Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia.

Show simple item record Byrnes Catherine Ann en Trenholme Adrian en Lawrence Shirley en Aish Harley en Higham Julie Anne en Hoare Karen en Elborough Aileen en McBride Charissa en Le Comte Lyndsay en McIntosh Christine en Chan Mow Florina en Jaksic Mirjana en Metcalfe Russell en Coomarasamy Christin en Leung William en Vogel Alison en Percival Teuila en Mason Henare en Stewart Joanna en 2020-11-09T00:48:43Z 2020-11-09T00:48:43Z 2020-4 en
dc.identifier.citation Thorax 75(4):298-305 Apr 2020
dc.identifier.issn 0040-6376 en
dc.description.abstract BACKGROUND:Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge. METHODS:This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22. FINDINGS:400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe. INTERPRETATION:We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years. TRIAL REGISTRATION NUMBER:ACTRN12610001095055. en
dc.format.medium Print-Electronic en
dc.language eng en
dc.publisher BMJ PUBLISHING GROUP en
dc.relation.ispartofseries Thorax en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri en
dc.subject Humans en
dc.subject Pneumonia, Bacterial en
dc.subject Bronchiectasis en
dc.subject Bronchiolitis en
dc.subject Anti-Bacterial Agents en
dc.subject Prognosis en
dc.subject Hospitalization en
dc.subject Severity of Illness Index en
dc.subject Risk Assessment en
dc.subject Follow-Up Studies en
dc.subject Prospective Studies en
dc.subject Single-Blind Method en
dc.subject Parents en
dc.subject Time Factors en
dc.subject Infant en
dc.subject Caregivers en
dc.subject Community Health Services en
dc.subject Australia en
dc.subject Female en
dc.subject Male en
dc.subject Outcome Assessment, Health Care en
dc.subject 1117 Public Health and Health Services en
dc.subject Clinical en
dc.subject Public Health en
dc.subject Prevention en
dc.subject Clinical Trials and Supportive Activities en
dc.subject Lung en
dc.subject Clinical Research en
dc.subject Infectious Diseases en
dc.subject Pediatric en
dc.subject Respiratory en
dc.subject Science & Technology en
dc.subject Life Sciences & Biomedicine en
dc.subject Respiratory System en
dc.subject paediatric lung disaese en
dc.subject pneumonia en
dc.subject respiratory infection en
dc.subject bronchiectasis en
dc.subject CYSTIC-FIBROSIS en
dc.subject LUNG-FUNCTION en
dc.subject BRONCHIECTASIS en
dc.subject CHILDHOOD en
dc.subject SOCIETY en
dc.subject HEALTH en
dc.subject DYSFUNCTION en
dc.subject GUIDELINES en
dc.subject MANAGEMENT en
dc.subject 1103 Clinical Sciences en
dc.title Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia. en
dc.type Journal Article en
dc.identifier.doi 10.1136/thoraxjnl-2019-213142 en
pubs.issue 4 en
pubs.begin-page 298 en
pubs.volume 75 en 2020-10-01T22:11:44Z en
dc.rights.holder Copyright: The authors en en
pubs.end-page 305 en
pubs.publication-status Published en
dc.rights.accessrights en
pubs.subtype Research Support, Non-U.S. Gov't en
pubs.subtype research-article en
pubs.subtype Randomized Controlled Trial en
pubs.subtype Journal Article en
pubs.elements-id 795842 en
dc.identifier.eissn 1468-3296 en

Files in this item

Find Full text

This item appears in the following Collection(s)

Show simple item record


Search ResearchSpace