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Hospital admissions and readmissions for asthma in the age group 0-4 years
J Wever-Hess1, J Hermans, J M Kouwenberg
1Department of Pediatric Respiratory Medicine, Juliana Children's Hospital, Sportlaan 600, 2566 MJ The Hague, The Netherlands.
Insights
Asthma readmissions are highest in children under 5. Inhalant allergen sensitization increases readmission risk in 2-4 year olds, while younger children require closer follow-up and potentially more aggressive anti-inflammatory treatment.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
Background:
- Childhood asthma admissions and readmissions are most prevalent in children under five years old.
- Understanding factors contributing to hospital admissions and readmissions is crucial for effective asthma management in young children.
Purpose of the Study:
- To investigate factors associated with asthma admissions and readmissions in children aged 0-4 years.
- To analyze differences in risk factors and clinical characteristics between age groups (0-1 year and 2-4 years) regarding asthma readmissions.
Main Methods:
- A registration study followed 100 children (0-4 years) for one year, recording 136 asthma admissions.
- Evaluated patient histories, laboratory tests for atopic status (including radioallergosorbent test - RAST), and clinical data.
- Analyzed data separately for age groups 0-1 year (n=54) and 2-4 years (n=46).
Main Results:
- Readmission rates were 37% in the 0-1 year group and 20% in the 2-4 year group.
- In 2-4 year olds, sensitization to inhalant allergens (RAST positive) significantly increased readmission risk (RR=1.54).
- In 0-1 year olds, lower allergen sensitization prevalence (20%) posed a slight risk (P=0.097), and 60% of readmissions occurred within 2 months. A trend showed less frequent prescription of inhaled steroids for readmitted children (20% vs 44%).
Conclusions:
- Inhalant allergen sensitization is a significant risk factor for asthma readmissions in children aged 2-4 years.
- Younger children (0-1 year) experience more frequent readmissions, often shortly after initial hospitalization, suggesting a need for intensified management.
- Aggressive anti-inflammatory therapy and close post-discharge follow-up are indicated for young children with recurrent asthma admissions.
Abstract:
SUMMARY. Childhood rates for admission and readmission for asthma are highest under the age of 5 years. From a registration study in 0-4-year-olds, 100 patients (68 male) were admitted to hospital for asthma and followed for 1 year, yielding a total of 136 admissions. To examine factors that may play a role in admissions and readmissions, histories and laboratory tests for atopic status at initial presentation, and clinical data on admission were evaluated. Age groups 0-1 year (n = 54) and 2-4 years (n = 46) were analyzed separately, of whom 20 (37%) and 9 (20%) patients, respectively, had at least one readmission. In the age group 2-4 years, patients with antibodies against inhalant allergens, determined by radioallergosorbent test (RAST), had a significantly higher risk of readmission (RR = 1.54; 95% CI, 1.22-1.95). In the age group 0-1, year prevalence of sensitization to inhalant allergens was low (20% vs. 72% in age group 2-4 years) and constituted only a slight risk (P = 0.097) for readmission. A history of eczema showed a negative association in the age group 0-1 year. Treatment of the first admission did not differ between children only admitted once and those requiring readmission. In both age groups, clinical features at admission did not differ significantly between first and subsequent admissions, and neither did length of stay. Number of readmissions were higher in the age group 0-1 year than in the age group 2-4 years (27/81 (33%) vs. 9/55 (16%), P = 0.028), with no indication of a lower threshold for admission. In the age group 0-1 year, 60% of the readmissions occurred within 2 months of first hospitalization. Moreover, in the age group 0-1 year a trend was observed that inhaled steroids were prescribed less frequently on discharge following first admission in those children who were readmitted than in the children who had a first admission only (4/20 (20%) vs. 15/34 (44%), P = 0.073). More "aggressive" therapy with anti-inflammatory drugs and close medical follow-up after discharge seem to be indicated.