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Pneumonia Prevention Strategies for Children With Neurologic Impairment
Children with neurologic impairment (NI) face high risk of recurrent severe pneumonia, with prevention strategies of unknown effectiveness. We evaluated the comparative effectiveness of secondary prevention strategies for severe pneumonia in children with NI. We included children enrolled in Califor...
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Published in: | Pediatrics (Evanston) 2019-10, Vol.144 (4), p.e20190543 |
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description | Children with neurologic impairment (NI) face high risk of recurrent severe pneumonia, with prevention strategies of unknown effectiveness. We evaluated the comparative effectiveness of secondary prevention strategies for severe pneumonia in children with NI.
We included children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with NI and 1 pneumonia hospitalization. We examined associations between subsequent pneumonia hospitalization and expert-recommended prevention strategies: dental care, oral secretion management, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, outpatient antibiotics before index hospitalization, and clinic visit before or after index hospitalization. We used a 1:2 propensity score matched model to adjust for covariates, including sociodemographics, medical complexity, and severity of index hospitalization.
Among 3632 children with NI and index pneumonia hospitalization, 1362 (37.5%) had subsequent pneumonia hospitalization. Only dental care was associated with decreased risk of subsequent pneumonia hospitalization (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.49-0.85). Exposures associated with increased risk included gastrostomy tube placement (aOR: 2.15; 95% CI: 1.63-2.85), chest physiotherapy (aOR: 2.03; 95% CI: 1.29-3.20), outpatient antibiotics before hospitalization (aOR: 1.42; 95% CI: 1.06-1.92), clinic visit before (aOR: 1.30; 95% CI: 1.11-1.52), and after index hospitalization (aOR: 1.72; 95% CI: 1.35-2.20).
Dental care was associated with decreased recurrence of severe pneumonia. Several strategies, including gastrostomy tube placement, were associated with increased recurrence, possibly due to unresolved confounding by indication. Our results support a clinical trial of dental care to prevent severe pneumonia in children with NI. |
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We included children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with NI and 1 pneumonia hospitalization. We examined associations between subsequent pneumonia hospitalization and expert-recommended prevention strategies: dental care, oral secretion management, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, outpatient antibiotics before index hospitalization, and clinic visit before or after index hospitalization. We used a 1:2 propensity score matched model to adjust for covariates, including sociodemographics, medical complexity, and severity of index hospitalization.
Among 3632 children with NI and index pneumonia hospitalization, 1362 (37.5%) had subsequent pneumonia hospitalization. Only dental care was associated with decreased risk of subsequent pneumonia hospitalization (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.49-0.85). Exposures associated with increased risk included gastrostomy tube placement (aOR: 2.15; 95% CI: 1.63-2.85), chest physiotherapy (aOR: 2.03; 95% CI: 1.29-3.20), outpatient antibiotics before hospitalization (aOR: 1.42; 95% CI: 1.06-1.92), clinic visit before (aOR: 1.30; 95% CI: 1.11-1.52), and after index hospitalization (aOR: 1.72; 95% CI: 1.35-2.20).
Dental care was associated with decreased recurrence of severe pneumonia. Several strategies, including gastrostomy tube placement, were associated with increased recurrence, possibly due to unresolved confounding by indication. Our results support a clinical trial of dental care to prevent severe pneumonia in children with NI.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2019-0543</identifier><identifier>PMID: 31537634</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adolescent ; Anti-Bacterial Agents - adverse effects ; Antibiotics ; California - epidemiology ; Chest ; Child ; Child, Preschool ; Children ; Dental care ; Dental Care for Children ; Female ; Gastric juice ; Gastrostomy - adverse effects ; Gastrostomy - instrumentation ; Hospitalization ; Hospitalization - statistics & numerical data ; Humans ; Impairment ; Infant ; Infant, Newborn ; Intellectual Disability - complications ; Logistic Models ; Male ; Odds Ratio ; Ostomy ; Pediatrics ; Pneumonia ; Pneumonia - epidemiology ; Pneumonia - etiology ; Pneumonia - prevention & control ; Prevention ; Propensity Score ; Recurrence ; Respiratory Therapy - adverse effects ; Retrospective Studies ; Secondary Prevention - methods ; Secretion ; Young Adult</subject><ispartof>Pediatrics (Evanston), 2019-10, Vol.144 (4), p.e20190543</ispartof><rights>Copyright © 2019 by the American Academy of Pediatrics.</rights><rights>Copyright American Academy of Pediatrics Oct 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-c79d8082b1ae0e9393538f8f5a76a1f0e3187ec58d9de16f2507db0be13c32df3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31537634$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin, Jody L</creatorcontrib><creatorcontrib>Van Haren, Keith</creatorcontrib><creatorcontrib>Rigdon, Joseph</creatorcontrib><creatorcontrib>Saynina, Olga</creatorcontrib><creatorcontrib>Song, Hannah</creatorcontrib><creatorcontrib>Buu, MyMy C</creatorcontrib><creatorcontrib>Thakur, Yogita</creatorcontrib><creatorcontrib>Srinivas, Nivedita</creatorcontrib><creatorcontrib>Asch, Steven M</creatorcontrib><creatorcontrib>Sanders, Lee M</creatorcontrib><title>Pneumonia Prevention Strategies for Children With Neurologic Impairment</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>Children with neurologic impairment (NI) face high risk of recurrent severe pneumonia, with prevention strategies of unknown effectiveness. We evaluated the comparative effectiveness of secondary prevention strategies for severe pneumonia in children with NI.
