The burden of community-managed acute respiratory infections in the first 2-years of life

• Published in: Pediatric pulmonology Vol. 51; no. 12; pp. 1336 - 1346
• Main Authors: Sarna, Mohinder, Ware, Robert S., Sloots, Theo P., Nissen, Michael D., Grimwood, Keith, Lambert, Stephen B.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Acute Disease; Ambulatory Care; Australia - epidemiology; Child, Preschool; children; Cohort Studies; Cough - epidemiology; Cough - therapy; Dyspnea - epidemiology; Dyspnea - therapy; Female; Humans; Incidence; Infant; Longitudinal Studies; Male; management; Morbidity; Otitis Media - epidemiology; Otitis Media - therapy; Pneumonia - epidemiology; Pneumonia - therapy; Primary Health Care; Respiratory Sounds; respiratory symptoms; respiratory tract infections; Respiratory Tract Infections - epidemiology; Respiratory Tract Infections - therapy; respiratory tract infections; respiratory symptoms; children; management
• DOI: 10.1002/ppul.23480
• ISSN: 8755-6863

Summary Background Contemporary information on acute respiratory infections (ARIs) in children is based on hospital cohorts, primary healthcare presentations, and high‐risk birth cohort studies. We describe the burden and determinants of symptomatic episodes of ARIs in unselected healthy infants in the first 2‐years of life. Methods One hundred and fifty‐four infants from subtropical Brisbane, Australia participated in a longitudinal, community‐based birth cohort study. A daily tick‐box diary captured pre‐defined respiratory symptoms. Parents also completed a burden diary, recording family physician and hospital visits, and antibiotic use. Results Participants contributed 88,032 child‐days (78.2% of expected), of which 17,316 (19.7%) days were symptomatic during 1,651 ARI episodes: incidence rate 0.56 ARIs per child‐month (95%CI: 0.54, 0.59). Runny nose (14,220 days; 6.0‐days median duration) and dry cough (6,880 days; 4.0‐days median duration) were reported most frequently. Overall, 955 burden diaries recorded 455 family physician visits (1–8 visits per ARI) and 48 hospital presentations, including six hospital admissions. Antibiotics were prescribed on 209 occasions (21.9% of ARI episodes where burden diary submitted). Increasing age, non‐summer seasons, and attendance at childcare were associated with an increased risk of ARI. Conclusions ARIs are a common cause of morbidity in the first 2‐years of life, with children experiencing 13 discrete ARI episodes and almost 5‐months of respiratory symptoms. Most ARIs are managed in the community by parents and family physicians. Antibiotic prescribing remains common for ARIs in young children. Secular societal changes, including greater use of childcare in early childhood, may have maintained the high ARI incidence in this age‐group. Pediatr Pulmonol. 2016;51:1336–1346. © 2016 Wiley Periodicals, Inc.