Pneumonia in infancy spells bigger risk of subsequent chronic respiratory disorders

The occurrence of community-acquired pneumonia (CAP) in infancy, especially closer to preschool age, confers a heightened risk of developing subsequent chronic respiratory disorders, a study has found.

Researchers looked at 1,343 children hospitalized for CAP within the first 2 years of life and 6,715 matched children without CAP (comparator). They evaluated outcomes, including any chronic respiratory disorder, reactive airway disease (asthma, hyperactive airway disease, recurrent wheezing), and CAP hospitalization occurring between age 2–5 years, overall as well as by age and aetiology at first CAP hospitalization.

Most children (97 percent) in the CAP group had only one qualifying hospitalization before age 2 years, and their mean age at first hospitalization was 8.9 months. Forty-one percent of the hospitalizations occurred from birth to <6 months of age, 23 percent from ≥6 to <12 months of age, and 36 percent from ≥12 to <24 months of age. CAP aetiology during the first hospitalization was bacterial in 20 percent, viral in 27 percent, and unspecified in 53 percent.

The rate of any chronic respiratory disorder from age 2–5 years was 11.6 per 100 patient-years in the CAP group and 4.9 per 100 patient-years in the comparator group (relative rate [RR], 2.4, 95 percent confidence interval [CI], 2.1–2.6).

Likewise, the CAP group had higher rates of reactive airway disease (6.1 vs 1.9 per 100 patient-years; RR, 3.2, 95 percent CI, 2.6–3.8) and CAP hospitalization (1.0 vs 0.2 per 100 patient-years; RR, 6.3, 95 percent CI, 3.6–10.9).

The rates of study outcomes were highest among CAP patients who had their initial hospitalization in the second year of life.

The findings are in line with the hypothesis that inflammation persists beyond the acute stage of pneumonia and plays a role in the development of chronic respiratory sequelae.