Factors Associated With In‐Hospital and Postdischarge Adverse Outcomes Among Children Hospitalized With Community‐Acquired Pneumonia in Sabah, Malaysia: A Prospective Cohort Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: ABSTRACT Introduction Adverse in‐hospital outcomes of childhood pneumonia are well‐documented, but adverse postdischarge outcomes remain unclear, especially in middle‐income countries. We investigated factors associated with in‐hospital and postdischarge adverse outcomes in Malaysian children with pneumonia. Methods Between April 2022 and April 2023, a prospective cohort of Malaysian children aged 1 month to < 12 years hospitalized with radiographic‐confirmed pneumonia were enrolled and reviewed 4–6 weeks postdischarge. Composite in‐hospital adverse outcomes were death, intensive care admission, or prolonged hospitalization > 5 days. Composite postdischarge adverse outcomes were chronic (> 4 weeks) wet cough, rehospitalization for acute lower respiratory infection (ALRI), or unscheduled respiratory‐related doctor visit by 4–6 weeks. Results In 868 children, composite in‐hospital adverse outcomes occurred in 139 (16%) (2 deaths [< 1%], 46 [5%] intensive care admissions, 136 [16%] prolonged hospitalizations). Risk factors for in‐hospital adverse outcomes were: age < 6 months (adjusted odds ratio [OR adj ] = 3.84, 95% confidence interval [CI] 2.13–6.93), preterm birth (OR adj = 1.81, 95% CI 1.01–3.23), partial/unvaccinated status (OR adj = 2.28, 95% CI 1.13–4.60), hypoxemia (OR adj = 4.91, 95% CI 2.95–8.20), airspace abnormalities (OR adj = 9.80, 95% CI 3.84–24.98), and anemia (OR adj = 1.70, 95% CI 1.08–2.68). Among 689/866 (80%) children reviewed postdischarge, 666 (97%) had complete data. Of these, composite postdischarge outcomes occurred in 134 (20%) children (20 [3%] chronic wet cough, 71 [11%] hospitalized ALRIs, 128 [19%] unscheduled respiratory‐related doctor visits). Preterm birth (OR adj = 2.28, 95% CI 1.37–3.81) and invasive mechanical ventilation (OR adj = 2.64, 95% CI 1.16–6.00) were risk factors for postdischarge adverse outcomes. Conclusions Children hospitalized with radiographic‐confirmed pneumonia and at risk of in‐hospital adverse outcomes should be monitored closely. Postdischarge follow‐up is recommended for preterm children or those requiring invasive mechanical ventilation because of their risk of long‐term respiratory morbidity.
Source: Pediatric Pulmonology
DOI: 10.1002/ppul.71380
Authors: Hing Cheong Kok, Siew Moy Fong, Stephanie T. Yerkovich, Keith Grimwood, Ian Brent Masters, Gabrielle B. McCallum, Nicholas Fancourt, Chai Woon Gan, Qing Yu Tan, Ethan M. Moore, Anne B. Chang
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4416239297