Abstract
BackgroundThe risks of long term sequelae from childhood pneumonia have not been systematically assessed. The aims of this study were to: (i) estimate the risks of respiratory sequelae after pneumonia in children under five years; (ii) estimate the distribution of the different types of respiratory sequelae; and (iii) compare sequelae risk by hospitalisation status and pathogen.MethodsWe systematically reviewed published papers from 1970 to 2011. Standard global burden of disease categories (restrictive lung disease, obstructive lung disease, bronchiectasis) were labelled as major sequelae. ‘Minor’ sequelae (chronic bronchitis, asthma, other abnormal pulmonary function, other respiratory disease), and multiple impairments were also included. Thirteen papers were selected for inclusion. Synthesis was by random effects meta-analysis and meta-regression.ResultsRisk of at least one major sequelae was 5.5% (95% confidence interval [95% CI] 2.8–8.3%) in non hospitalised children and 13.6% [6.2–21.1%]) in hospitalised children. Adenovirus pneumonia was associated with the highest sequelae risk (54.8% [39.2–70.5%]) but children hospitalised with no pathogen isolated also had high risk (17.6% [10.9–24.3%]). The most common type of major sequela was restrictive lung disease (5.4% [2.5–10.2%]) . Potential confounders such as loss to follow up and median age at infection were not associated with sequelae risk in the final models.ConclusionsAll children with pneumonia diagnosed by a health professional should be considered at risk of long term sequelae. Evaluation of childhood pneumonia interventions should include potential impact on long term respiratory sequelae.
Highlights
Pneumonia is the most common cause of mortality in children under five years of age
It is well known that children with immunodeficiency and cystic fibrosis have long term respiratory problems such as recurrent pneumonia, bronchiectasis and restrictive lung disease [3]
Pathogen specific pneumonia was defined as any child under 5 years with clinical signs of pneumonia plus laboratory evidence of a recognised pneumonia pathogen e.g. Streptococcus pneumoniae, Haemophilus influenzae type b, Staphlococcus aureus, Adenovirus Mycoplasma pneumoniae, Chlamydia pneumoniae, or Respiratory syncitial virus
Summary
It is well known that children with immunodeficiency and cystic fibrosis have long term respiratory problems such as recurrent pneumonia, bronchiectasis and restrictive lung disease [3]. There is poor understanding of long term respiratory outcomes from pneumonia in children without risk factors or highly virulent pathogens; especially outcomes for children who have not been hospitalised. This information is needed to ensure that children with pneumonia are correctly managed by health professionals after they have recovered from their acute illness. The aims of this study were to: (i) estimate the risks of respiratory sequelae after pneumonia in children under five years; (ii) estimate the distribution of the different types of respiratory sequelae; and (iii) compare sequelae risk by hospitalisation status and pathogen
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