Pediatric lower respiratory illness continues after hospital discharge

By medwireNews Reporters

One-third of children hospitalized with severe lower respiratory illness (LRI) have chronic moist cough a year after discharge, research shows.

In addition, 61% of children have an abnormal chest X-ray and 71% of children had an intermittent history of wheezing in the year following admission for severe LRI.

"Fifty-six percent and 51% of these children had required further primary and hospital care, respectively, for LRIs within this one-year time frame," according to lead researcher Adrian Trenholme (University of Auckland, New Zealand) and colleagues in Pediatric Pulmonology.

Respiratory morbidities were assessed in 94 children from New Zealand hospitalized with LRIs over a 6-month period in 2007.

Of the 81 children with a readable chest X-ray, 60 (74%) had either chronic moist cough or crackles in the clinic and/or an abnormal chest X-ray. Nine (11%) children had chronic moist cough, crackles, and an abnormal chest X-ray.

Just over 25% of the children had no abnormalities on follow up at 1 year.

Overall, 71% of the children had an interval history of wheezing, 43% of whom had more than six wheezing episodes. Bronchodilators were used by 64% of children at some stage and 4% were using them regularly, while 28% of children were prescribed corticosteroids and 4% used the drugs regularly.

The researchers note that four children already had a chest high-resolution computed tomography scan as part of other clinical care.

"Three had definitive bronchiectasis, and the fourth persistent atelectasis with tractional bronchiectasis," report Trenholme and colleagues.

Nearly 40% of the children lived in social housing and 62% of the homes were described as "moldy" by the parents. More than half of the children were exposed to smoking in the house.

The presence of mold in the house and exposure to smoking were each associated with an increased number of symptoms.

The next step, according to the researchers, will be to design an intervention program to determine if clinicians can decrease these ongoing respiratory symptoms.

The rate of hospitalization for LRIs in New Zealand children aged 1 year or younger is 154 cases per 1000 children. This rate is even higher in Pacifica and Maori children.

These rates compare unfavorably with children from other countries, where hospitalization for LRIs range from 12 to 65 cases per 1000 children.

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