Risk factors for readmission of children hospitalized with acute asthma attacks in South China

Mechanisms of Long-Term Persistence of Mycoplasmas in Children with Asthma

Improving the management of children with asthma associated with mycoplasma infection is important. Aim: To study the duration of the persistence of antigens, and DNA in a free state, in the structures of circulating immune complexes (CICs) and living cells of Mycoplasma pneumoniae (Mpn) and Mycoplasma hominis (Mh) in children with asthma. In total, 205 children with asthma from 1 to 14 years were observed. The reaction of aggregate-hemagglutination (AHAA), the direct immunofluorescence reaction (DIF), the reaction of the polymerase chain reaction (PCR), and the culture method were used. In addition, 47 children were re-examined 1.5 months after the treatment of mycoplasma infection with azithromycin. The number of samples positive for antigens and DNA in the free state and in the structures of CICs significantly decreased. Then, 50 blood serum samples containing Mh antigens, and 50 samples containing Mpn antigens were analyzed by culture method. Mh was isolated in 21 (65.5%) of 32 samples containing DNA. Mpn was isolated from antigen-positive samples in nine cases. The presented data indicate the long-term persistence of antigens, and DNA of mycoplasma cells in the free state, in the structure of CICs, as well as in the form of "microcolonies". A high level of CICs can be used to predict the course of the disease and the response to therapy.

Modifiable factors associated with pediatric asthma readmissions: a multi-center linked cohort study

OBJECTIVES

To (a) identify rates of hospital readmission and emergency department (ED) re-presentation for asthma within a 12-month period, (b) estimate the effects of modifiable hospital, general practitioner (GP) and home environmental factors on hospital readmission, ED re-presentations and rescue oral corticosteroid use.

METHODS

We recruited 767 children aged 3-18 years who were admitted to 3 hospitals in Victoria, Australia between 2017 and 2018 with a validated diagnosis of asthma on chart review. Primary outcome was hospital readmission with asthma within 12 months of index admission. Secondary outcomes were ED re-presentation for asthma and rescue oral corticosteroid use. All outcomes were identified through linked administrative datasets. Their caregivers and 277 nominated GPs completed study surveys regarding the home environment and their usual asthma management practices respectively.

RESULTS

Within 12 months of an index admission for asthma 263 (34.3%) participants were readmitted to a hospital for asthma, with participants between the ages of 3-5 years accounting for 69.2% of those readmitted. The estimated effect of GP reported guideline discordant care on the odds of readmission was OR 1.57, 95% CI 1.00-2.47, p = 0.05. None of the hospital or home environmental factors appeared to be associated with hospital readmissions.

CONCLUSIONS

Hospital readmissions among Australian children with asthma are increasing, and linked datasets are important for objectively identifying the health services burden of asthma. They also confirm the important role of the GP in the management of pediatric asthma.

The effects of different parity and delivery mode on wheezing disorders in the children-a retrospective cohort study in Fujian, China

BACKGROUND

The relationship between childbirth delivery methods and the risk of wheezing in children remains controversial. Few studies have explored it under different maternal conditions.

OBJECTIVE

To explore the influence of childbirth delivery method on the onset of wheezing in children of different parity.

METHODS

A total of 21716 patients were included in this retrospective observational study. Multivariable logistic regression was used to analyze the relationship between childbirth delivery method and wheezing in children under 18 years of age in Fujian Province.

RESULTS

Wheezing differed statistically based on the child's sex, age, season of onset, parity, jaundice history, and feeding patterns (P < 0.05). After adjusting for confounding factors, in cases of parity greater than two, the risk of wheezing in cesarean section deliveries was higher than that in vaginal deliveries (OR: 1.107; 95% CI 1.010-1.214). In girls with parity greater than two (OR: 1.179; 95% CI 1.003-1.387) and normal-weight infants with parity greater than two (OR: 1.106; 95% CI 1.003-1.220), the risk of wheezing in cesarean section deliveries was higher. The interaction term between the mode of childbirth and parity was significant in girls (P = 0.014).

CONCLUSION

The method of childbirth delivery and parity are related to the risk of wheezing and may be relevant to gender and birth weight. Parity and gender have synergistic effects on wheezing.

Understanding caregiver perspectives on challenges and solutions to pediatric asthma care for children with a previous hospital admission: a multi-site qualitative study

OBJECTIVE

Pediatric hospital admissions for asthma provide an opportunity to trigger a review of the current management with an aim of preventing readmissions. However, caregiver voices on how best to improve care are missing.

METHODS

As part of a larger, mixed methods cohort study, we identified caregivers of children aged 3-18 years who had an index hospital admission to a tertiary pediatric, mixed adult and pediatric, or regional hospital in Victoria, Australia, between 1st September 2017 and 31st August 2018 with a discharge diagnosis of "Asthma" or "Wheeze" based on International Classification of Disease-10 coding. We conducted qualitative semi-structured interviews with a purposive sample of 39 caregivers. We used content analysis to identify themes from the data.

RESULTS

Caregivers identified both challenges associated with asthma care for children with a previous hospital admission as well as solutions to improve care and potentially reduce readmissions. Key challenges included: unclear pathways for follow up care, inconsistent advice, lack of personalized management, delays in getting a diagnosis, delays in the prescription of a preventer medication, and difficulty accessing primary care during exacerbations. Follow up with an "asthma specialist", early access to a trial of preventer medication, personalized Written Asthma Action Plans and increased access to and quality of community-based asthma support services were identified as key solutions.

CONCLUSIONS

Caregivers have identified several potential solutions that could be implemented to improve care and possibly reduce pediatric asthma hospital readmissions. The challenge now is to co-design, embed and evaluate these in healthcare systems.

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