Clinical characteristics of lower respiratory tract infection in low birth weight children

Yoonsun Yoon; Geehae Jung; Soohyun Ri; Ji Tae Choung; Young Yoo

doi:10.4168/aard.2018.6.4.211

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Yoon, Jung, Ri, Choung, and Yoo: Clinical characteristics of lower respiratory tract infection in low birth weight children

Original Article

Allergy Asthma Respir Dis 2018;6(4):211-218.

Published online: 5 July 2018

DOI: https://doi.org/10.4168/aard.2018.6.4.211

Clinical characteristics of lower respiratory tract infection in low birth weight children

Yoonsun Yoon¹, Geehae Jung¹, Soohyun Ri¹, Ji Tae Choung^1,², Young Yoo^1,^2,³

¹Department of Pediatrics, Korea University College of Medicine, Seoul, Korea

²Environmental Health Center, Korea University Anam Hospital, Seoul, Korea

³Allergy Immunology Center, Korea University, Seoul, Korea

Correspondence to: Young Yoo https://orcid.org/0000-0003-3354-6969 Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Sungbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5090, Fax: +82-2-922-7476, E-mail: yoolina@korea.ac.kr

Received 12 October 20179 February 2018 Accepted 24 February 2018

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/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Lower respiratory tract infection (LRTI) is one of the most common causes of hospitalization in the pediatric population. In this study, we investigated the clinical characteristics of LRTI, particularly in low birth weight children.

Methods

We reviewed medical records of children at ages 0–6 years with LRTI in Korea University Anam Hospital between January and December of 2014. Clinical data including age, sex, birth history, viral pathogens, blood test results, and clinical courses were collected.

Results

In the 828 eligible cases, 617 (74.5%) were pneumonia and followed by bronchiolitis 180 (21.7%) and bronchitis 31 (3.7%). The median age of the subjects was 17 months (interquartile range [IQR], 7–28 months), the median gestational age was 39.0 weeks (IQR, 38.0–40.0 weeks) and the median birth weight was 3,200 g (IQR, 2,900–3,480 g). Sixty-four children (7.7%) were low birth weight (<2,500 g) and their median gestational age and birth weight were 33.0 weeks (IQR, 30.0–36.0 weeks) and 2,045 g (IQR, 1,565–2,300 g), respectively. The rates of oxygen supplement (17.2% vs. 4.6%, P<0.001) and systemic steroid use (20.3% vs. 4.7%, P<0.001) were significantly higher in low birth weight children than normal birth weight children. Respiratory viruses were identified in 82.6% (519 of 628 subjects); RSV was detected in 240 subjects (38.2%), followed by rhinovirus 168 (26.8%) and adenoviruses 75 (11.9%). The distribution of respiratory viruses was not different between normal birth weight children and low birth weight children.

Conclusion

Low birth weight children show more severe clinical manifestations than normal birth weight children during hospitalization for LRTI, although respiratory viral pathogens were not different. Clinicians should be aware that the severity may be increased when low birth weight children were hospitalized due to low respiratory tract infection.

Keywords: Lower respiratory tract infection, Low birth weight, Respiratory virus

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Fig. 1.

Monthly distribution of respiratory viruses from subjects with lower respiratory tract infections between January to December in 2014. RSV, respiratory syncytial virus.

Table 1.

Demographics of study subjects (n=828)

Variable	Value
Age (mo)	17.0 (7.0–28.0)
Boys	476 (57.5)
Birth weight (g)	3,200 (2,900–3,480)
Gestational age (wk)	39.0 (38.0–40.0)
Low birth weight∗	64 (7.7)
Preterm birth^†	76 (9.2)
Duration of hospitalization (day)	6.0 (4.0–7.0)
Duration of fever (day)	4.0 (2.0–6.0)
Lower respiratory tract infection
Pneumonia:bronchiolitis:bronchitis	617 (74.5):180 (21.7):31 (3.7)
Laboratory findings
WBC (×10³/µL)	10.3 (7.7–13.8)
Eosinophils (%)	0.6 (0.1–1.7)
ESR (mm/hr)	16.0 (9.0–26.0)
CRP (mg/L)	9.0 (2.4–23.8)
AST (IU/L)	41.0 (35.0–49.0)
ALT (IU/L)	18.0 (14.0–25.0)
Virus detection (n=628)	519 (82.6)
Viral coinfection (n=628)	135 (21.5)
Use of antibiotics	103 (12.5)
Use of systemic steroid	49 (5.9)
O_₂ supplement	46 (5.6)

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

WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, c-reactive protein; AST, aspartate transaminase; ALT, alanine transaminase.

