Subscribe to RSS
DOI: 10.1055/s-0039-3401984
Pulmonary Hypertension in Children with Lower Respiratory Tract Infections in the Konya Province of Turkey
Publication History
21 June 2019
14 November 2019
Publication Date:
02 January 2020 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00029028/202002/lookinside/thumbnails/10-1055-s-0039-3401984_1900065-1.jpg)
Abstract
Objective Lower respiratory tract infections (LRTI) are one of the most important causes of morbidity and mortality in childhood. Hypoxemia, pulmonary hypertension (PH) due to pulmonary vasoconstriction, and heart failure due to various causes are the most important risk factors for mortality in LRTI. The aim of this study was to investigate characteristics of the patients with LRTI and the frequency of PH that developed secondary to LRTI.
Materials and Methods The study included 70 patients who were diagnosed as having LRTI clinically and radiologically between January 2012 and March 2013 at Department of Pediatrics, Konya Training and Research Hospital. Age, sex, risk factors for LRTI, symptoms and physical examination findings, laboratory tests, and Doppler echocardiography findings of the patients were retrospectively reviewed.
Results Of the patients, 44 (62.9%) were male and 26 (37.1%) were female. Thirty-seven (52.9%) patients were younger than 1 year, and the mean age was 2.5 ± 3.11 years. The most common symptoms of the patients were cough and fever. Rhonchus, retraction, and crackles were found to be the most common findings in physical examinations. Heart failure was found in 10% of patients and PH was detected in 8.6% through Doppler echocardiography. Development of heart failure and the presence of bilateral patch infiltration on posteroanterior chest X-rays were significantly more frequent in patients with PH. Some 42.9% of patients had at least one viral agent in their nasopharyngeal swabs. The most common viral agents were respiratory syncytial virus and rhinoviruses.
Conclusion PH may develop during the course of LRTI in children. Given that the development of PH can cause life-threatening complications such as heart failure, affected patients should be kept under close follow-up. It should be remembered that PH is more likely to develop in patients with bilateral patch infiltration on chest X-ray.
-
References
- 1 GBD 2015 LRI Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 2017; 17 (11) 1133-1161
- 2 Korsun N, Angelova S, Trifonova I. , et al. Viral pathogens associated with acute lower respiratory tract infections in children younger than 5 years of age in Bulgaria. Braz J Microbiol 2019; 50 (01) 117-125
- 3 Mani CS, Murray DL. Acute pneumonia and its complications. In: Long SS, Pickering LK, Prober CG. , eds. Principles and Practice of Pediatric Infectious Diseases, 3rd ed. Philadelphia: Elsevier Inc; 2008: 245-257
- 4 Akçalı S, Yılmaz N, Güler N. , et al. Frequency of respiratory viruses in children with lower respiratory tract infection. Turk Arch Ped 2013; 48: 215-220
- 5 Uygur P, Oktem S, Boran P, Tutar E, Tokuc G. Low- versus high-flow oxygen delivery systems in children with lower respiratory infection. Pediatr Int (Roma) 2016; 58 (01) 49-52
- 6 Rojas MX, Granados Rugeles C, Charry-Anzola LP. Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age. Cochrane Database Syst Rev 2009; (01) 1CD005975
- 7 Kabir S, Khatoon S, Fatmi L. , et al. Cardiovascular changes in children with acute lower respiratory tract infection. Bangladesh Child Health. 2019; 43 (01) 27-34
- 8 Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012; 125 (06) 773-781
