Archives of disease in childhoodJournal Article
09 May 2025
Association between hospitalised childhood pneumonia and follow-up chest radiographs in high-risk populations: a secondary analysis of a multicentre randomised controlled trial.
Objective
As children hospitalised with community-acquired pneumonia (CAP) are at risk of persistent chest radiograph (CXR) abnormalities and respiratory sequelae, we investigated factors associated with incomplete CXR resolution at 4 weeks and 12 months post-discharge in children from populations at high-risk of chronic lung disease.
Design
Secondary analysis-multicentre, placebo-controlled, randomised controlled trial.
Settings and patients
324 children aged 3 months to ≤5 years hospitalised with radiographic-confirmed CAP were enrolled from seven hospitals in Australia, New Zealand and Malaysia. After 1-3 days of intravenous antibiotics, then 3 days of oral amoxicillin-clavulanate, they were randomised to extended (13-14 days) or standard (5-6 days) courses of antibiotics.
Intervention
CXRs were performed at admission, 4 weeks, and 12 months post-discharge and reviewed in a blinded manner.
Main outcome measures
Radiographic changes of pneumonia at 4 weeks and 12 months post-discharge compared with admission CXRs.
Results
Among children with interpretable CXRs, incomplete resolution was seen in 42/253 (17%) at 4 weeks, and 29/212 (14%) at 12 months. Characteristics at admission associated with incomplete CXR resolution at 4 weeks were previous pneumonia hospitalisation (adjusted odds ratio [OR])=6.46, 95% confidence interval [CI] 2.21 to 18.85) and increasing age (OR=0.60 per-year, 95% CI 0.38 to 0.94). Continuing respiratory symptoms/signs at 4 weeks post-discharge was also associated with incomplete resolution (OR=5.63, 95% CI 2.38 to 13.32). At 12 months, previous pneumonia hospitalisation was associated with persistent incomplete CXR resolution (OR=4.03, 95 % CI 1.25 to 13.02).
Conclusion
In high-risk settings, younger age, those with previous pneumonia hospitalisation, or ongoing respiratory symptoms/signs 4 weeks post-discharge from hospitalised CAP may be associated with incomplete CXR resolution. Consequently, follow-up imaging and monitoring may be warranted in these children.
COI Statement
Competing interests: ABC, KG, STY, RSW, GBM, NF, PSM, JWU and PJT report grants from the Australian National Health and Medical Research Council (NHMRC) and NHMRC-managed grants (Medical Research Futures Fund), during the conduct of the study. AC is also an independent data management committee member for clinical trials for Moderna (COVID-19 and EBV vaccines) and of an unlicensed vaccine (GlaxoSmithKline) and monoclonal antibody (AstraZeneca), received fees to the institution for consulting on the study designs for Zambon and Boehringer Ingelheim, airfares for travel from the European Respiratory Society and Boehringer Ingelheim and personal fees for being an author of two UpToDate chapters that are outside the submitted work. HCK, SMF, AMN, CAB, NN, NS, TWY, VMO, IBM, JAdB, KPE, BL and MHO have no conflicts of interest to disclose.
Article info
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Doi:
10.1136/archdischild-2024-328111
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