Children with a high burden of infections in their first three years of life were over twice as likely to experience severe infections and increased antibiotic use later in childhood, according to a recent study. 

Researchers from the Copenhagen Prospective Studies on Asthma in Childhood examined the long-term impact of early-life infection burden on later risks of moderate to severe infections and systemic antibiotic use in childhood. The study tracked 614 children from birth to age 10 or 13 years, from the Danish population, utilizing diary-recorded data of common infections and national health records for follow-up.

From birth to age three, parents documented daily episodes of infections, including colds, otitis media, tonsillitis, pneumonia, gastroenteritis, and fever. These data were reviewed during routine clinic visits to ensure accuracy. Outcomes, including moderate to severe infections and systemic antibiotic treatments, were assessed using adjusted incidence rate ratios (AIRRs) derived from quasi-Poisson regression models. Researchers accounted for potential confounders such as maternal education, day care exposure, and living environment.

Children with a high burden of early-life infections (≥16 episodes, median split) had a significantly increased risk of later moderate to severe infections (181 vs. 87 episodes; AIRR, 2.39; 95% confidence interval [CI], 1.52–3.89) and systemic antibiotic use (799 vs. 623 episodes; AIRR, 1.34; 95% CI, 1.07–1.68). Each additional infection episode increased the risk of later infections (AIRR, 1.05; 95% CI, 1.02–1.08) and antibiotic treatments (AIRR, 1.02; 95% CI, 1.01–1.04). Subtype analysis revealed significant associations for early colds, otitis media, pneumonia, and gastroenteritis with subsequent infection risks.

Published in JAMA Network Open, the study highlights respiratory infections as the most frequent early-life infections, with pneumonia comprising 77.6% of moderate to severe infections after age three. Viral analyses indicated that early rhinovirus and enterovirus episodes were associated with increased later pneumonia risk (AIRR, 1.70; 95% CI, 1.34–2.12 and AIRR, 1.89; 95% CI, 1.37–2.58, respectively). RSV showed no significant association.

These findings may provide insights into potential associations that could inform prognosis and follow-up for children with a high burden of common infections in early life.

Full disclosures can be found in the published study.