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OBJECTIVES: to analyze the climate seasonality of respiratory diseases in children aged 0-9 years and present a model to predict hospital admissions for 2021 to 2022. METHODS: verify, in a temporal manner, the correlation of admissions for pneumonia, bronchitis/bronchiolitis, and asthma with meteorological variables, aiming to demonstrate seasonality with the adjustment of temporal series models. RESULTS: there was a seasonal effect in the number of registered cases for all diseases, with the highest incidence of registrations in the months of autumn and winter. CONCLUSIONS: it was possible to observe a tendency towards a decrease in the registration of pneumonia cases; In cases of admissions due to bronchitis and bronchiolitis, there was a slight tendency towards an increase; and, in occurrence rates of asthma, there was no variation in the number of cases.

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La bronquiolitis aguda es una condición respiratoria frecuente en los niños menores de 2 años. Representa la principal causa de hospitalización infantil y se caracteriza por la presencia de sibilancias asociada a signos de una infección respiratoria alta. El agente etiológico más común es el virus respiratorio sincicial. Existe una falta de consenso con respecto a su definición clínica; y por ello, su tratamiento varía en todo el mundo. El diagnóstico es clínico, sin necesidad de emplear laboratorio o imágenes en forma rutinaria. Diversas revisiones han demostrado que los broncodilatadores, adrenalina, corticoides y antibióticos, entre otros, carecen de eficacia por lo que no se sugiere su empleo. El tratamiento sigue siendo de soporte, mediante la administración de oxígeno y manteniendo una adecuada hidratación. Cuando no se logra disminuir el trabajo respiratorio o corregir la hipoxemia se puede utilizar la presión positiva en la vía aérea para prevenir y controlar la insuficiencia respiratoria. Este artículo desarrolla una breve revisión de las principales características clínicas, epidemiológicas, radiológicas, así como algunos de los diferentes tratamientos publicados en las últimas dos décadas.

Acute bronchiolitis is a common respiratory condition in children under 2 years old. It represents the main cause of childhood hospitalization characterized by the presence of wheezing associated with signs of an upper respiratory infection. The most common etiologic agent is respiratory syncytial virus. There is a lack of consensus regarding its clinical definition; and therefore, its treatment varies around the world. Diagnosis is clinical, without the need for routine laboratory or imaging. Various reviews have shown that bronchodilators, epinephrine, corticosteroids, and antibiotics, among others, lack efficacy, so their use is not suggested. Treatment continues to be supportive, by administering oxygen and maintaining adequate hydration. When it is not possible to reduce the work of breathing or correct the hypoxemia, positive airway pressure can be used to prevent and control respiratory failure. This article develops a brief review of the main clinical, epidemiological, and radiological characteristics, as well as some of the different treatments published in the last two decades.

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Fundamento: la bronquiolitis aguda es una enfermedad de etiología viral caracterizada por obstrucción de la pequeña vía aérea que afecta a los niños menores de 24 meses. Objetivo: determinar los factores asociados al desarrollo de la bronquiolitis aguda. Métodos: se realizó un estudio de casos y controles en el municipio de Guáimaro, provincia Camagüey, entre junio de 2016 a diciembre de 2017. Los casos fueron 37 niños menores de dos años con diagnóstico clínico de bronquiolitis e igual cantidad de niños sin este diagnóstico conformaron los controles. La información se obtuvo mediante un cuestionario a los padres, donde se obtuvo información sobre: la edad del niño, el sexo, la severidad, edad gestacional al nacer, vía de nacimiento, peso al nacer, lactancia materna exclusiva, historia de atopia familiar, concurrir a circulo infantil, hermanos en edad escolar, madre fumadora en el embarazo y exposición al humo del tabaco en el domicilio. Resultados: hubo predominio de los menores de seis meses de sexo masculino y clasificado de leves. Las condiciones que mostraron asociación estadística con la aparición de la bronquiolitis fueron: madre fumadora en el embarazo, ausencia de lactancia materna exclusiva, la historia familiar de atopia y la exposición al humo del tabaco en el domicilio. Conclusiones: fueron los factores de riesgo para el desarrollo de la bronquiolitis: el fumar en el embarazo, ausencia de lactancia materna exclusiva, la historia familiar de atopia y la exposición al humo del tabaco en el domicilio (AU)

Background: the acute bronchiolitis is a disease caused by viruses that produced obstruction of the airways in children less than two years old. Objective: to determine the factors associated with the development of acute bronchiolitis. Methods: a case-control study was made in Guáimaro, Camagüey province, Cuba from June 2015 to January 2017. The cases were 37 children under two years old with diagnostic of bronchiolitis and the same number of children without diagnostic were the controls. The information was obtained through a questionnaire applied to parents of children. The variables analyzed were age, gender, severity, weight at birth, gestational age at birth, childbirth, breastfeeding, family history of atopic disease, siblings in scholar age, nursery assistance, smoker mother during pregnancy and exposition to tobacco smoke in the home.Results: there was predominance of the minors of six months, of masculine sex and classified of light. There was significant relationships between bronchiolitis and the smoker mother during pregnancy, absence of exclusive breastfeeding, family history of atopic disease and exposition to tobacco smoke in the home. Conclusions: were factors for the development of bronchiolitis: mother smoked during pregnancy, absence of exclusive breastfeeding, family history of atopic disease and exposition to tobacco smoke in the home (AU)

