Pneumonia in Infancy and Risk for Asthma: The Role of Familial Confounding and Pneumococcal Vaccination

Penicillin V versus amoxicillin for pneumonia in children - a Swedish nationwide emulated target trial

OBJECTIVES

While most countries recommend amoxicillin for pediatric pneumonia, there is a long tradition of treatment with penicillin V (PcV) in Sweden, thus not empirically covering Haemophilus influenzae. There are, however, large regional differences in treatment practice. The aim was to compare clinical outcomes (treatment failure and severe complications), in children aged 1 to 59 months treated with PcV versus amoxicillin for pneumonia.

METHODS

This population-based emulated target trial included all children born in Sweden between 2001-2021, utilizing national health, sociodemographic, and population registers. All pneumonia cases from hospitals and pediatric outpatient clinics in children aged 1 to 59 months treated as outpatients with PcV or amoxicillin between July 2005-December 2021, were identified. Adjusted odds ratios (aOR)s and 95% confidence intervals (CI)s for treatment failure (new dispensed antibiotic prescription or pneumonia associated hospitalization day 1-14) and severe complications (lung complications, invasive bacterial disease, admission to intensive care unit or death day 1-28) were calculated with logistic regression analysis.

RESULTS

PcV was prescribed in 14,766 cases, and amoxicillin in 10,566. Treatment failure occurred in 7.7% with PcV versus 4.7% with amoxicillin, aOR 1.76 (95% CI: 1.54-2.00). Severe complications were rare, with no significant difference between PcV and amoxicillin (0.3% vs. 0.2%, aOR 0.96, 95% CI: 0.53-1.73). Sensitivity and interaction analyses showed consistent results.

CONCLUSIONS

PcV treatment compared to amoxicillin, was associated with an increased risk for treatment failure but not for severe complications. The absolute risks for adverse outcomes were low in both groups suggesting a minor role of H. influenzae in pediatric pneumonia.

Associations of early life and childhood risk factors with obstructive sleep apnoea in middle-age

BACKGROUND AND OBJECTIVE

Early-life risk factors for obstructive sleep apnoea (OSA) are poorly described, yet this knowledge may be critical to inform preventive strategies. We conducted the first study to investigate the association between early-life risk factors and OSA in middle-aged adults.

METHODS

Data were from population-based Tasmanian Longitudinal Health Study cohort (n = 3550) followed from 1st to 6th decades of life. Potentially relevant childhood exposures were available from a parent-completed survey at age 7-years, along with previously characterized risk factor profiles. Information on the primary outcome, probable OSA (based on a STOP-Bang questionnaire cut-off ≥5), were collected when participants were 53 years old. Associations were examined using logistic regression adjusting for potential confounders. Analyses were repeated using the Berlin questionnaire.

RESULTS

Maternal asthma (OR = 1.5; 95% CI 1.1-2.0), maternal smoking (OR = 1.2; 1.05, 1.5), childhood pleurisy/pneumonia (OR = 1.3; 1.04, 1.7) and frequent bronchitis (OR = 1.2; 1.01, 1.5) were associated with probable OSA. The risk-factor profiles of 'parental smoking' and 'frequent asthma and bronchitis' were also associated with probable OSA (OR = 1.3; 1.01, 1.6 and OR = 1.3; 1.01-1.9, respectively). Similar associations were found for Berlin questionnaire-defined OSA.

CONCLUSIONS

We found novel temporal associations of maternal asthma, parental smoking and frequent lower respiratory tract infections before the age of 7 years with adult OSA. While determination of their pathophysiological and any causal pathways require further research, these may be useful to flag the risk of OSA within clinical practice and create awareness and vigilance among at-risk groups.