Clinical characteristics of lower respiratory infections in preterm children with bronchopulmonary dysplasia

Na Hyun Lee; Se Jin Kim; Hee Joung Choi

doi:10.4168/aard.2017.5.2.92

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Lee, Kim, and Choi: Clinical characteristics of lower respiratory infections in preterm children with bronchopulmonary dysplasia

Original Article

Allergy, Asthma & Respiratory Disease 2017; 5(2): 92-98.

Published online: 31 March 2017

DOI: https://doi.org/10.4168/aard.2017.5.2.92

Clinical characteristics of lower respiratory infections in preterm children with bronchopulmonary dysplasia

Na Hyun Lee, Se Jin Kim, Hee Joung Choi

Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea.

Correspondence to: Hee Joung Choi. Department of Pediatrics, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel: +82-53-250-7524, Fax: +82-53-250-7783, joung756@dsmc.or.kr

Received 29 July 2016 Revised 22 October 2016 Accepted 23 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

We evaluated the clinical characteristics of lower respiratory infections of preterm children with bronchopulmonary dysplasia (BPD) and compared them between those with and without lower respiratory infections that of preterm patients without BPD.

Methods

This study enrolled preterm patients under 2 years old, who admitted with acute lower respiratory infection from March 2014 to May 2016. The patients were divided into 2 groups according to BPD, and we retrospectively reviewed their medical records.

Results

A total of 71 patients (106 cases) were enrolled; the BPD group consisited of 29 patients (54 cases) and the control group 42 patients (52 cases). Compared to the patients in the control group, those in the BPD group were older (P=0.001), had lower gestational age and birth weight (P<0.001), and showed more frequent readmission in hospital (P=0.017). The most common causative virus was human rhinovirus (hRV) in the BPD group, whereas respiratory syncytial virus (RSV) in the control group. The patients in the BPD group showed a higher incidence of tachypnea, decreased aeration, and chest retraction (P<0.001, P=0.009, and P=0.026, respectively), a higher respiratory symptom score (P=0.011), a longer duration of cough and wheezy sounds (P=0.004 and P=0.009, respectively), and higher incidence and longer duration of treatment with oxygen, and mechanical ventilator support (P=0.016 and P=0.017, respectively) than those in the control group. In the BPD group, the patients with RSV showed a higher incidence of tachypnea and rales (P=0.033 and P=0.033, respectively) than those with hRV.

Conclusion

The preterm children with BPD may have more severe clinical manifestations than those without.

Keywords: Bronchopulmonary dysplasia, Prematurity, Respiratory infection

Figures and Tables

Fig. 1

Proportion of repeated admission between groups. The proportion of repeated admission of bronchopulmonary dysplasia (BPD) group was significantly higher than control group.

Fig. 2

The causing viruses of lower respiratory tract infection according to bronchopulmonary dysplasia (BPD; A) and palivizumab prophylaxis in total group (B), BPD group (C) and control group (D). The most common causing virus was human rhinovirus (hRV) in BPD group, whereas respiratory syncytial virus (RSV) in control group. hMPV, human metapneumonvirus; PIV, parainfluenza virus; hBoV, human bocavirus; hCoV, human coronavirus; IFV, influenzavirus.

Table 1

Comparison of clinical manifestations of patients

Variable	BPD (n = 54)	Control (n = 52)	P-value
Final diagnosis
Pneumonia	11	14
Bronchiolitis	43	38
No. of hospitalization	1 (1–5)	1 (1–3)	0.007
Age (mo)	9 (1–23)	5 (1–20)	0.001
Sex, male:female	1.5:1	1.4:1	0.076
Weight (kg)	7.0 (2.3–10.2)	6.1 (2.2–11.0)	0.674
Age at first hospitalization (mo)	7 (1–22)	4 (1–20)	0.007
Weight at first hospitalization (kg)	6.4 (2.3–9.4)	6.1 (2.2–10.9)	0.842
Gestational age (wk)	27.2 (23.4–36.5)	31.4 (27.0–36.3)	< 0.001
Birth weight (g)	1,000 (620–2,100)	1,700 (900–3,000)	< 0.001
NICU admission duration (day)	92 (44–209)	32 (5–89)	< 0.001
Period from NICU discharge to first hospitalization (mo)	3 (1–14)	3 (1–19)	0.953
Palivizumab prophylaxis	42 (77.8)	13 (25.0)	< 0.001
Previous LRTI history	32 (59.3)	15 (28.8)	0.002
Combined congenital anomalies	32 (59.3)	21 (40.4)	0.052
Older siblings	25 (46.3)	38 (73.1)	0.005
Family history of allergic disease	0 (0)	2 (3.8)	0.146

Values are presented as number, number (%), or median (range).

