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Published on: December 10, 2013
A Retrospective Cohort Study on Infant Respiratory Tract Infection Hospitalizations and Recurrent Wheeze and Asthma
Maarten van Wijhe1,2, Caroline Klint Johannesen1,3, Lone Simonsen2
1Statens Serum Institute, Copenhagen, Denmark.
Insights
Infant respiratory syncytial virus (RSV) hospitalization increases the risk of recurrent wheeze and asthma in children. RSV prophylaxis, such as vaccines, could significantly lower the burden of these conditions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Infant respiratory syncytial virus (RSV) infection is a known risk factor for developing asthma later in life.
- This study investigates the association between infant RSV hospitalization and the subsequent risk of recurrent wheeze or asthma.
Purpose of the Study:
- To compare the risk of recurrent wheeze or asthma in children hospitalized with infant RSV infection versus other respiratory infections.
- To identify risk factors associated with recurrent wheeze or asthma following infant hospitalization.
Main Methods:
- A retrospective cohort study utilizing Danish national hospital discharge registers.
- Infants under 6 months hospitalized for RSV were compared to those hospitalized for injuries, other respiratory infections, or pertussis.
- Follow-up occurred until age 10, with adjustments for sex, age, maternal smoking, prematurity, and congenital factors.
Main Results:
- Infant RSV hospitalization was linked to a higher cumulative incidence rate of recurrent wheeze or asthma compared to injuries, AURTI, or pertussis.
- Adjusted hazard ratios for recurrent wheeze or asthma decreased with age, particularly in preterm-born children.
- Sex, maternal smoking, length of hospital stay, congenital risk factors, and APGAR scores were independent risk factors.
Conclusions:
- Infant RSV hospitalization is significantly associated with recurrent wheeze and asthma, especially at preschool age.
- If a causal link is confirmed, RSV prophylaxis, including vaccines, could substantially reduce the burden of childhood wheeze and asthma.
Background:
Infant respiratory syncytial virus infection (RSV) has been associated with asthma later in life. We explored the risk of recurrent wheeze or asthma in children with infant RSV-associated hospitalization compared to other respiratory infections.
Methods:
We performed a retrospective cohort study using Danish national hospital discharge registers. Infants younger than 6 months, born between January 1995 and October 2018, and with a RSV hospital admission were compared to infants hospitalized for injuries, non-RSV acute upper respiratory tract infection (AURTI), pneumonia and other respiratory pathogens, nonpathogen-coded lower respiratory tract infections (LRTI), pertussis, or nonspecific respiratory infections. Infants were followed until recurrent wheeze or asthma diagnosis, death, migration, age 10 years, or study end. We estimated cumulative incidence rate ratios (CIRR) and hazard ratios (HR) adjusted for sex, age at inclusion, hospital length of stay (LOS), maternal smoking, 5-minute APGAR score (APGAR5), prematurity, and congenital risk factors (CRF).
Results:
We included 68 130 infants, of whom 20 920 (30.7%) had RSV hospitalization. The cumulative incidence rate of recurrent wheeze or asthma was 16.6 per 1000 person-years after RSV hospitalization, higher than after injury (CIRR, 2.69; 95% confidence interval [CI], 2.48-2.92), AURTI (CIRR, 1.48; 95% CI, 1.34-1.58), or pertussis (CIRR, 2.32; 95% CI, 1.85-2.91), similar to pneumonia and other respiratory pathogens (CIRR, 1.15; 95% CI, .99-1.34) and LRTI (CIRR, 0.79; 95% CI, .60-1.04), but lower than nonspecific respiratory infections (CIRR, 0.79; 95% CI, .73-.87). Adjusted HRs for recurrent wheeze or asthma after RSV hospitalization compared to injuries decreased from 2.37 (95% CI, 2.08-2.70) for 0 to <1 year to 1.23 (95% CI, .88-1.73) for 6 to <10 years for term-born children, and from 1.48 (95% CI, 1.09-2.00) to 0.60 (95% CI, .25-1.43) for preterm-born children. Sex, maternal smoking, LOS, CRF, and APGAR5 were independent risk factors.
Conclusions:
Infant RSV hospitalization is associated with recurrent wheeze and asthma hospitalization, predominantly at preschool age. If causal, RSV prophylaxis, including vaccines, may significantly reduce disease burden of wheeze and asthma.
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