From the Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.
Research Design and Biostatistics Core, Sanford Research Center, Sioux Falls, SD.
Pediatr Infect Dis J. 2022 Mar 1;41(3):205-210. doi: 10.1097/INF.0000000000003406.
American Indian (AI) children are at increased risk for severe disease during lower respiratory tract infection (LRTI). The reasons for this increased severity are poorly understood. The objective of this study was to define the clinical presentations of LRTI and highlight the differences between AI and non-AI previously healthy patients under the age of 24 months.
We performed a retrospective chart review between October 2010 and December 2019. We reviewed 1245 patient charts and 691 children met inclusion criteria for this study. Data records included demographics, clinical, laboratory data, and illness outcomes.
Of 691 patients, 120 were AI and 571 were non-AI. There was a significant difference in breast-feeding history (10% of AI vs. 28% of non-AI, P < 0.0001) and in secondhand smoke exposure (37% of AI vs. 21% of non-AI, P < 0.0001). AI children had increased length of hospitalization compared with non-AI children (median of 3 vs. 2 days, P < 0.001). In addition, AI children had higher rates of pediatric intensive unit admission (30%, n = 37) compared with non-AI children (11%; n = 67, P < 0.01). AI children also had higher rates (62.5%, n = 75) and duration of oxygen supplementation (median 3 days) than non-AI children (48%, n = 274, P = 0.004; median 2 days, P = 0.0002). On a multivariate analysis, AI race was an independent predictor of severe disease during LRTI.
AI children have increased disease severity during LRTI with longer duration of hospitalization and oxygen supplementation, a higher rate of oxygen requirement and Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation pediatric intensive care unit admissions, and a greater need for mechanical ventilation. These results emphasize the need for improvement in health policies and access to health care in this vulnerable population.
美国印第安人（AI）儿童在下呼吸道感染（LRTI）期间患重病的风险增加。导致这种严重程度增加的原因尚不清楚。本研究的目的是定义 LRTI 的临床表现，并强调 24 个月以下的 AI 和非 AI 既往健康患者之间的差异。
我们进行了一项回顾性图表审查，时间为 2010 年 10 月至 2019 年 12 月。我们审查了 1245 名患者的图表，其中 691 名儿童符合本研究的纳入标准。数据记录包括人口统计学、临床、实验室数据和疾病结果。
在 691 名患者中，有 120 名是 AI，571 名是非 AI。母乳喂养史（10%的 AI 与 28%的非 AI，P < 0.0001）和二手烟暴露（37%的 AI 与 21%的非 AI，P < 0.0001）存在显著差异。与非 AI 儿童相比，AI 儿童的住院时间更长（中位数 3 天与 2 天，P < 0.001）。此外，AI 儿童的儿科重症监护病房入院率（30%，n = 37）高于非 AI 儿童（11%；n = 67，P < 0.01）。AI 儿童的氧疗补充率（中位数 3 天）和时间也高于非 AI 儿童（62.5%，n = 75 与 48%，n = 274，P = 0.004；中位数 2 天，P = 0.0002）。多变量分析表明，AI 种族是 LRTI 期间严重疾病的独立预测因素。
AI 儿童在下呼吸道感染期间疾病严重程度增加，住院时间和氧疗补充时间延长，需要氧气的比例和儿科重症监护病房入院率更高，需要机械通气的比例也更高。这些结果强调了需要改善这一脆弱人群的健康政策和获得医疗保健的机会。
