Background Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge. Methods This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to ‘intervention’ or ‘control’. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22. Findings 400 children (203 intervention, 197 control) were enrolled in 2011–2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe. Interpretation We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years. Trial registration number ACTRN12610001095055.

中文翻译：

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预防严重细支气管炎或肺炎住院后儿童呼吸道疾病的前瞻性社区计划与父母驱动的护理

背景 儿童早期因严重下呼吸道感染 (LRTI) 住院与持续的呼吸道症状和以后可能发生的支气管扩张有关。我们的目标是在出院时通过社区干预计划来减少这种中度呼吸道疾病的发病率。方法 这项随机、对照、单盲试验将因严重 LRTI 住院的 2 岁以下儿童纳入“干预”或“对照”。干预是三个月一次的社区诊所，用长期抗生素治疗湿咳，转介无反应者。所有其他健康问题都得到解决，并鼓励健康适应行为，并转介住房或吸烟问题。控制遵循父母发起的医疗保健访问的通常途径。24个月后，所有儿童均由对湿咳、异常检查（噼啪声或杵状指）或胸部 X 射线 Brasfield 评分≤22 的主要结局随机化不知情的儿科医生进行评估。结果 2011-2012 年招募了 400 名儿童（203 名干预，197 名对照）；平均年龄 6.9 个月，230 名男孩，87% 是毛利人/太平洋岛民，83% 来自最贫困的五分之一。321/400 (80.3%) 的最终评估显示湿咳的存在（33.9% 干预，36.5% 对照，相对风险 (RR) 0.93，95% CI 0.69 至 1.25）、异常检查（21.7% 干预，23.9 % 对照，RR 0.92，95% CI 0.61 至 1.38）或 Brasfield 评分≤22（32.4% 干预，37.9% 对照，RR 0.85，95% CI 0.63 至 1.17）。在此时间范围内，有 12 人（所有干预措施）被诊断为支气管扩张。解释 我们已经确定了患有严重 LRTI 入院后患持续性呼吸系统疾病的高风险儿童，他们的干预计划在 2 年内没有改变结果。试用注册号 ACTRN12610001095055。