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Pulmonary damage after burns can linger in children at least 10 years

Systemic responses triggered by burn injuries, such as respiratory infection and edema, may persist in some children for at least 10 years after the wound has healed, according to data published in Pediatrics.

The study, conducted in Western Australia, also demonstrated increased respiratory infection admissions after burns. The researchers added that pediatric burn patients should receive prolonged clinical and routine assessments in primary care following discharge.

“Despite a decline in the incidence of burn admissions in developed countries over the past few decades, children remain a vulnerable high-risk group,” Janine M. Duke, PhD, of the University of Western Australia School of Surgery’s Burn Injury Unit, and colleagues wrote. “The burden of burn injury is significant in terms of acute care and chronic health effects. Burns initiate a range of acute systemic responses to restore tissue integrity and homeostasis, including activating the immune system, the blood coagulation cascade and inflammatory pathways.”

To determine hospital service use for respiratory morbidity in children with cutaneous burns but no smoke inhalation over the course of a decade, the researchers conducted a population-based longitudinal study. They used data from linked hospital and death in Western Australia for children younger than 5 years hospitalized for a first burn injury between 1980 and 2012 (n = 5,290). They also examined a frequency matched noninjury comparison cohort randomly selected from Western Australia birth registrations (n = 27,061).

To generate adjusted incidence and hazard ratios, the researchers used multivariate negative binomial and Cox proportional hazards regression models.

According to the researchers, after adjusting for demographics and preexisting health status, the burn cohort showed higher rates of admissions for influenza and viral pneumonia (IRR = 1.78; 95% CI, 1.1-2.87), bacterial pneumonia (IRR = 1.34; 95% CI, 1.06-1.7), and other respiratory infections (IRR = 1.65; 95% CI, 1.43-1.9) when compared with the noninjured cohort. There was no significant difference between the groups for other upper respiratory tract conditions or chronic lower respiratory diseases.

“Our results identify the need for prolonged clinical care of pediatric burn patients and regular health assessments via primary care after discharge,” Duke and colleagues wrote. “Burns affect multiple systems of the body and the pathophysiological mechanisms are most likely wide-ranging.” – by Jason Laday

Disclosure: Duke reports no relevant financial disclosures. See the full study for additional researchers’ disclosures.