^∗ Low birth weight (birth weight <2,500 g).

^† Preterm (gestational age <37 weeks).

Table 2.

Clinical characteristics according to the respiratory disease

Variable	Pneumonia (n=617)	Bronchiolitis (n=180)	Bronchitis (n=31)	P-value
Age (mo)	21.0 (4.0–7.0)∗	5.0 (3.0–11.8)^†	19.0 (10.0–36.0)	<0.001
Low birth weight	37 (6.0)	24 (13.3)	3 (9.7)	0.006
Preterm	48 (7.8)	25 (13.9)	3 (9.7)	0.044
Duration of hospitalization (day)	5.0 (4.0–7.0)^†	6.0 (4.0–7.0)^†	7.0 (5.0–8.0)^‡	0.028
Duration of fever (day)	5.0 (3.0–6.0)∗^,†	1.0 (0.0–4.0)	2.0 (1.0–5.0)^‡	<0.001
Laboratory findings
WBC (×10³/µL)	10.1 (7.6–13.5)∗	10.6 (8.7–14.2)	11.0 (6.9–15.1)	0.033
Eosinophils (%)	0.5 (0.1–1.5)∗	1.3 (0.2–2.5)	0.7 (0.2–2.0)	<0.001
ESR (mm/hr)	17.0 (10.0–27.0)∗^,†	14.0 (7.0–28.0)	13.0 (5.0–20.0)^‡	0.019
CRP (mg/L)	10.8 (3.2–27.8)∗	4.4 (0.6–11.3)^†	12.9 (1.8–30.5)	<0.001
AST (IU/L)	41.0 (35.0–48.8)^†	42.0 (36.0–53.0)^†	37.0 (31.0–43.0)^‡	0.015
ALT (IU/L)	16.0 (13.0–22.0)∗	24.0 (18.0–36.0)^†	17.0 (13.0–24.0)	<0.001
No. of viruses PCR (+)	n=493	n=164	n=16	0.102
Adenovirus	59 (12.0)	14 (8.5)	2 (12.5)	0.579
Rhinovirus	120 (24.3)	39 (23.8)	9 (56.3)	0.170
Influenza virus A, B	22 (4.5)	1 (0.6)	1 (6.3)	0.081
Parainfluenza virus	34 (6.9)	11 (6.7)	1 (6.3)	0.917
RSV A, B	152 (30.8)	86 (52.4)	2 (12.5)	<0.001
Bocavirus	30 (6.1)	3 (1.8)	1 (6.3)	0.121
Coronavirus	19 (3.9)	5 (3.0)	0 (0)	0.620
Metapneumovirus	57 (11.6)	5 (3.0)	0 (0)	0.002
M. pneumoniae IgM (+)	28 (4.5)	2 (1.1)	0 (0)	0.052
Use of antibiotics	83 (13.5)	10 (5.6)	10 (32.3)	<0.001
Use of systemic steroid	18 (2.9)	28 (15.6)	3 (9.7)	<0.001
O₂ supplement	17 (2.8)	29 (16.1)	0 (0)	<0.001

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

WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, c-reactive protein; AST, aspartate transaminase; ALT, alanine transaminase; PCR, polymerase chain reaction; RSV, respiratory syncytial virus; M. pneumonia, Mycoplasma pneumonia.

^∗ P<0.05, compared with bronchiolitis.

^† P<0.05, compared with bronchitis.

^‡ P<0.05, compared with pneumonia (Bonferroni correction).

Table 3.

Comparison of clinical characteristics between normal birth weight children and low birth weight children

