Freedman Judah, Leibovitz Eugene, Sergienko Ruslan, Levy Amalia
Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
Pediatr Neonatol. 2023 Mar;64(2):133-139. doi: 10.1016/j.pedneo.2022.06.012. Epub 2022 Sep 17.
Children hospitalized with infectious diseases may develop severe, life-threatening conditions, often requiring admission to pediatric intensive care unit (PICU). The objectives of this study were to identify independent risk factors for PICU hospitalization with an infectious disease in children <5 years of age.
In southern Israel, two populations live side by side: the middle-high income Jewish population and the low-income Bedouin population, both receiving equal and free medical care at the only tertiary medical center in the area. The study population included all children born in southern Israel and hospitalized at PICU with an infectious disease during 1991-2012. Risk factors for PICU hospitalizations were retrospectively studied by Kaplan-Meier and Cox proportional hazard survival analyses.
9951 Jewish children and 18,002 Bedouin children were enrolled; overall, 1135 episodes of PICU hospitalizations with an infectious disease were recorded (879, 77.4% Bedouin and 256, 22.6% Jewish patients). Bedouin children had a higher risk for PICU hospitalization with an infectious disease compared with Jewish children (adjusted Hazard Ratio [adj. HR] 1.7, 95% CI 1.5-2.0); maternal multiparity and low-birth weight (<2500 g) were additional risk factors for PICU hospitalization with an infectious disease compared to firstborns (adj. HR = 1.2, 95% CI 1.0-1.5) or to children with a birth weight ≥2500 g (adj. HR = 1.5, 95% 1.2-1.9). Older age was a protective factor for PICU hospitalization (adj. HR = 0.98, 95% CI 0.97-0.99). Children hospitalized with a central nervous system infection had the highest risk of PICU hospitalization (adj. HR 6.8, 95% CI 5.5-8.4), followed by those with urinary tract infections (UTI, adj. HR 3.1, 95% CI 2.5-3.8) and those with lower respiratory tract infections (LRTI, adj. HR 2.9, 95% CI 2.4-3.4).
Bedouin ethnicity, low birth weight, maternal multiparity and younger age were significant risk factors for PICU hospitalizations with an infectious disease. Among the infectious diseases analyzed, CNS infection had the highest risk for PICU hospitalization, followed by UTI and LRTI.
因传染病住院的儿童可能会发展为严重的、危及生命的病症，常常需要入住儿科重症监护病房（PICU）。本研究的目的是确定5岁以下儿童因传染病入住PICU的独立危险因素。
在以色列南部，两个群体毗邻而居：中高收入的犹太人群体和低收入的贝都因人群体，二者在该地区唯一的三级医疗中心接受同等的免费医疗服务。研究人群包括1991年至2012年期间在以色列南部出生并因传染病入住PICU的所有儿童。通过Kaplan-Meier法和Cox比例风险生存分析对入住PICU的危险因素进行回顾性研究。
纳入了9951名犹太儿童和18002名贝都因儿童；总体而言，记录到1135例因传染病入住PICU的病例（879例，77.4%为贝都因患者；256例，22.6%为犹太患者）。与犹太儿童相比，贝都因儿童因传染病入住PICU的风险更高（调整后风险比[adj. HR]为1.7，95%置信区间[CI]为1.5 - 2.0）；与头胎儿童相比（adj. HR = 1.2，95% CI为1.0 - 1.5）或与出生体重≥2500 g的儿童相比（adj. HR = 1.5，95% CI为1.2 - 1.9），母亲多胎妊娠和低出生体重（<2500 g）是因传染病入住PICU的其他危险因素。年龄较大是入住PICU的保护因素（adj. HR = 0.98，95% CI为0.97 - 0.99）。因中枢神经系统感染住院的儿童入住PICU的风险最高（adj. HR为6.8，95% CI为5.5 - 8.4），其次是尿路感染（UTI，adj. HR为3.1，95% CI为2.5 - 3.8）和下呼吸道感染（LRTI，adj. HR为2.9，95% CI为2.4 - 3.4）。
贝都因族裔、低出生体重、母亲多胎妊娠和年龄较小是因传染病入住PICU的重要危险因素。在所分析的传染病中，中枢神经系统感染入住PICU的风险最高，其次是尿路感染和下呼吸道感染。
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