Underlying causes of recurrent pneumonia in children

Objectives: To determine the relative frequency of underlying factors for r ecurrent pneumonia and the proportion of patients in whom the underlying il lness diagnosis was known prior to pneumonia recurrence. Methods: Retrospective medical record review for a 10-year period from Janu ary 1987 through December 1997 at The Hospital for Sick Children in Toronto , Ontario, a tertiary care pediatric hospital. Recurrent pneumonia nas defi ned as at least 2 pneumonia episodes in a 1-year period or at least 3 durin g a lifetime. Results: Of 2952 children hospitalized with pneumonia, 238 (8%) met criteri a for recurrent pneumonia. An underlying illness diagnosis was identified i n 220 (92%). Of these, the underlying illness was diagnosed prior to pneumo nia in 178 (81%), with the first episode in 25 (11%), and during recurrence in 17 (8%). Underlying illnesses included oropharyngeal incoordination wit h aspiration syndrome (114 cases [48%]), immune disorder (24 [10%]), congen ital cardiac defects (22 [9%]), asthma (19 [8%]), pulmonary anomalies (18 [ 8%]), gastroesophageal reflux (13 [5%]), and sickle cell anemia (10 [4%]). Clinical clues to diagnosis were recurrent infections at other locations an d failure to thrive in the cases of an immune disorder, recurrences involvi ng the same location in those with underlying pulmonary pathology, the asso ciation of respiratory symptoms with feeding in those with gastroesophageal reflux, or recurrent wheezing in asthmatic children. Conclusions: Recurrent pneumonia occurs in fewer than one tenth of all chil dren hospitalized with pneumonia. Most of them have a known predisposing fa ctor. The most common cause was oropharyngeal incoordination.