Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
Paediatric Respiratory Department, Starship Children's Health, Auckland, New Zealand.
Thorax. 2020 Apr;75(4):298-305. doi: 10.1136/thoraxjnl-2019-213142. Epub 2020 Feb 24.
Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge.
This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22.
400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe.
We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years.
ACTRN12610001095055.
儿童早期因严重下呼吸道感染（LRTI）住院与持续的呼吸道症状和日后可能发展为支气管扩张症有关。我们的目的是通过在出院时实施社区干预计划来减少这种中期呼吸道发病率。
这项随机、对照、单盲试验纳入了因严重 LRTI 住院的年龄<2 岁的儿童，分为“干预”或“对照”组。干预措施是每三个月进行一次社区诊所治疗湿咳，并对无反应者延长抗生素治疗。处理所有其他健康问题，并鼓励健康恢复行为，针对住房或吸烟问题进行转介。对照组则按照父母发起的常规医疗途径就诊。24 个月后，所有儿童均由一位儿科医生进行评估，该医生对随机分组情况不知情，主要结局为湿咳、异常检查（湿啰音或杵状指）或 Brasfield 评分≤22 的胸部 X 射线。
2011 年至 2012 年期间，共纳入 400 名儿童（203 名干预组，197 名对照组）；平均年龄为 6.9 个月，230 名男孩，87%为毛利/太平洋岛民种族，83%来自最贫困的五分位数。对 400 名儿童中的 321 名（80.3%）进行了最终评估，结果显示湿咳（干预组 33.9%，对照组 36.5%，相对风险（RR）0.93，95%CI 0.69 至 1.25）、异常检查（干预组 21.7%，对照组 23.9%，RR 0.92，95%CI 0.61 至 1.38）或 Brasfield 评分≤22（干预组 32.4%，对照组 37.9%，RR 0.85，95%CI 0.63 至 1.17）的存在无差异。在此期间，有 12 名（均为干预组）被诊断为支气管扩张症。
我们已经确定了因严重 LRTI 住院的儿童在出院后存在持续呼吸道疾病的高风险，而该干预计划在 2 年内并未改变这些儿童的结局。
ACTRN12610001095055。
