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Published on: June 28, 2018
Factors Associated With In-Hospital and Postdischarge Adverse Outcomes Among Children Hospitalized With
Hing Cheong Kok1,2,3, Siew Moy Fong2, Stephanie T Yerkovich1,3
1Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Insights
Adverse outcomes in hospitalized children with pneumonia are common, with younger age, hypoxemia, and anemia being key risk factors. Postdischarge follow-up is crucial for preterm infants and those needing mechanical ventilation to manage respiratory risks.
Area of Science:
- Pediatric Respiratory Medicine
- Infectious Diseases
- Public Health
Background:
- Childhood pneumonia poses significant in-hospital risks, but postdischarge outcomes are less understood, particularly in middle-income nations.
- This study addresses the knowledge gap regarding adverse outcomes following hospitalization for pneumonia in Malaysian children.
Purpose of the Study:
- To identify factors associated with adverse in-hospital outcomes in children hospitalized with pneumonia.
- To investigate risk factors for adverse postdischarge outcomes, including respiratory morbidity, in this population.
Main Methods:
- A prospective cohort study enrolled 868 Malaysian children (1 month to <12 years) hospitalized with pneumonia from April 2022 to April 2023.
- In-hospital outcomes included death, ICU admission, or prolonged stay (>5 days). Postdischarge outcomes (assessed 4-6 weeks later) included chronic cough, rehospitalization for acute lower respiratory infection (ALRI), or unscheduled respiratory visits.
Main Results:
- 16% of children experienced in-hospital adverse outcomes. Risk factors included younger age (<6 months), preterm birth, unvaccinated status, hypoxemia, airspace abnormalities, and anemia.
- Among 666 children with complete postdischarge data, 20% had adverse outcomes. Preterm birth and invasive mechanical ventilation were significant risk factors for postdischarge adverse events.
Conclusions:
- Children hospitalized with pneumonia, especially those with identified in-hospital risk factors, require close monitoring.
- Postdischarge follow-up is essential for preterm children and those who received invasive mechanical ventilation due to their increased risk of long-term respiratory issues.
Introduction:
Adverse in-hospital outcomes of childhood pneumonia are well-documented, but adverse postdischarge outcomes remain unclear, especially in middle-income countries. We investigated factors associated with in-hospital and postdischarge adverse outcomes in Malaysian children with pneumonia.
Methods:
Between April 2022 and April 2023, a prospective cohort of Malaysian children aged 1 month to < 12 years hospitalized with radiographic-confirmed pneumonia were enrolled and reviewed 4-6 weeks postdischarge. Composite in-hospital adverse outcomes were death, intensive care admission, or prolonged hospitalization > 5 days. Composite postdischarge adverse outcomes were chronic (> 4 weeks) wet cough, rehospitalization for acute lower respiratory infection (ALRI), or unscheduled respiratory-related doctor visit by 4-6 weeks.
Results:
In 868 children, composite in-hospital adverse outcomes occurred in 139 (16%) (2 deaths [< 1%], 46 [5%] intensive care admissions, 136 [16%] prolonged hospitalizations). Risk factors for in-hospital adverse outcomes were: age < 6 months (adjusted odds ratio [ORadj] = 3.84, 95% confidence interval [CI] 2.13-6.93), preterm birth (ORadj = 1.81, 95% CI 1.01-3.23), partial/unvaccinated status (ORadj = 2.28, 95% CI 1.13-4.60), hypoxemia (ORadj = 4.91, 95% CI 2.95-8.20), airspace abnormalities (ORadj = 9.80, 95% CI 3.84-24.98), and anemia (ORadj = 1.70, 95% CI 1.08-2.68). Among 689/866 (80%) children reviewed postdischarge, 666 (97%) had complete data. Of these, composite postdischarge outcomes occurred in 134 (20%) children (20 [3%] chronic wet cough, 71 [11%] hospitalized ALRIs, 128 [19%] unscheduled respiratory-related doctor visits). Preterm birth (ORadj = 2.28, 95% CI 1.37-3.81) and invasive mechanical ventilation (ORadj = 2.64, 95% CI 1.16-6.00) were risk factors for postdischarge adverse outcomes.
Conclusions:
Children hospitalized with radiographic-confirmed pneumonia and at risk of in-hospital adverse outcomes should be monitored closely. Postdischarge follow-up is recommended for preterm children or those requiring invasive mechanical ventilation because of their risk of long-term respiratory morbidity.
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