Tekrarlayan Akciğer Enfeksiyonu Olan Hastaların Etiyoloji ve Uzun Dönem İzlemlerinin İncelenmesi

Abstract

Although various outcomes have been reported regarding the prognosis of recurring lower respiratory tract infections starting in childhood, there is no clear and definite information about the risk of developing chronic lung disease in later years. In this study, we planned to investigate the etiology and long-term outcomes of patients referred due to recurring lung infections, whose information was accessed from the hospital record system and who were followed between 2014 and 2023 with a diagnosis of recurring lung infections in the Pediatric Pulmonology Department of Hacettepe University Faculty of Medicine. A total of 480 patients were retrospectively examined in our study, the initial ages of the patients ranged from 0 to 17 years, with 59.6% of them being male. The rate of patients with a history of preterm birth was 25.9%. The average number of pneumonia episodes before admission was 5.29, and the average hospitalization due to pneumonia was 3.32. 82% of the patients had a history of severe lung infections. Atelectasis was most commonly observed in the right middle lobe on thoracic computed tomography (CT) examination, followed by the left lower lobe. Etiology was determined in 84% of the 480 patients. Among the patients with identified etiology, 54,3% had asthma, 38,5% had cardiac disease, 14,4% had congenital anomalies of the airways, 12,4% had neuromuscular diseases, 11,9% had genetic diseases, and 27,8% had other causes. Among the other causes, swallowing dysfunction was found in 16,1% of the patients, gastroesophageal reflux in 11,7%, and bronchopulmonary dysplasia (BPD) in 5%.The most commonly identified bacteria in the cultures of patients were Haemophilus influenzae, and the most commonly detected viral agents were Rhinovirus, Influenza A, and RSV. All patients whose mothers smoked during pregnancy had a history of severe lung infection. The average first forced expiratory flow between 25% and 75% (FEF 25-75) z-score of patients whose mothers smoked during pregnancy was significantly lower than those whose mothers did not smoke during pregnancy. The average final forced expiratory volume in 1 second (FEV1) z-score and the final FEV1/forced vital capacity (FVC) ratio of children of smoking mothers were significantly lower than those of children of nonsmoking mothers. In patients who received breast milk for less than 6 months, the average intensive care unit admission rate was significantly higher, while the average first FEV1 percentage and first FVC percentage were significantly lower compared to others. Patients with a history of BPD had higher rates of intensive care admission and mechanical ventilation history. Patients with a history of hospitalization, antibiotic use, respiratory support, and oxygen requirement in the neonatal period had higher numbers of pneumonia before or after admission, hospitalizations due to pneumonia, and intensive care admissions, and their lengths of stay were also longer. The group with the highest number of pneumonia episodes before admission had the lowest average gestational age, the lowest average birth weight, and the highest average neutrophil/lymphocyte ratio (2.13±3.13). Patients with bronchiectasis on thoracic CT also had higher neutrophil/lymphocyte ratio (NLR) values. Clearly distinguishing diseases such as pneumonia, bronchitis, bronchiolitis, etc., under the heading of recurrent lung infections, determining the underlying etiology, and providing treatment accordingly will not only improve the course of the disease and contribute positively to the prognosis of the patient but will also prevent unnecessary, incorrect diagnostic and treatment modalities for physicians, preventing time and financial losses.