Children with CLDP in daycare at increased risk for respiratory complications

**McGrath-Morrow S. Pediatrics. 2010;126:632-637.**

Children with chronic lung disease of prematurity who were enrolled in day care were found to be at an increased risk for contracting respiratory infections compared with those infants and children who were not enrolled in day care, according to a recent study.

Between January 2008 and October 2009, researchers studied 111 children and infants with chronic lung disease of prematurity (CLDP) who were born at less than 32 weeks’ gestation, were diagnosed with bronchopulmonary dysplasia before they were discharged from the neonatal ICU and were younger than 3 years at the time of the study. Twenty-two children in the group had attended day care; 89 had never attended day care.

Marked variations were found in the respiratory health of those with CLDP who attended day care and those who did not, and previous studies have shown that exposure to respiratory viruses may be increased in a day care setting. Primary outcomes of the study included reports of respiratory distress that required hospitalization or an ED visit, as well as use of systemic corticosteroids and/or antibiotics and incidences of trouble breathing.

Thirty-seven percent of those who attended day care had an ED visit involving distressing respiratory symptoms vs. 11.5% who were not in day care (OR=3.74; 95% CI, 1.41-9.91). Systemic corticosteroid use for the treatment of respiratory illness was more frequent in those patients with CLDP in day care vs. those not in day care (39.1% vs. 19.4%; OR=2.22; 95% CI, 1.10-4.49). Antibiotic use was 50% higher in the day care group vs. 25.5% in the non-day care group (OR=2.4; 95% CI, 1.08-5.30), as were incidences of labored breathing — 71.5% vs. 47.8%. The rate of hospitalizations for lung-related illnesses were also higher for those in day care (15.2% vs. 5.5%), although this was not considered statistically significant (OR=3.22; 95% CI, 0.97-10.72).

“We found that day care attendance is associated with increased respiratory morbidities in young children with CLDP,” the researchers wrote. “Physicians should consider screening for and educating caregivers about the risks of day care attendance by young children with CLDP.”

PERSPECTIVE

Young children who receive care in out-of-home group settings have a well-defined, increased risk of acquiring a variety of infectious diseases, particularly viral respiratory disease attributable to rhinoviruses, RSV, human metapneumoviruses, influenza viruses, parainfluenza viruses and adenoviruses. The article by McGrath-Morrow and co-workers demonstrates that young children with underlying lung disease who participate in a child care program may experience more frequent respiratory infections with a corresponding increase in need for medical care than similar infants who do not attend child care.

Risk of infection in a child care setting is determined by a number of factors, including hygiene practices by the staff, number, age and immunization status of the children, and ratio of children to caregivers. Routes of spread of respiratory viruses include aerosols, respiratory droplets and contact with contaminated secretions or fomites. Control of infections in such a setting includes education and adherence to standard precautions by the staff (including emphasis on hand hygiene), immunization when appropriate (especially influenza immunization), and exclusion of symptomatic children with more than mild respiratory symptoms from the group setting (although transmission may occur before an index case becomes symptomatic).

– H. Cody Meissner, MD
Chief, Pediatric Infectious Disease, Tufts Medical Center;
Professor of Pediatrics, Tufts University School of Medicine

Follow the PediatricSuperSite.com on Twitter.