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Burden of Recurrent Respiratory Tract Infections in Children: A Prospective Cohort Study
Laura Toivonen1, Sinikka Karppinen, Linnea Schuez-Havupalo
1From the *Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; †Turku Institute for Child and Youth Research, ‡Department of Medical Microbiology and Immunology, and §Department of Virology, University of Turku, Turku, Finland.
Insights
Recurrent respiratory infections in young children lead to frequent healthcare use, antibiotic treatments, and increased risk of asthma. Older siblings are a significant risk factor for these infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- The clinical impact and risk factors for recurrent respiratory infections (RRIs) in young children remain incompletely understood.
- This study aimed to characterize RRIs in children from birth to two years of age.
Purpose of the Study:
- To define and characterize clinical manifestations, risk factors, and short-term consequences of RRIs in young children.
- To identify children with a high burden of respiratory illness.
Main Methods:
- A prospective cohort study followed 1089 children from birth to 2 years.
- Respiratory infections were monitored via daily symptom diaries, with viral analysis of nasal swabs and bacterial cultures of nasopharyngeal swabs.
- Recurrent respiratory tract infections were defined as the top 10% of children with the highest number of annual respiratory illness days (≥98 days).
Main Results:
- The top 10% of children (n=109) experienced a median of 9.6 acute respiratory infections annually, with Rhinovirus detected in 58%.
- These children had high rates of acute otitis media (60%), antibiotic use (73%), hospitalizations (21%), and surgical interventions (tympanostomy 35%, adenoidectomy 13%).
- Asthma was diagnosed in 12% by age 24 months. Older siblings and early Streptococcus pneumoniae colonization were identified as risk factors.
Conclusions:
- Children with RRIs frequently utilize healthcare services, require antibiotics, and undergo surgery.
- RRIs are associated with an increased risk of early-onset asthma.
- The presence of older siblings is a significant risk factor for developing RRIs.
Background:
The burden of recurrent respiratory infections is unclear. We identified young children with recurrent respiratory infections in order to characterize the clinical manifestations, risk factors and short-term consequences.
Methods:
In this prospective cohort study, 1089 children were followed from birth to 2 years of age for respiratory infections by a daily symptom diary. Nasal swabs taken during respiratory infections were analyzed for viruses from 714 children. Nasopharyngeal swabs collected at 2 months of age were cultured for bacteria. The 10% of children with the highest number of annual respiratory illness days were defined to have recurrent respiratory tract infections.
Results:
The 90th percentile in the number of annual respiratory illness days was 98. Children above this limit (n = 109) had a median of 9.6 acute respiratory infections per year. Rhinovirus was detected in 58% of their infections. Of the children with recurrent infections, 60% were diagnosed with at least 3 episodes of acute otitis media, 73% received at least 3 antibiotic treatments and 21% were hospitalized for an acute respiratory infection. Tympanostomy was performed for 35% and adenoidectomy for 13% of the children. Asthma was diagnosed in 12% by 24 months of age. Older siblings increased the risk of recurrent respiratory infections. Early nasopharyngeal colonization with Streptococcus pneumoniae was common in children who later developed recurrent infections.
Conclusions:
Children with recurrent respiratory infections frequently use health care services and antibiotics, undergo surgical procedures and are at risk for asthma in early life. Having older siblings increases the risk of recurrent infections.
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