Perinatal factors and hospitalisations for severe childhood infections: a population-based cohort study in Sweden

Abstract

ObjectiveTo examine the association between perinatal factors and hospitalisations for sepsis and bacterial meningitis in early childhood (from 28 days to 2 years of age).DesignA population‐based cohort study. The Swedish Medical Birth Register was combined with the National Inpatient Register, the Cause of Death Register, the Total Population Register and the Longitudinal integration database for health insurance and labour market studies. Associations between perinatal factors and hospitalisations were examined using negative binomial regression models.SettingSweden.Participants1 406 547 children born in Sweden between 1997 and 2013.Main outcome measuresHospital admissions for sepsis and bacterial meningitis recorded between 28 days and 2 years of life.ResultsGestational age was inversely associated with severe infections, that is, extreme prematurity was strongly associated with an increased risk of sepsis, adjusted incidence rate ratio (aIRR) 10.37 (95% CI 6.78 to 15.86) and meningitis aIRR 6.22 (95% CI 2.28 to 16.94). The presence of congenital malformation was associated with sepsis aIRR 3.89 (95% CI 3.17 to 4.77) and meningitis aIRR 1.69 (95% CI 1.09 to 2.62). Moreover, children born small or large for gestational age were more likely to be hospitalised for sepsis and children exposed to maternal smoking were more likely to be hospitalised for meningitis.ConclusionsPrematurity and several other perinatal factors were associated with an increased risk of severe infections in young children. Therefore, clinical guidelines for risk assessment of infections in young children should consider perinatal factors.

Genetic Diseases and Invasive Infections in Infants 100 Days or Younger

“…Inborn errors of immunity are also known to underlie infectious diseases. 24 Our study revealed that peripheral blood neutropenia (an absolute count <1500/mm 3 ) occurred in 6 deceased cases, 4 of which were classified as PID and 2 as non-PID, supporting the notion that host genetic factors 25,26 and inborn errors of immunity may predispose individuals to severe infections. Interestingly, controls had a significantly higher neutrophil percentage 27,28 (59.95 ± 18.19% vs. 50.97 ± 21.31%) ( P < 0.05) and a higher incidence of fever (76.13% vs. 69.64%) ( P > 0.05) than cases, possibly because of their lack of genetic etiology and reduced risk of damage to the innate immune system and neuronal circuitry during severe infections.…”