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Clinical characteristics of recurrent pneumonia in children with or without underlying diseases
Li-Lun Chen1, Yun-Chung Liu2, Hsiao-Chi Lin1
1Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Insights
Children with underlying diseases face more severe recurrent pneumonia, increased risk of resistant bacteria, and poorer outcomes. Prompt clinical attention and tailored therapeutic plans are crucial for this vulnerable group.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Clinical Pediatrics
Background:
- Recurrent pneumonia in children is uncommon, with limited research on the impact of underlying conditions.
- Investigating the clinical differences in recurrent pneumonia based on the presence of underlying diseases is essential.
Purpose of the Study:
- To compare clinical manifestations, causative pathogens, and prognosis of recurrent pneumonia in children with and without underlying diseases.
- To identify specific risk factors and outcomes associated with recurrent pneumonia in pediatric populations.
Main Methods:
- Retrospective study of pediatric recurrent pneumonia cases (2007-2019) at National Taiwan University Hospital.
- Inclusion criteria: children under 18 with >=2 pneumonia episodes/year (interval >1 month), excluding aspiration pneumonia.
- Collection and comparison of demographic and clinical characteristics.
Main Results:
- 802/8508 (9.4%) children had recurrent pneumonia; 81.7% had underlying diseases (neurological, allergic, cardiovascular).
- Children with underlying diseases had higher rates of Staphylococcus aureus and gram-negative bacteria, more episodes, longer hospital stays, higher ICU admission, and increased mortality.
- Children without underlying diseases more frequently presented with viral bronchopneumonia.
Conclusions:
- Underlying diseases in children predispose them to recurrent pneumonia, increased susceptibility to resistant microorganisms, and more severe disease with poorer outcomes.
- Clinical severity and targeted therapeutic strategies are critical for managing pediatric recurrent pneumonia, especially in those with comorbidities.
Background:
Recurrent pneumonia is uncommon in children and few studies investigate the clinical impact of underlying diseases on this issue. This study aimed to explore the difference in clinical manifestations, pathogens, and prognosis of recurrent pneumonia in children with or without underlying diseases.
Methods:
We conducted a retrospective study of pediatric recurrent pneumonia from 2007 to 2019 in National Taiwan University Hospital. Patients under the age of 18 who had two or more episodes of pneumonia in a year were included, and the minimum interval of two pneumonia episodes was more than one month. Aspiration pneumonia was excluded. Demographic and clinical characteristics of patients were collected and compared.
Results:
Among 8508 children with pneumonia, 802 (9.4%) of them had recurrent pneumonia. Among these 802 patients, 655 (81.7%) had underlying diseases including neurological disorders (N = 252, 38.5%), allergy (N = 211, 32.2%), and cardiovascular diseases (N = 193, 29.5%). Children without underlying diseases had more viral bronchopneumonia (p < 0.001). Children with underlying diseases were more likely to acquire Staphylococcus aureus (p = 0.001), and gram-negative bacteriae, more pneumonia episodes (3 vs 2, p < 0.001), a longer hospital stay (median: 7 vs. 4 days, p < 0.001), a higher ICU rate (28.8% vs 3.59%, p < 0.001), and a higher case-fatality rate (5.19% vs 0%, p < 0.001) than those without underlying diseases.
Conclusion:
Children with underlying diseases, prone to have recurrent pneumonia and more susceptible to resistant microorganisms, had more severe diseases and poorer clinical outcomes. Therefore, more attention may be paid on clinical severity and the therapeutic plan.
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