- 9 Kurskaya O, Ryabichenko T, Leonova N. , et al. Viral etiology of acute respiratory infections in hospitalized children in Novosibirsk City, Russia (2013–2017). PLoS One 2018; 13 (09) e0200117
- 10 le Roux DM, Nicol MP, Myer L. , et al. Lower respiratory tract infections in children in a well-vaccinated South African birth cohort: spectrum of disease and risk factors. Clin Infect Dis 2019; 69 (09) 1588-1596
- 11 Shi T, Balsells E, Wastnedge E. , et al. Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: systematic review and meta-analysis. J Glob Health 2015; 5 (02) 020416
- 12 Shafik CF, Mohareb EW, Yassin AS. , et al. Viral etiologies of lower respiratory tract infections among Egyptian children under five years of age. BMC Infect Dis 2012; 12: 350
- 13 Jıang Y, Zhu Q, Wu J. , et al. Viral etiology and clinical features of severe acute respiratory infection (SARI) in children under 5 years admitted to the Children's Hospital in Suzhou, China [in Chinese]. Fudan Univ J Med Sci 2013; 40 (04) 407-412
- 14 Ma YJ, Wang SM, Cho YH. , et al; Taiwan Pediatric Infectious Disease Alliance. Clinical and epidemiological characteristics in children with community-acquired mycoplasma pneumonia in Taiwan: a nationwide surveillance. J Microbiol Immunol Infect 2015; 48 (06) 632-638
- 15 Berg AS, Inchley CS, Fjaerli HO, Leegaard TM, Lindbaek M, Nakstad B. Clinical features and inflammatory markers in pediatric pneumonia: a prospective study. Eur J Pediatr 2017; 176 (05) 629-638
- 16 Cevey-Macherel M, Galetto-Lacour A, Gervaix A. , et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr 2009; 168 (12) 1429-1436
- 17 Kocabaş E, Doğru Ersöz D, Karakoç F. , et al. Çocuklarda Toplumda Gelişen Pnömoni Tanı ve Tedavi Uzlaşı Raporu. Türk Toraks Dergisi. 2009; 10: 5-26
- 18 Şişmanlar T, Aslan AT, Gülbahar Ö, Özkan S. The effect of vitamin D on lower respiratory tract infections in children. Turk Pediatri Ars 2016; 51 (02) 94-99
- 19 Nimdet K, Techakehakij W. Congestive heart failure in children with pneumonia and respiratory failure. Pediatr Int (Roma) 2017; 59 (03) 258-264
- 20 İlten F, Şenocak F, Zorlu P, Teziç T. Cardiovascular changes in children with pneumonia. Turk J Pediatr 2003; 45 (04) 306-310
- 21 Sadoh WE, Osarogiagbon WO. Pneumonıa complıcated by congestıve heart faılure ın Nıgerıan chıldren. East Afr Med J 2012; 89 (10) 322-326
- 22 Reshadat S. Prevalence of pneumonia among children with congestive heart failure (CHF) admitted at Shaheed Beheshti Hospital (Kermansllab-1997). J Kerman Univ Med Sci (Behbood) 2002; 5: 48-53
- 23 Bardi-Peti L, Ciofu EP. Pulmonary hypertension during acute respiratory diseases in infants. Maedica (Buchar) 2010; 5 (01) 13-19
- 24 Uner A, Caksen H, Arslan S, Abuhandan M, Oner AF, Odabaş D. Doppler echocardiographic evaluation of pulmonary artery pressure in children with acute pneumonia. Acta Paediatr Taiwan 2002; 43 (01) 10-14
- 25 Sreeram N, Watson JG, Hunter S. Cardiovascular effects of acute bronchiolitis. Acta Paediatr Scand 1991; 80 (01) 133-136
- 26 Rodriguez-Gonzalez M, Benavente-Fernandez I, Castellano-Martinez A, Lechuga-Sancho AM, Lubian-Lopez SP. NT-proBNP plasma levels as biomarkers for pulmonary hypertension in healthy infants with respiratory syncytial virus infection. Biomarkers Med 2019; 13 (08) 605-618
- 27 Kimura D, McNamara IF, Wang J, Fowke JH, West AN, Philip R. Pulmonary hypertension during respiratory syncytial virus bronchiolitis: a risk factor for severity of illness. Cardiol Young 2019; 29 (05) 615-619
- 28 Shann F, MacGregor D, Richens J, Coakley J. Cardiac failure in children with pneumonia in Papua New Guinea. Pediatr Infect Dis J 1998; 17 (12) 1141-1143
- 29 Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT features of viral pneumonia. Radiographics 2018; 38 (03) 719-739