de Vries Esther, van Hout Roeland W N M
Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.
Laboratory for Medical Microbiology and Immunology, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands.
Front Pediatr. 2020 Dec 17;8:583630. doi: 10.3389/fped.2020.583630. eCollection 2020.
To study the pattern of respiratory symptoms in children in the general population. We followed a cohort of children for up to 2 years through parents completing weekly online questionnaires in the Child-Is-Ill study ("Kind-en-Ziekmeting" in Dutch); the study was running 2012-2015. Inclusion criteria were "an ordinary child" (according to the parents) and <18 years old at inclusion. We especially encouraged participation of post-infancy children. Age at inclusion, sex, smoking exposure, allergy in the family, and frequent infections in the family were noted. Pearson's correlation, principal component analysis, latent class analysis, latent profile analysis, linear regression, and linear mixed effects regression were used in the statistical analyses. Data were collected on 55,524 childweeks in 755 children (50% girls; median age, 7 years; interquartile range, 4-11 years, 97% ≥2 years at inclusion), with reported symptom(s) in 8,425 childweeks (15%), leading to school absenteeism in 25%, doctor's visits in 12%, and parental sick leave in 8%; symptoms lasting ≥3 weeks were rare (2% of episodes). Linear mixed effects regression showed significant, but only limited, effects of season on the proportion of "symptom(s) reported" per individual child. Only runny nose showed a significant, but very small, age effect. However, the variability between the children was considerable. There were no obvious subgroups of children with specific symptom combinations. In any randomly chosen week, the vast majority of children (85%) in our-mainly-post-infancy cohort derived from the general population did not have any symptom, even in the younger age group, even in winter. The children showed considerable variability; no clear subgroups of symptom patterns could be identified, underlining the difficult position of healthcare providers. These results support our opinion that post-infancy children in the general population should not be evaluated as if they are infants when they have recurrent respiratory symptoms. If they clearly deviate from the above-described most common pattern, it is wise to keep an eye on potential, maybe even rare, serious underlying causes.
为研究普通人群中儿童的呼吸道症状模式。我们在“儿童患病监测”研究（荷兰语为“Kind-en-Ziekmeting”）中，通过让家长每周在线填写问卷，对一组儿童进行了长达2年的跟踪；该研究于2012年至2015年开展。纳入标准为“普通儿童”（根据家长描述）且纳入时年龄<18岁。我们特别鼓励婴儿期后的儿童参与。记录了纳入时的年龄、性别、吸烟暴露情况、家族过敏史以及家族中频繁感染情况。在统计分析中使用了Pearson相关性分析、主成分分析、潜在类别分析、潜在剖面分析、线性回归和线性混合效应回归。共收集了755名儿童（50%为女孩；中位年龄7岁；四分位间距4 - 11岁，97%纳入时≥2岁）的55524个儿童周的数据，其中8425个儿童周（15%）报告有症状，导致25%的儿童缺课、12%的儿童看医生以及8%的家长请病假；症状持续≥3周的情况很少见（占发作次数的2%）。线性混合效应回归显示季节对每个儿童“报告有症状”的比例有显著但有限的影响。只有流鼻涕显示出显著但非常小的年龄效应。然而，儿童之间的变异性很大。没有明显的具有特定症状组合的儿童亚组。在任何随机选择的一周中，我们主要为婴儿期后的来自普通人群的队列中的绝大多数儿童（85%）没有任何症状，即使在较年幼的年龄组，即使在冬季也是如此。儿童表现出很大的变异性；无法确定明确的症状模式亚组，这凸显了医疗服务提供者的困境。这些结果支持我们的观点，即普通人群中婴儿期后的儿童出现反复呼吸道症状时，不应像对待婴儿一样进行评估。如果他们明显偏离上述最常见模式，明智的做法是关注潜在的、甚至可能罕见的严重潜在病因。