We included children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with NI and 1 pneumonia hospitalization. We examined associations between subsequent pneumonia hospitalization and expert-recommended prevention strategies: dental care, oral secretion management, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, outpatient antibiotics before index hospitalization, and clinic visit before or after index hospitalization. We used a 1:2 propensity score matched model to adjust for covariates, including sociodemographics, medical complexity, and severity of index hospitalization.
Among 3632 children with NI and index pneumonia hospitalization, 1362 (37.5%) had subsequent pneumonia hospitalization. Only dental care was associated with decreased risk of subsequent pneumonia hospitalization (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.49-0.85). Exposures associated with increased risk included gastrostomy tube placement (aOR: 2.15; 95% CI: 1.63-2.85), chest physiotherapy (aOR: 2.03; 95% CI: 1.29-3.20), outpatient antibiotics before hospitalization (aOR: 1.42; 95% CI: 1.06-1.92), clinic visit before (aOR: 1.30; 95% CI: 1.11-1.52), and after index hospitalization (aOR: 1.72; 95% CI: 1.35-2.20).
Dental care was associated with decreased recurrence of severe pneumonia. Several strategies, including gastrostomy tube placement, were associated with increased recurrence, possibly due to unresolved confounding by indication. Our results support a clinical trial of dental care to prevent severe pneumonia in children with NI.</description><subject>Adolescent</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Antibiotics</subject><subject>California - epidemiology</subject><subject>Chest</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Dental care</subject><subject>Dental Care for Children</subject><subject>Female</subject><subject>Gastric juice</subject><subject>Gastrostomy - adverse effects</subject><subject>Gastrostomy - instrumentation</subject><subject>Hospitalization</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Impairment</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intellectual Disability - complications</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Odds Ratio</subject><subject>Ostomy</subject><subject>Pediatrics</subject><subject>Pneumonia</subject><subject>Pneumonia - epidemiology</subject><subject>Pneumonia - etiology</subject><subject>Pneumonia - prevention & control</subject><subject>Prevention</subject><subject>Propensity Score</subject><subject>Recurrence</subject><subject>Respiratory Therapy - adverse effects</subject><subject>Retrospective Studies</subject><subject>Secondary Prevention - methods</subject><subject>Secretion</subject><subject>Young Adult</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNpVkM9LwzAUx4Mobk6vHqXgufOlaZrmIsjQORg6UPEY0vZ1y2ibmrYD_3tbNoee3uF9f_Eh5JrClPIwuKsxa6YBUOkDD9kJGVOQsR8Ggp-SMQCjfgjAR-SiabYAEHIRnJMRo5yJiIVjMl9V2JW2MtpbOdxh1RpbeW-t0y2uDTZebp0325gic1h5n6bdeC_YOVvYtUm9RVlr48redUnOcl00eHW4E_Lx9Pg-e_aXr_PF7GHppyGNWz8VMoshDhKqEVAyyTiL8zjnWkSa5oCMxgJTHmcyQxrlAQeRJZAgZSkLspxNyP0-t-6SErO0r3a6ULUzpXbfymqj_n8qs1Fru1OSS04F7wNuDwHOfnXYtGprO1f1m1XAACiPIi571XSvSp1tGof5sYGCGsCrAbwawKsBfG-4-bvrKP8lzX4ADp2AjA</recordid><startdate>20191001</startdate><enddate>20191001</enddate><creator>Lin, Jody L</creator><creator>Van Haren, Keith</creator><creator>Rigdon, Joseph</creator><creator>Saynina, Olga</creator><creator>Song, Hannah</creator><creator>Buu, MyMy C</creator><creator>Thakur, Yogita</creator><creator>Srinivas, Nivedita</creator><creator>Asch, Steven M</creator><creator>Sanders, Lee M</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>5PM</scope></search><sort><creationdate>20191001</creationdate><title>Pneumonia Prevention Strategies for Children With Neurologic Impairment</title><author>Lin, Jody L ; Van Haren, Keith ; Rigdon, Joseph ; Saynina, Olga ; Song, Hannah ; Buu, MyMy C ; Thakur, Yogita ; Srinivas, Nivedita ; Asch, Steven M ; Sanders, Lee M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-c79d8082b1ae0e9393538f8f5a76a1f0e3187ec58d9de16f2507db0be13c32df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Antibiotics</topic><topic>California - epidemiology</topic><topic>Chest</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Dental care</topic><topic>Dental Care for Children</topic><topic>Female</topic><topic>Gastric juice</topic><topic>Gastrostomy - adverse effects</topic><topic>Gastrostomy - instrumentation</topic><topic>Hospitalization</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Impairment</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intellectual Disability - complications</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Odds Ratio</topic><topic>Ostomy</topic><topic>Pediatrics</topic><topic>Pneumonia</topic><topic>Pneumonia - epidemiology</topic><topic>Pneumonia - etiology</topic><topic>Pneumonia - prevention & control</topic><topic>Prevention</topic><topic>Propensity Score</topic><topic>Recurrence</topic><topic>Respiratory Therapy - adverse effects</topic><topic>Retrospective Studies</topic><topic>Secondary Prevention - methods</topic><topic>Secretion</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin, Jody L</creatorcontrib><creatorcontrib>Van Haren, Keith</creatorcontrib><creatorcontrib>Rigdon, Joseph</creatorcontrib><creatorcontrib>Saynina, Olga</creatorcontrib><creatorcontrib>Song, Hannah</creatorcontrib><creatorcontrib>Buu, MyMy C</creatorcontrib><creatorcontrib>Thakur, Yogita</creatorcontrib><creatorcontrib>Srinivas, Nivedita</creatorcontrib><creatorcontrib>Asch, Steven M</creatorcontrib><creatorcontrib>Sanders, Lee M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin, Jody L</au><au>Van Haren, Keith</au><au>Rigdon, Joseph</au><au>Saynina, Olga</au><au>Song, Hannah</au><au>Buu, MyMy C</au><au>Thakur, Yogita</au><au>Srinivas, Nivedita</au><au>Asch, Steven M</au><au>Sanders, Lee M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pneumonia Prevention Strategies for Children With Neurologic Impairment</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2019-10-01</date><risdate>2019</risdate><volume>144</volume><issue>4</issue><spage>e20190543</spage><pages>e20190543-</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><abstract>Children with neurologic impairment (NI) face high risk of recurrent severe pneumonia, with prevention strategies of unknown effectiveness. We evaluated the comparative effectiveness of secondary prevention strategies for severe pneumonia in children with NI.
We included children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with NI and 1 pneumonia hospitalization. We examined associations between subsequent pneumonia hospitalization and expert-recommended prevention strategies: dental care, oral secretion management, gastric acid suppression, gastrostomy tube placement, chest physiotherapy, outpatient antibiotics before index hospitalization, and clinic visit before or after index hospitalization. We used a 1:2 propensity score matched model to adjust for covariates, including sociodemographics, medical complexity, and severity of index hospitalization.
Among 3632 children with NI and index pneumonia hospitalization, 1362 (37.5%) had subsequent pneumonia hospitalization. Only dental care was associated with decreased risk of subsequent pneumonia hospitalization (adjusted odds ratio [aOR]: 0.64; 95% confidence interval [CI]: 0.49-0.85). Exposures associated with increased risk included gastrostomy tube placement (aOR: 2.15; 95% CI: 1.63-2.85), chest physiotherapy (aOR: 2.03; 95% CI: 1.29-3.20), outpatient antibiotics before hospitalization (aOR: 1.42; 95% CI: 1.06-1.92), clinic visit before (aOR: 1.30; 95% CI: 1.11-1.52), and after index hospitalization (aOR: 1.72; 95% CI: 1.35-2.20).
Dental care was associated with decreased recurrence of severe pneumonia. Several strategies, including gastrostomy tube placement, were associated with increased recurrence, possibly due to unresolved confounding by indication. Our results support a clinical trial of dental care to prevent severe pneumonia in children with NI.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>31537634</pmid><doi>10.1542/peds.2019-0543</doi><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Anti-Bacterial Agents - adverse effects Antibiotics California - epidemiology Chest Child Child, Preschool Children Dental care Dental Care for Children Female Gastric juice Gastrostomy - adverse effects Gastrostomy - instrumentation Hospitalization Hospitalization - statistics & numerical data Humans Impairment Infant Infant, Newborn Intellectual Disability - complications Logistic Models Male Odds Ratio Ostomy Pediatrics Pneumonia Pneumonia - epidemiology Pneumonia - etiology Pneumonia - prevention & control Prevention Propensity Score Recurrence Respiratory Therapy - adverse effects Retrospective Studies Secondary Prevention - methods Secretion Young Adult |
title | Pneumonia Prevention Strategies for Children With Neurologic Impairment |
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