Abstract
BackgroundPneumonia in infancy has been linked to long-term consequences for the rapidly developing lung. We examined the impact of hospitalized community-acquired pneumonia (CAP) on subsequent respiratory health. MethodsWe conducted a retrospective matched-cohort study using the Optum® de-identified Electronic Health Record Dataset (2009–2018). Study population comprised healthy infants hospitalized for CAP (“CAP patients”), and matched comparators without pneumonia (“comparison patients”), before age 2 years. Study outcomes included any chronic respiratory disorder, reactive airway disease (asthma, hyperactive airway disease, recurrent wheezing), and CAP hospitalization occurring between age 2–5 years, and were evaluated overall as well as by age and etiology at first CAP hospitalization. ResultsStudy population totaled 1,343 CAP patients and 6,715 comparison patients. Rates per 100 patient-years and relative rates (RR) of study outcomes from age 2–5 years for CAP patients versus comparison patients were: any chronic respiratory disorder, 11.6 vs. 4.9 (RR = 2.4 [95% CI: 2.1–2.6]); reactive airway disease, 6.1 vs 1.9 (RR = 3.2 [2.6–3.8]); and CAP hospitalization, 1.0 vs 0.2 (RR = 6.3 [3.6–10.9]). Rates of study outcomes were highest among CAP patients who had their initial hospitalization in the second year of life. ConclusionsInfant CAP foreshadows an increased risk of subsequent chronic respiratory disorders, which may be elevated when CAP occurs closer to pre-school age (i.e., age 2–5 years). These findings are most consistent with the hypothesis that inflammation persists beyond the acute stage of pneumonia and plays a role in the development of chronic respiratory sequelae.
Highlights
Lower respiratory tract infections (LRTI) during the first years of life cause injury to the rapidly developing lung at its most critical stage
Among children in the source population, 2,024 (0.4%) had ≥1 hospi talization for community-acquired pneumonia (CAP) before age 2 years, which were identified via acutecare admissions with a principal diagnosis of pneumonia (N = 1,942) as well as acute-care admissions with a principal diagnosis of bacter emia/respiratory failure and a secondary diagnosis of pneumonia (N = 83)
Mean (SD) duration of follow-up was 757 (356) days for CAP patients and 731 (364) for comparison patients, and 46% of CAP pa tients and 45% of comparison patients had evidence of ≥1 administra tion of pneumococcal conjugate vaccine based on their medical records
Summary
Lower respiratory tract infections (LRTI) during the first years of life cause injury to the rapidly developing lung at its most critical stage. In addition to sequelae in childhood, evidence suggests that chronic lung disease in adults may result from insults, such as LRTI, during fetal life or the first postnatal years of life [1] This period of time may be critical as lung growth and development is rapid, expanding from ~50 million alveoli at birth to 300 million by adolescence, with most of the increase during the first two years of life [9]. Conclusions: Infant CAP foreshadows an increased risk of subsequent chronic respiratory disorders, which may be elevated when CAP occurs closer to pre-school age (i.e., age 2–5 years). These findings are most consistent with the hypothesis that inflammation persists beyond the acute stage of pneumonia and plays a role in the devel opment of chronic respiratory sequelae
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