Symptom Burden and Factors Associated with Acute Respiratory Infections in the First Two Years of Life—Results from the LoewenKIDS Cohort

Abstract

Acute respiratory infections (ARIs) are the most common childhood illnesses worldwide whereby the reported frequency varies widely, often depending on type of assessment. Symptom diaries are a powerful tool to counteract possible under-reporting, particularly of milder infections, and thus offer the possibility to assess the full burden of ARIs. The following analyses are based on symptom diaries from participants of the German birth cohort study LoewenKIDS. Primary analyses included frequencies of ARIs and specific symptoms. Factors, which might be associated with an increased number of ARIs, were identified using the Poisson regression. A subsample of two hundred eighty-eight participants were included. On average, 13.7 ARIs (SD: 5.2 median: 14.0 IQR: 10–17) were reported in the first two years of life with an average duration of 11 days per episode (SD: 5.8, median: 9.7, IQR: 7–14). The median age for the first ARI episode was 91 days (IQR: 57–128, mean: 107, SD: 84.5). Childcare attendance and having siblings were associated with an increased frequency of ARIs, while exclusive breastfeeding for the first three months was associated with less ARIs, compared to exclusive breastfeeding for a longer period. This study provides detailed insight into the symptom burden of ARIs in German infants.

Exclusive Breastfeeding and Childhood Morbidity: A Narrative Review

“…A total of three papers found no significant relationship between EBF and ARI [ 50 , 68 , 77 ]. One paper from Germany reported that a longer duration of EBF led to a higher risk of ARI [ 37 ]. All studies assessing lower respiratory tract infections ( n = 6), pneumonia ( n = 5), bronchiolitis ( n = 1), and broad respiratory/chest infections ( n = 5) reported a protective association with EBF [ 11 , 18 , 21 , 28 , 32 , 33 , 34 , 35 , 39 , 40 , 41 , 48 , 49 , 50 , 56 , 57 , 79 ].…”

Perinatal and Other Risk Factors for Common Infections in Infancy: A Prospective Cohort Study

“…2,3,10 However, the differences in the methods of reporting symptoms need to be noted when comparing these results. Only one of the previous birth cohort studies made partial use of electronic data collection, 3 whereas the present data were collected prospectively with an electronic online system. UTI has been reported to be one of the leading reasons for intravenous antibiotic treatment for hospitalized children in a high-income country with a comprehensive immunization program.…”

“…Although the risks of RTIs and lung health, 15,16 GIs, 17 urinary tract infections (UTIs) 18 and infections during chemotherapy 19 in children have been shown to be associated with the composition of the gut and respiratory microbiota, limited data are available on the perinatal factors previously shown to modify gut and respiratory tract colonization 20,21 as risk factors for common infections in childhood in prospective cohort studies in high-income countries. 1–4,10…”

Randomised multicentre effectiveness trial of rapid syndromic testing by panel assay in children presenting to European emergency departments with acute respiratory infections—trial protocol for the ADEQUATE Paediatric trial

“… 1 2 While most ARI cause mild symptoms and are self-limiting, lower respiratory tract infections, including pneumonia, globally cause more than half a million deaths in <5-year-old children per year. 3 Especially since the wide roll-out of conjugate vaccines, most of these infections in children do not require treatment with antibiotics. Antibiotic consumption is a driver of development of antimicrobial resistance (AMR) and where use of antibiotics in the individual is not warranted, the ecological and economic cost of AMR per antibiotic consumed is considerable.…”

“…Children hospitalised for ARI stay in hospital for a median of 2–3 days and resolution of symptoms takes much longer. 3 11 Interventions reducing hospital stays have a high potential to reduce psychosocial costs for families and economic costs for the health system.…”