Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Suite 3029, 200 N Wolfe St, Baltimore, MD 21287-2533, USA.
Pediatrics. 2010 Oct;126(4):632-7. doi: 10.1542/peds.2010-0844. Epub 2010 Sep 27.
Infants and children with chronic lung disease of prematurity (CLDP) are at increased risk for morbidity and mortality from respiratory viral infections. Exposure to respiratory viruses may be increased in the day care environment. The risk of respiratory morbidity from day care attendance in the CLDP population is unknown. We therefore sought to determine if day care attendance is a significant risk factor for increased respiratory morbidity and symptoms in infants and children with CLDP.
Between January 2008 and October 2009, parents of infants and children with CLDP were surveyed. Information on perinatal history, sociodemographic information, day care attendance, and indicators of respiratory morbidity, including emergency department (ED) visits, hospitalizations, systemic corticosteroid use, antibiotic use, and respiratory symptoms, was collected on children<3 years of age. Logistic regression models were constructed to examine associations between exposure to day care and respiratory morbidities.
Data were collected from 111 patients with CLDP. The average gestational age was 26.2±2.0 weeks. Day care attendance was associated with significantly higher adjusted odds for ED visits (odds ratio [OR]: 3.74 [95% confidence interval (CI): 1.41-9.91]; P<.008), systemic corticosteroid use (OR: 2.22 [CI: 1.10-4.49]; P<.026), antibiotic use (OR: 2.40 [CI: 1.08-5.30]; P<.031), and days with trouble breathing (OR: 2.72 [CI: 1.30-5.69]; P<.008). Although there was an increased OR for hospitalization (OR: 3.22 [CI: 0.97-10.72]; P<.057), this did not reach statistical significance.
We found that day care attendance is associated with increased respiratory morbidities in young children with CLDP. Physicians should consider screening for and educating caregivers about the risks of day care attendance by young children with CLDP.
患有早产儿慢性肺疾病（CLDP）的婴儿和儿童患呼吸道病毒感染的发病率和死亡率增加。在日托环境中，接触呼吸道病毒的风险可能会增加。在 CLDP 人群中，日托出勤率与呼吸道发病率的关系尚不清楚。因此，我们试图确定日托出勤率是否是 CLDP 婴儿和儿童呼吸道发病率增加的重要危险因素。
2008 年 1 月至 2009 年 10 月，对 CLDP 婴儿和儿童的父母进行了调查。收集了围产期史、社会人口统计学信息、日托出勤率以及与呼吸道发病率相关的指标，包括急诊就诊、住院、全身皮质类固醇使用、抗生素使用和呼吸道症状等信息。对<3 岁的儿童进行了 Logistic 回归模型构建，以检查暴露于日托与呼吸道发病率之间的关联。
共收集了 111 名 CLDP 患儿的数据。平均胎龄为 26.2±2.0 周。日托出勤率与急诊就诊的调整后优势比（OR）显著升高（OR：3.74 [95%置信区间（CI）：1.41-9.91]；P<.008）、全身皮质类固醇使用（OR：2.22 [CI：1.10-4.49]；P<.026）、抗生素使用（OR：2.40 [CI：1.08-5.30]；P<.031）和呼吸急促天数（OR：2.72 [CI：1.30-5.69]；P<.008）。虽然住院的 OR 增加（OR：3.22 [CI：0.97-10.72]；P<.057），但未达到统计学意义。
我们发现，日托出勤率与 CLDP 幼儿的呼吸道发病率增加有关。医生应考虑对小儿 CLDP 患儿的照料者进行筛查和教育，以了解日托的风险。
