Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; Department of Infectious Disease, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan.
J Infect Chemother. 2022 Mar;28(3):384-388. doi: 10.1016/j.jiac.2021.11.013. Epub 2021 Nov 23.
Children with severe motor and intellectual disabilities (SMID) are susceptible to severe lower respiratory tract infection (LTRI). As SMID patients are prone to develop recurrent wheezing and are often diagnosed with bronchial asthma, they frequently receive systemic corticosteroids as an adjunctive treatment for LRTIs. However, the efficacy of corticosteroid therapy for LTRIs in SMID children is unclear. We investigated whether or not corticosteroid therapy was associated with better clinical outcomes for SMID children with LRTIs.
Our retrospective study enrolled 217 SMID children 1-15 years old hospitalized for LTRIs. We compared the clinical characteristics and outcomes between patients with and without corticosteroid therapy.
Of the 217 patients, 29 (13.3%) received corticosteroid therapy. The proportion of patients with a history of bronchial asthma was higher and LRTI was more severe in patients with corticosteroid therapy than in those without the therapy. The length of hospital stay (LOHS) was significantly longer in patients with corticosteroid therapy (median 13 days) than in those without corticosteroid therapy (median 9 days) (P = 0.02). The same tendency was shown for the LOHS in patients with severe or moderate LRTI, although not to a significant extent.
Systemic corticosteroid therapy was not associated with better clinical outcomes in SMID children with LRTIs, even if the patients suffer from severe LRTIs. Corticosteroids should be used cautiously for LRTIs in SMID children because bronchial asthma is likely to be overdiagnosed in these children.
患有严重运动和智力障碍（SMID）的儿童易患严重下呼吸道感染（LTRI）。由于 SMID 患者易发生反复喘息，且常被诊断为支气管哮喘，因此常接受全身皮质类固醇作为 LRTIs 的辅助治疗。然而，皮质类固醇治疗 LTRIs 在 SMID 儿童中的疗效尚不清楚。我们调查了皮质类固醇治疗是否与 LTRIs 中 SMID 儿童的更好临床结果相关。
我们的回顾性研究纳入了 217 名 1-15 岁因 LTRIs 住院的 SMID 儿童。我们比较了接受和未接受皮质类固醇治疗的患者的临床特征和结局。
在 217 名患者中，有 29 名（13.3%）接受了皮质类固醇治疗。接受皮质类固醇治疗的患者中支气管哮喘病史的比例较高，且 LRTI 比未接受皮质类固醇治疗的患者更为严重。接受皮质类固醇治疗的患者的住院时间（LOHS）明显更长（中位数 13 天），而未接受皮质类固醇治疗的患者（中位数 9 天）（P=0.02）。在严重或中度 LRTI 的患者中也表现出同样的趋势，尽管没有达到显著程度。
即使患者患有严重的 LRTI，全身皮质类固醇治疗也与 SMID 儿童的 LRTIs 临床结局无改善相关。皮质类固醇在 SMID 儿童的 LRTIs 中应谨慎使用，因为在这些儿童中可能过度诊断支气管哮喘。
