Commentary: Recognizing subsequent infection risk following hospital discharge among children.

Abstract

Rambliere et al.’s study1 adds to the body of research around heightened infectious disease risk following hospital discharge among young children, particularly in low- and middle-income countries. This important area of child health requires further recognition and attention. Infectious diseases are a leading cause of global childhood morbidity and mortality, even during the months immediately following discharge for an acute episode, where increased rates have been reported.2 The increased post-discharge rates contribute to a post-hospital syndrome which has been described as a transient acquired condition of vulnerability for a number of adverse health outcomes for several weeks following hospital discharge.3 Persistent effects of the original illness may partially contribute to the post-discharge period of vulnerability, but other contributing factors may be the physical and emotional instability associated with a hospital stay, such as changes to sleep, diet, stress and separation from family, which may have long-lasting effects on child health. In certain settings, the additional stress and financial strains resulting from a hospital stay may affect living conditions, food supply and overall health for several months. Whereas most research to date has focused on post-discharge mortality in children, little attention has been placed on morbidity. The aim of Rambliere’s study is to measure the independent effect of hospitalization for any initial health event, compared with management in primary health care facilities, on subsequent infection risk. The study provides findings for infection morbidity associated with any initial health event, not just specific health events, and has important implications for discharge approaches for at-risk children.