%), wheeze with shortness of breath 20.6% (95% CI 17.9–23.5), recurrent wheeze 19.4% (95% CI 16.8–22.2) and atopic wheeze 6% (95% CI 4.6–7.8). Respiratory illness resulted in primary health‐care utilisation in 82.2% (95% CI 79.3–84.8) of participants and hospital presentation in 8.8% (95% CI 7.2–10.6). Maternal smoking during pregnancy was uncommon (15.7%) and was not associated with wheeze or health resource utilisation. Male gender, familial atopy and asthma and smaller household size were associated with a higher incidence of wheeze. Conclusions The incidence of wheezing illness among Australian infants remains high despite relatively low rates of maternal smoking during pregnancy. The majority of the health‐care burden is borne by primary health‐care services. Further research is required to inform novel prevention strategies.

“…The pre-school age group is important from a wheezy illness disease burden perspective. In addition to being the most common reason for hospitalisation of children <6 years old in Australasia, 3,4 of all hospitalisations in the UK with acute wheeze or asthma, 75% occur in children <5 years old. 38 This study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Pre‐school wheeze hospital presentations: A demographic profile and review of clinical management

Walsh

Gangakhedkar

Jelleyman

2023

Aim Pre‐school wheeze is a common hospital presentation in Australasia. The aim of this study was to describe the regional hospital presentation and cost of pre‐school wheeze. Methods Audit of children diagnosed with pre‐school wheeze at two hospitals in Auckland, New Zealand from October 2017 to September 2019. Guideline adherence was determined. Results One hundred and ninety‐two children made 247 pre‐school wheeze hospital presentations. Pre‐school wheeze accounted for a larger proportion of acute hospital presentations for Māori versus non‐Māori children (rate ratio 1.76, 95% confidence intervals 1.32–2.31). Hospital representations with pre‐school wheeze occurred in 38/192 (20%) children. The proportion with a pre‐school wheeze representation was larger for Māori than non‐Māori (30% vs. 16%, P = 0.02). Pre‐school wheeze event median length of stay increased as household deprivation increased (P = 0.01). Clinical severity of 247 pre‐school wheeze episodes was mild (n = 64, 26%), moderate (n = 153, 62%) and severe (n = 30, 12%). Of 244 episodes, inhaled bronchodilators only were given for 149 (61%), oxygen for 54 (22%) and intravenous treatment for 41 (17%). Hospital guideline use was evident in 164/247 (66%) episodes. Neither clinical severity nor treatment intensity varied with child sex, age or ethnicity or household deprivation. The estimated median (interquartile range) direct medical costs of each pre‐school wheeze episode were NZ$1279 (NZ$774–2158). Conclusions In Auckland, pre‐school wheeze accounts for a larger proportion of acute hospital presentations for Māori compared with non‐Māori and Māori children have increased odds of pre‐school wheeze readmissions. Length of hospital stay for pre‐school wheeze episodes increased with household deprivation. In this audit pre‐school wheeze guideline adherence was poor.