Imperial College School of Public Health, London, UK.
Imperial College London, Dr Foster Unit, London, UK.
Arch Dis Child. 2019 Jul;104(7):658-663. doi: 10.1136/archdischild-2018-316317. Epub 2019 Mar 6.
Bronchiolitis causes significant infant morbidity worldwide from hospital admissions. However, studies quantifying the subsequent respiratory burden in children under 5 years are lacking.
To estimate the risk of subsequent respiratory hospital admissions in children under 5 years in England following bronchiolitis admission in infancy.
Retrospective population-based birth cohort study.
Public hospitals in England.
We constructed a birth cohort of 613 377 infants born between 1 April 2007 and 31 March 2008, followed up until aged 5 years by linking Hospital Episode Statistics admissions data.
We compared the risk of respiratory hospital admission due to asthma, wheezing and lower and upper respiratory tract infections (LRTI and URTI) in infants who had been admitted for bronchiolitis with those who had not, using Cox proportional hazard regression. We adjusted hazard ratios (HR) for known respiratory illness risk factors including living in deprived households, being born preterm or with a comorbid condition.
We identified 16 288/613 377 infants (2.7%) with at least one admission for bronchiolitis. Of these, 21.7% had a further respiratory hospital admission by age 5 years compared with 8% without a previous bronchiolitis admission (HR (adjusted) 2.82, 95% CI 2.72 to 2.92). The association was greatest for asthma (HR (adjusted) 4.35, 95% CI 4.00 to 4.73) and wheezing admissions (HR (adjusted) 5.02, 95% CI 4.64 to 5.44), but were also significant for URTI and LRTI admissions.
Hospital admission for bronchiolitis in infancy is associated with a threefold to fivefold risk of subsequent respiratory hospital admissions from asthma, wheezing and respiratory infections. One in five infants with bronchiolitis hospital admissions will have a subsequent respiratory hospital admission by age 5 years.
毛细支气管炎会导致全球婴儿出现严重的发病和住院率。然而，目前缺乏研究来量化 5 岁以下儿童的后续呼吸道负担。
评估英格兰婴儿毛细支气管炎住院后 5 岁以下儿童后续呼吸道住院的风险。
回顾性基于人群的出生队列研究。
英格兰公立医院。
我们构建了一个 613377 名 2007 年 4 月 1 日至 2008 年 3 月 31 日期间出生的婴儿的出生队列，通过链接医院入院统计数据进行随访，直到 5 岁。
我们比较了因哮喘、喘息和下呼吸道感染（LRTI）和上呼吸道感染（URTI）而住院的毛细支气管炎患儿与未住院患儿的呼吸道住院风险，使用 Cox 比例风险回归。我们调整了风险比（HR），以包括已知的呼吸道疾病风险因素，如生活在贫困家庭、早产或合并症。
我们确定了 16288/613377 名（2.7%）婴儿至少有一次毛细支气管炎住院。其中，21.7%的患儿在 5 岁前有进一步的呼吸道住院，而没有既往毛细支气管炎住院的患儿为 8%（调整后的 HR（调整）2.82，95%CI 2.72 至 2.92）。这种关联在哮喘（HR（调整）4.35，95%CI 4.00 至 4.73）和喘息入院方面最为显著，但在 URTI 和 LRTI 入院方面也有显著意义。
婴儿毛细支气管炎住院与哮喘、喘息和呼吸道感染后继发呼吸道住院的风险增加 3 倍至 5 倍相关。五分之一的毛细支气管炎住院患儿在 5 岁前会有后续的呼吸道住院。
