Underlying causes and outcomes of recurrent pneumonia in hospitalized children

Abstract Objectives To describe the clinical characteristics and underlying causes of recurrent pneumonia (RP) among hospitalized children, and to identify risk factors associated with adverse outcomes. Methods We reviewed the medical records of hospitalized children diagnosed with RP at the Children's Hospital of Fudan University from January 2016 to January 2021 and then described clinical characteristics and underlying causes. The associations between factors and adverse outcomes were assessed using logistic regression. Results Of 551 children with RP, 483 (87.7%) manifested underlying causes, with recurrent aspiration (127, 23.0%), primary immunodeficiency (PID) (91, 16.5%), and congenital heart diseases (63, 11.4%) being the most common. Genetic defects were identified in about a quarter (158, 28.7%) of the patients. PID odds ratio (OR, 7.9; 95% confidence interval [CI], 2.8–22.8), primary ciliary dyskinesia (OR, 12.9; 95% CI, 3.0–54.8), bronchiolitis obliterans (OR, 7.0; 95% CI, 1.7–28.5), and a diagnosis of RP at an age of >3 years (OR, 3.4; 95% CI, 1.3–9.0) were risk factors for severe outcomes. Aspiration (OR, 2.9; 95% CI, 1.3–6.3) and an abnormal family history (OR, 3.3; 95% CI, 1.3–8.2) were risk factors for rehospitalization. Conclusions The majority (87.7%) of hospitalized children with RP exhibited underlying causes, and genetic defects were common.