473 - The Lasting Burden of Early Infections on Respiratory and Infectious Morbidity in Children and Adolescents

Publication Number: 4464.473

Joseph Ting, University of Alberta, Edmonton, AB, Canada; Ye Shen, BC Children's Hospital Research Institute, Vancouver, BC, Canada; Connie Yang, The Hospital for Sick Children, Toronto, ON, Canada; Sumera Aziz, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Jeffrey Bone, BCCHR, Vancouver, BC, Canada; Ashley Roberts, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Edmond Chan, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Jonathan Wong, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Lindsay Richter, University of British Columbia, Vancouver, BC, Canada

Background: While the short term consequences of neonatal infections such as mortality and adverse neurodevelopmental outcomes are well documented, much less is known about the long term burden of morbidity extending into later childhood and adolescence.

Objective: To evaluate the risk of asthma and infectious morbidity in children who experienced infections within the first three months of life.

Design/Methods: This population-based cohort study included all live births between 22 and 44 weeks of gestation age (GA) in British Columbia, Canada, from April 1, 2004, to December 31, 2022. Data were obtained through Population Data BC, which enables linkage across multiple provincial databases, including the British Columbia Perinatal Data Registry, the Discharge Abstract Database, and the Medical Services Plan. Infants were excluded if they had incomplete linkage, or discontinuation of provincial medical insurance coverage. Early infection was defined as any diagnosis of bacteremia or localized infection within the first three months of life, based on ICD-10-CA codes (A00-B99, N39.0, O85-O86, P35-P39). Outcomes included hospitalizations or outpatient visits for common conditions during following intervals: 3 months-5 years, 6-10 years, and 11-17 years. Poisson regression with robust standard errors were used to estimate risk ratios (RR) with 95% confidence intervals (CIs), adjusted for confounding variables.

Results: A total of 735,375 infants were included, with 15,317, 57,414, and 662,644 born at 22 to 33, 34 to 36, and 37 to 44 weeks of GA, respectively. [Table 1] Infants with early infections had substantially higher risks of developing pneumonia, asthma, influenza, otitis media, and UTI between 3 months and 5 years of age across all GA groups. [Table 2] In later childhood, those with a history of early infection were more likely to be hospitalized for asthma and to experience outpatient treated pneumonia, otitis media, and urinary tract infection (UTI). [Table 3] Infants born at 22 to 33 weeks (aRR 1.30, 95% CI 1.15 to 1.47) and those born at 37 to 44 weeks (aRR 1.24, 95% CI 1.25 to 1.33) were more likely to require outpatient follow up for asthma during adolescence.

Conclusion(s): Infants who experience infections within the first three months of life are at increased risk of developing pneumonia, asthma, influenza, otitis media, and UTI in their early childhood. These findings underscore the need for further research into the underlying immunological mechanisms associated with early infections, as well as the development of preventive strategies to mitigate long term morbidity.

Table 1: Characteristics of cohort


Table 2: Health outcomes of children with and without early infection: 3 months - 5 years of age
Confounders: gestational age category, maternal age, prior delivery, region of residence (rural/urban), smoking status, hypertension, diabetes
ICD-10-CA codes used for definitions:
Pneumonia: J12; J13; J14; J15; J16; J17; J18; Asthma: J45, J46; Influenza: J09; J10; J11; Urinary Tract Infection (UTI): N10; N11; N12; N39.0; Otitis Media: H65; H66; H67
ICD-9 codes used for asthma physician services: 49.3; Pneumonia: 480; 481; 482; 485; 486; Asthma: 493; Influenza: 487; UTI: 040; 590.80; 599.0; Otitis Media: 382


Table 3: Health outcomes of children with and without early infection: 6 - 10 years of age
Confounders: gestational age category, maternal age, prior delivery, region of residence (rural/urban), smoking status, hypertension, diabetes
ICD-10-CA codes used for definitions:
Pneumonia: J12; J13; J14; J15; J16; J17; J18; Asthma: J45, J46; Influenza: J09; J10; J11; Urinary Tract Infection (UTI): N10; N11; N12; N39.0; Otitis Media: H65; H66; H67
ICD-9 codes used for asthma physician services: 49.3; Pneumonia: 480; 481; 482; 485; 486; Asthma: 493; Influenza: 487; UTI: 040; 590.80; 599.0; Otitis Media: 382