Minerva Pediatrica 2021 Jan 13

DOI: 10.23736/S0026-4946.20.06065-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Risk factors associated with wheezing in severe pediatric community-acquired pneumonia: a retrospective study

Lumin CHEN ¹, Chong MIAO ², Yanling CHEN ¹, Xian HAN ³, Ziying LIN ³, Hong YE ¹, Chengyi WANG ¹, Huijie ZHANG ¹, Jingjing LI ¹, Xi LIU ¹, Libo XU ², Guanghua LIU ¹ ✉

¹ Department of Pediatrics, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; ² Information Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China; ³ Unimed Scientific, Inc. Wuxi, China

BACKGROUND: Wheezing is a common clinical manifestation in children with pneumonia. However, the risk factors associated with the development of wheezing pneumonia and its clinical features are not fully characterized, especially in children with severe pneumonia.
METHODS: We retrospectively recruited 1434 pediatric patients diagnosed with severe pneumonia between April 2012 and September 2019 in Fujian Maternity and Child Health Hospital. The medical records regarding demographic information, clinical manifestations, radiographic/laboratory findings, and complications were collected. Based on the presence or absence of wheezing symptoms and signs, subjects were divided into wheezing cohort (n=684) and non-wheezing cohort (n=750), and their clinical data were compared. Multivariate cox regression analysis was performed to identify independent risk factors of wheezing.
RESULTS: Demographic features including gender, weigh, onset season, birth weight, full-term birth or not, history of pneumonia were significantly associated with the occurrence of wheezing in severe CAP (P<0.05). Specifically, male gender, onset seasons in autumn/winter, and absence of a history of pneumonia were identified as independent risk factors of wheezing in multivariate analysis (P<0.05). As for clinical features, wheezing cohort differed from the non-wheezing one in terms of clinical manifestation (higher incidence of cough and breathless, but lower incidence of fever), laboratory finding (higher levels of red blood cells, hemoglobin, and albumin and lower levels of total or indirect bilirubin and creatine), pathogen detection (higher incidence of respiratory syncytial viral infection), and clinical complications (lesser risk of sepsis and hydrothorax) (P<0.05).
CONCLUSIONS: Severe CAP with wheezing is a special clinical entity of severe pneumonia in children, which has specific risk factors and differ from non-wheezing pneumonia in terms of clinical features and etiologic pathogens.

KEY WORDS: Wheezing; Pediatric severe pneumonia; Risk factors; Clinical features