Respiratory Morbidity After Childhood Burns: A 10-Year Follow-up Study

Abstract

BACKGROUND AND OBJECTIVE: The systemic responses triggered by burns and resuscitative measures may cause pulmonary damage and edema in the acute phase. These effects may occur in the absence of inhalation injury. Currently, there is a paucity of data on the recovery of the respiratory system postburn. This study aimed to examine 10-year hospital service use for respiratory morbidity in children with cutaneous burns and no smoke inhalation injury. METHODS: A population-based longitudinal study with 10-year follow-up using linked hospital and death from Western Australia for children <5 years when hospitalized for a first burn injury (n = 5290) between 1980 and 2012 and a frequency matched noninjury comparison cohort, randomly selected from Western Australia’s birth registrations (n = 27 061). Multivariate negative binomial and Cox proportional hazards regression models were used to generate adjusted incidence rate ratios (IRR) and hazard ratios, respectively. RESULTS: After adjustment for demographic factors and preexisting health status, the burn cohort had higher rates of admissions for influenza and viral pneumonia (IRR, 1.78; 95% confidence interval [CI], 1.10–2.87), bacterial pneumonia (IRR, 1.34; 95% CI, 1.06–1.70), and other respiratory infections (IRR, 1.65; 95% CI, 1.43–1.90. No significant difference was found for other upper respiratory tract conditions (IRR, 1.10; 95% CI, 0.98–1.23) or chronic lower respiratory diseases (IRR, 0.99; 95% CI, 0.80–1.23) compared with the uninjured cohort. CONCLUSIONS: These findings demonstrated increased respiratory infection admissions after burns. These outcomes suggest that immune changes triggered by a burn injury may persist in some children for at least 10 years after wound healing.