Children with CHD Hospitalized for Pneumonia At High-Risk of Comorbidities

Fu-Sheng Chou, MD

Although impaired lung function is associated with congenital heart disease (CHD) in newborns, leaving children more vulnerable to pneumonia, there is a lack of studies on the effect of CHD in pneumonia cases.

As a result, investigators, led by Fu-Sheng Chou, MD, Department of Pediatrics, Loma Linda University, assessed the impact of CHD on vaccine-preventable pneumonia incidence, morbidity, and mortality, hypothesizing an increase in each metric in children with CHD.

In data presented at the 2021 American Academy of Pediatrics Virtual Meeting, the team observed children with CHD who are then hospitalized due to pneumonia show greater risk for comorbidities, advanced cardiopulmonary support, and mortality.

Methodology

Investigators performed an analysis on retrospective, cross-sectional data from the Kid’s Inpatient Database (KID) published from 2003 - 2016.

It was restricted to children above 1 year of age who were admitted with a diagnosis of pneumonia from vaccine-preventable sources including streptococcus pneumoniae, haemophilus influenzae, or influenza (n  = 47,242).

Additionally, the team analyzed information on diagnosis, pneumonia hospitalizations, all-cause mortality, length of stay, as well as other comorbidities.

Then, investigators used weighted-adjusted logistic regression models adjusted for age, sex, race and ethnicity, chromosomal anomalies, respiratory tract anomalies, and musculoskeletal anomalies.

Findings

Out of the total pediatric population with pneumonia, 1,026 children (2%) had a diagnosis of CHD.

After adjusting for age, sex, race/ethnicity, and anatomical or chromosomal anomalies, this cohort did not have a greater overall risk of hospitalization due to pneumonia (adjusted odds ratio, 0.94, 95% CI: 0.84 - 1.03).

In a subgroup analysis, a significantly increased risk of hospitalization from pneumonia was observed due to haemophilus influenzae (aOR, 2.1; 95% CI, 1.6 - 2.7) and decreased risk from influenza (aOR, 0.85; 95% CI, 0.75 - 0.96) and Streptococcus pneumoniae (aOR 0.9, 95% CI: 0.77 - 1.04).

Further, data show the risk of mortality increased in children with CHD (aOR, 3.1; 95% CI, 1.8 - 5.2), while the length of stay in the hospital also increased.

Then, the team saw the CHD cohort experienced an increased frequency of comorbidities such as respiratory failure (aOR 1.9, 95% CI: 1.5 - 2.3), acute kidney injury (aOR 2.8, 95% CI: 1.9 - 4.3), and sudden cardiac arrest (aOR 3.8, 95% CI: 1.8 - 7.7).

Investigators also saw children with CHD more frequently required advanced cardiopulmonary support such as mechanical ventilation (aOR 2.5, 95% CI: 2.1 - 3.0).

Takeaways

The team concluded children with CHD hospitalized due to pneumonia at a greater risk for comorbidities, advanced cardiopulmonary support, and mortality.

“This study emphasizes the need for increased clinical surveillance as well as increased advocacy in cases of vaccine hesitancy,” investigators wrote.

The study, “Outcomes of Vaccine-preventable Pneumonia in Pediatric Patients with Congenital Heart Disease,” was published online by AAP 2021.