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Analysis of Childhood Pneumonia: A Comparison Between the Pre- and During the COVID-19 Pandemic in a Reference
Eduardo Jorge Fonseca Lima1,2, Luiza Campos Corrêa de Araújo1, Karine Ferreira Agra2
1Department of Medicine, Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil.
Insights
Community-acquired pneumonia (CAP) in children saw increased complications during the COVID-19 pandemic. This study highlights a rise in severe cases and ICU admissions, underscoring the need for further investigation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Community-acquired pneumonia (CAP) is a leading cause of childhood illness and death globally.
- Vaccination efforts had reduced CAP incidence, but the COVID-19 pandemic disrupted vaccination schedules, potentially increasing cases.
- Complicated CAP (CCAP) represents a worsening of CAP and is associated with higher morbidity.
Purpose of the Study:
- To compare the clinical and epidemiological characteristics of CAP in children under five years old before and during the COVID-19 pandemic.
- To identify changes in CAP presentation, treatment, and outcomes associated with the pandemic.
- To analyze trends in complicated CAP during the specified periods.
Main Methods:
- A retrospective, cross-sectional study was conducted at the Professor Fernando Figueira Institute of Integral Medicine (IMIP).
- Sociodemographic and clinical data of children under five with CAP admitted between 2018 and 2022 were analyzed.
- Statistical analyses included Pearson's Chi-square, Fischer's exact, and Student's T tests.
Main Results:
- A total of 468 children were analyzed (382 pre-pandemic, 86 during pandemic).
- During the pandemic, there was a significant increase in pleural effusion (12.10% to 24.40%), pleural empyema (1.60% to 8.20%), and necrotizing pneumonia (1.30% to 5.90%).
- Intensive Care Unit (ICU) admissions rose sharply from 5.30% to 34.10%, and the use of Oxacillin and Ceftriaxone combination therapy increased.
Conclusions:
- Children with CAP experienced a higher frequency of complications during the COVID-19 pandemic compared to the pre-pandemic period.
- The findings suggest a concerning trend of increased CAP severity and complications linked to the pandemic.
- Further research is warranted to elucidate the specific factors contributing to the rise in CAP complications during this era.
Introduction:
Community-acquired pneumonia (CAP) is one of the most common causes of childhood morbidity and mortality, causing about two million deaths per year worldwide. The complicated CAP (CCAP) results from the worsening of CAP. Their incidence has reduced in the last 30 years due to vaccination. However, the coronavirus disease (COVID-19) pandemic reduced vaccination coverage, resulting in increased incidence of CCAP in 2021 and 2022.
Objective:
To analyze the clinical and epidemiological profile of CAP in children under five years of age in two periods: pre- (2018 to 2019) and during the COVID-19 pandemic (2020 to 2022).
Methods:
This cross-sectional retrospective study was conducted at the Professor Fernando Figueira Institute of Integral Medicine (IMIP). We analyzed the sociodemographic and clinical variables of children with CAP aged below five years who were admitted to IMIP from 2018 to 2022. Analysis encompassed the Pearson's Chi-square test, Fischer's exact test, and Student's T tests.
Results:
A total of 468 children were analyzed: 382 in the pre-pandemic period and 86 during the COVID-19 pandemic. Concerning the antibiotic therapy, the most prescribed was Ampicillin (45.00%) in both periods. The combination of Oxacillin and Ceftriaxone was prescribed in 6.86% of cases in the pre-pandemic period; this value increased to 20.90% during the COVID-19 pandemic. Pleural effusion represented 12.10% of cases in the pre-pandemic period and 24.40% during the COVID-19 pandemic. The presence of pleural empyema went from 1.60% to 8.20%, and necrotizing pneumonia from 1.30% to 5.90% in the respective periods. Regarding ICU admission, 5.30% were admitted during the pre-pandemic period and 34.10% during the COVID-19 pandemic. Clinical suspicion of influenza presented a positivity rate of 17.60%.
Conclusion:
Children with CAP presented a higher frequency of complications during the COVID-19 pandemic. Further research is needed to find the cause of increased CAP complications in this period.
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