Variable	Normal birth weight children (n=764)	Low birth weight children (n=64)	P-value
Age (mo)	17.0 (8.0–28.0)	20.0 (8.5–30.8)	0.333
Gestational age (wk)	39.0 (38.0–40.0)	33.0 (30.0–36.0)	<0.001
Birth weight (g)	3,250 (3,000–3,500)	2,045 (1,565–2,300)	<0.001
Duration of hospitalization	6.0 (4.0–7.0)	5.5 (4.0–7.0)	0.981
(day)
Duration of fever (day)	4.0 (2.0–6.0)	3.5 (0.5–5.0)	0.094
LRTI			0.005
Pneumonia	580 (75.9)	37 (57.8)
Bronchiolitis	156 (20.4)	24 (37.5)
Bronchitis	28 (3.7)	3 (4.7)
Laboratory findings
WBC (×10³/μL)	10.1 (7.7–13.5)	11.9 (8.9–16.2)	0.008
Eosinophils (%)	0.6 (0.1–1.7)	0.8 (0.1–2.0)	0.698
ESR (mm³/hr)	16.0 (9.0–26.0)	15.5 (10.0–24.8)	0.496
CRP (mg/L)	8.3 (1.7–23.8)	9.2 (2.4–23.9)	0.705
AST (IU/L)	41.0 (35.0–49.0)	41.5 (36.0–47.0)	0.761
ALT (IU/L)	18.0 (14.0–25.0)	20.0 (15.0–26.0)	0.144
No. of viruses PCR (+)	n=621	n=52	0.657
Adenovirus	71 (11.4)	4 (7.7)	0.368
Rhinovirus	155 (25.0)	13 (25.0)	0.895
Influenza virus A, B	22 (3.5)	2 (3.8)	0.945∗
Parainfluenza virus	43 (6.9)	3 (5.8)	1.000∗
RSV A, B	220 (35.4)	20 (38.5)	0.794
Bocavirus	30 (4.8)	4 (7.7)	0.338∗
Coronavirus	22 (3.5)	2 (3.8)	1.000∗
Metapneumovirus	58 (9.3)	4 (7.7)	0.807∗
M. pneumoniae IgM (+)	26 (3.4)	4 (6.3)	0.281
Use of antibiotics	97 (12.7)	6 (9.4)	0.431
Use of systemic steroid	36 (4.7)	13 (20.3)	<0.001∗
O₂ supplement	35 (4.6)	11 (17.2)	<0.001∗

Values are presented as median (interquartile range) or number (%). LRTI, lower respiratory tract infection; WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, c-reactive protein; AST, aspartate transaminase; ALT, alanine transaminase; PCR, polymerase chain reaction; RSV, respiratory syncytial virus; M. pneumonia, Mycoplasma pneumonia.

^∗ Fisher exact test.

Table 4.

Comparison of clinical characteristics according to the age group

Variable	<2 Years (n=540)	2–6 Years (n=288)	P-value
Birth weight (g)	3,225 (2,900–3,480)	3,185 (2,835–3,465)	0.314
Gestational age (wk)	38.4±2.2	38.7±2.2	0.883
Low birth weight	37 (6.9)	27 (9.4)	0.195
Duration of hospitalization	5.0 (4.0–7.0)	5.5 (4.0–7.0)	0.677
(day)
Duration of fever (day)	4.0 (1.0–5.0)	5.0 (3.0–6.0)	<0.001
LRTI			<0.001
Pneumonia	357 (66.1)	260 (90.3)
Bronchiolitis	166 (30.7)	14 (4.9)
Bronchitis	17 (3.1)	14 (4.9)
Laboratory findings
WBC (×10³/μL)	10.5 (8.3–13.9)	9.8 (6.9–13.1)	0.004
Eosinophils (%)	0.8 (0.1–2.1)	0.4 (0.1–1.1)	<0.001
ESR (mm/hr)	15.0 (8.0–28.0)	17.0 (11.0–25.0)	0.199
CRP (mg/L)	6.2 (1.6–19.7)	15.1 (5.0–31.8)	<0.001
AST (IU/L)	42.0 (37.0–52.0)	39.0 (33.0–45.0)	<0.001
ALT (IU/L)	21.0 (16.0–29.0)	14.0 (12.0–17.0)	<0.001
No. of viruses PCR (+)	n=543	n=265	0.205
Adenovirus	49 (9.0)	26 (9.8)	0.843
Rhinovirus	112 (2.6)	56 (21.1)	0.499
Influenza A, B virus	17 (3.1)	7 (2.6)	0.639
Parainfluenza virus	38 (7.0)	8 (3.0)	0.015
RSV A, B	172 (31.7)	68 (25.7)	0.026
Bocavirus	19 (3.5)	15 (5.7)	0.184
Coronavirus	14 (2.6)	10 (3.8)	0.397
Metapneumovirus	28 (5.2)	34 (12.8)	<0.001
Coinfection	94 (17.3)	41 (15.5)	0.264
M. pneumoniae IgM (+)	6 (1.1)	24 (8.3)	<0.001
Use of antibiotics	64 (11.9)	39 (13.5)	0.472
Use of systemic steroid	38 (7.0)	11 (3.8)	0.062
O_₂ supplement	42 (7.8)	4 (1.4)	<0.001

Values are presented as median (interquartile range), mean±standard deviation, or number (%).

LRTI, lower respiratory tract infection; WBC, white blood cell; ESR, erythrocyte sedimentation rate; CRP, c-reactive protein; AST, aspartate transaminase; ALT, alanine transaminase; PCR, polymerase chain reaction; RSV, respiratory syncytial virus; M pneumonia, Mycoplasma pneumonia.

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