BPD, bronchopulmonary dysplasia; NICU, neonatal intensive care unit; LRTI, lower respiratory tract infection

Table 2

Comparison of clinical manifestations of patients

Variable	BPD (n = 54)	Control (n = 52)	P-value
Duration of fever prior to admission (day)	0 (0–7)	0 (0–4)	0.746
Duration of cough prior to admission (day)	3 (0–21)	4 (0–21)	0.004
Rale	42 (77.8)	39 (75.0)	0.736
Duration until rale subside (day)	3 (0–17)	2 (0–10)	0.188
Wheezing	43 (79.6)	35 (67.3)	0.150
Duration until wheezing subside (day)	3 (0–17)	2 (0–8)	0.009
Tachypnea	43 (79.6)	21 (40.4)	< 0.001
Decreased aeration	43 (79.6)	29 (55.8)	0.009
Chest retraction	21 (38.9)	10 (19.2)	0.026
Apnea	3 (5.6)	2 (3.8)	0.678
Respiratory symptom score	4.5 (1–11)	3 (1–10)	0.011
Abnormal chest radiography	43 (79.6)	40 (76.9)	0.735
Hyperinflation	17	10
Lobar/lobular infiltration	6	3
Interstitial infiltration	34	36

Values are presented as median (range), number (%), or number.

BPD, bronchopulmonary dysplasia.

Table 3

Comparison of laboratory findings of patients

Variable	BPD (n = 54)	Control (n = 52)	P-value^*
White blood cell count (× 10⁹/L)	12.01 (8.98–15.63)	10.485 (8.6–13.515)	0.864
Neutrophil proportion (%)	49 (34–60)	33 (20–51)	0.066
Lymphocyte proportion (%)	36 (26–50)	49 (32–61)	0.072
Eosinophil proportion (%)	7 (5–10)	9 (6–11)	0.193
Hemoglobin (g/dL)	12.9 (12.2–13.7)	11.7 (10.7–12.7)	0.102
Platelet ( × 10³/μL)	368 (285–460)	435 (335–508)	0.155
Oxygen saturation (%)	96 (93–98)	98 (96–100)	0.001
pH	7.32 (7.28–7.37)	7.32 (7.29–7.35)	0.080
PaCO₂	43.8 (38.6–54.0)	45.1 (37.4–51.1)	0.011
Erythrocyte sedimentation rate (mm/hr)	5 (2–17)	8 (3–20)	0.037
C-reactive protein (mg/dL)	0.25 (0.04–1.24)	0.34 (0.04–0.86)	0.918
Procalcitonin	0.09 (0.08–0.14)	0.09 (0.08–0.11)	0.512

Values are presented as median (interquartile range).

BPD, bronchopulmonary dysplasia.

^*Analyzed by analysis of variance, adjusted for age.

Table 4

Comparison of in-hospital course of patients

Variable	BPD (n = 54)	Control (n = 52)	P-value
Treatment
Oxygen supply	22 (40.7)	10 (19.2)	0.016
Duration of oxygen use (day)	0 (0–59)	0 (0–5)	0.006
Duration of antibiotics use (day)	5 (0–17)	4 (2–9)	0.014
Steroid use	28 (51.9)	23 (44.2)	0.432
Duration of steroid use (day)	0.5 (0–12)	0 (0–8)	0.085
Intravenous immunoglobulin use	4 (7.4)	4 (7.7)	0.956
Ventilator care	10 (18.5)	2 (3.8)	0.017
Duration of ventilator care (day)	0 (0–54)	0 (0–2)	0.013
Admission duration (day)	6 (2–59)	5 (2–13)	0.138

Values are presented as number (%) or median (range).

BPD, bronchopulmonary dysplasia.

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ORCID iDs: Hee Joung Choi
https://orcid.org/http://orcid.org/0000-0002-7119-4194
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