Wheezing is a common clinical manifestation in children with
pneumonia. However, the risk factors associated with the development of
wheezing pneumonia and its clinical features are not fully characterized, especially in children with severe
pneumonia.
METHODS: We retrospectively recruited 1434 pediatric patients diagnosed with severe
pneumonia between April 2012 and September 2019 in Fujian Maternity and Child Health Hospital. The medical records regarding demographic information, clinical manifestations, radiographic/laboratory findings, and complications were collected. Based on the presence or absence of
wheezing symptoms and signs, subjects were divided into
wheezing cohort (n=684) and non-
wheezing cohort (n=750), and their clinical data were compared. Multivariate cox regression analysis was performed to identify independent risk factors of
wheezing.
RESULTS: Demographic features including gender, weigh, onset season,
birth weight, full-term birth or not, history of
pneumonia were significantly associated with the occurrence of
wheezing in severe CAP (P<0.05). Specifically, male gender, onset seasons in autumn/winter, and absence of a history of
pneumonia were identified as independent risk factors of
wheezing in multivariate analysis (P<0.05). As for clinical features,
wheezing cohort differed from the non-
wheezing one in terms of clinical manifestation (higher incidence of
cough and breathless, but lower incidence of
fever), laboratory finding (higher levels of red blood cells,
hemoglobin, and
albumin and lower levels of total or indirect
bilirubin and
creatine), pathogen detection (higher incidence of respiratory syncytial
viral infection), and clinical complications (lesser risk of
sepsis and
hydrothorax) (P<0.05).
CONCLUSIONS: Severe CAP with
wheezing is a special clinical entity of severe
pneumonia in children, which has specific risk factors and differ from non-
wheezing pneumonia in terms of clinical features and etiologic pathogens.