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OBJECTIVE: To evaluate trends and geographic distribution of infant bronchiolitis hospitalizations in Chile, a country with large variation in solar radiation (SR) and high rates of urban air pollution. METHODS: We performed a nationwide ecological study of bronchiolitis hospitalizations from 2001 to 2014. We investigated the associations of regional SR (a proxy of vitamin D status) and regional fine particulate matter (PM2.5) air pollution with bronchiolitis hospitalizations. We also evaluated the role of sociodemographic factors, including regional poverty, education, indigenous population, and rurality rates. RESULTS: During the study period, 119 479 infants were hospitalized for bronchiolitis in Chile; 59% were boys. The mean bronchiolitis hospitalization rate increased from 29 to 41 per 1000 infants per year (P = .02). There was an inverse correlation between regional SR and incidence of hospital admissions for bronchiolitis (r = -0.52, P = .049), accounting for 27% of these hospitalizations. There was also a significant direct correlation between regional ambient PM2.5 and bronchiolitis hospitalizations (R = 0.68, P = .006), accounting for 42% of the variation in admission rate. High firewood and/or coal residential use for heating, high regional poverty, lower years of education, and high rurality rates were also significantly correlated with bronchiolitis hospitalization rates. None of the environmental or sociodemographic factors evaluated were correlated with regional case fatality rates or length of stay at the hospital. CONCLUSIONS: This ecological study revealed significant associations between regional SR, air pollution, and sociodemographic factors with infant bronchiolitis hospitalizations in Chile, suggesting that these factors play a major role in the incidence and severity of respiratory infections in early childhood.

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The objective of this study was to determine the association of respiratory symptoms and medication use and exposure to various air pollutants, PM2.5 components, and source factors in a panel of asthmatic and nonasthmatic children in Santiago, Chile. To this end, 174 children (90 asthmatics and 84 nonasthmatics) were followed throughout the winter months of 2010 and 2011. During the study period, children filled out daily diaries to record respiratory symptoms and medication use. Air pollution data were obtained from government central site measurements and a PM2.5 characterization campaign. PM2.5 source factors were obtained using positive matrix factorization (PMF). Associations of symptoms and exposure to pollutants and source-factor daily scores were modeled separately for asthmatic and nonasthmatic children using mixed logistic regression models with random intercepts, controlling for weather, day of the week, year, and viral outbreaks. Overall, high concentrations of air pollutants and PM2.5 components were observed. Six source factors were identified by PMF (motor vehicles, marine aerosol, copper smelter, secondary sulfates, wood burning, and soil dust). Overall, single pollutant models showed significant and strong associations between 7-day exposures for several criteria pollutants (PM2.5, NO2, O3), PM2.5 components (OC, K, S, Se, V), and source factors (secondary sulfate) and coughing, wheezing and three other respiratory symptoms in both in asthmatic and nonasthmatic children. No associations were found for use of rescue inhalers in asthmatics. Two-pollutant models showed that several associations remained significant after including PM2.5, and other criteria pollutants, in the models, particularly components and source factors associated with industrial sources. In conclusion, exposure to air pollutants, especially PM2.5, NO2, and O3, were found to exacerbate respiratory symptoms in both asthmatic and nonasthmatic children. Some of the results suggest that PM2.5 components associated with a secondary sulfate source may have a greater impact on some symptoms than PM2.5. In general, the results of this study show important associations at concentrations close or below current air quality standards.

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Se revisa críticamente la información científica relacionada con deficiencia de vitamina D (DVD) y riesgo de infecciones respiratorias agudas bajas (IRAB) o asma bronquial en niños. Las IRAB, en especial por virus respiratorio sincicial (VRS) están asociadas a una alta carga de enfermedad. Al no contar aún con una vacuna para ellas, las medidas preventivas y de sostén son las más importantes. El DVD es prevalente en todos los ambientes geográficos, con consecuencias ligadas al metabolismo de calcio y óseo, pero también alteraciones de la inmunidad. Hay evidencia inicial de una asociación entre DVD y mayor riesgo de IRAB, especialmente durante los primeros meses de vida; alelos de algunos polimorfismos del receptor de vitamina D podrían asociarse a un mayor riesgo de IRAB. Este escenario cosmopolita, justifica estudiar el impacto de medidas de suplementación de VD adaptadas a las realidades locales, a la madre durante el embarazo y/o al niño en los primeros meses de vida, que impacten sobre el riesgo de presentar IRAB y asma.

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Se revisa críticamente la información científica relacionada con deficiencia de vitamina D (DVD) y riesgo de infecciones respiratorias agudas bajas (IRAB) o asma bronquial en niños. Las IRAB, en especial por virus respiratorio sincicial (VRS) están asociadas a una alta carga de enfermedad. Al no contar aún con una vacuna para ellas, las medidas preventivas y de sostén son las más importantes. El DVD es prevalente en todos los ambientes geográficos, con consecuencias ligadas al metabolismo de calcio y óseo, pero también alteraciones de la inmunidad. Hay evidencia inicial de una asociación entre DVD y mayor riesgo de IRAB, especialmente durante los primeros meses de vida; alelos de algunos polimorfismos del receptor de vitamina D podrían asociarse a un mayor riesgo de IRAB. Este escenario cosmopolita, justifica estudiar el impacto de medidas de suplementación de VD adaptadas a las realidades locales, a la madre durante el embarazo y/o al niño en los primeros meses de vida, que impacten sobre el riesgo de presentar IRAB y asma.

We critically review the information about vitamin D deficiency (VDD) and risk of lower respiratory infections and asthma in children. Acute lower respiratory infections (ALRI), particularly those due to respiratory syncytial virus (RSV) are associated with a high burden of disease. In theabsence of a vaccine for them, prevention and support during illness are important measures to reduce the risk of acquiring the condition or decreasing its severity. VDD has been described as prevalent in all geographical environments; its consequences are linked to calcium and bone metabolism, but also to impaired immunity. Recent evidence of an association between VDD and increased risk of ALRI, especially during the first few months of life has been demonstrated; alleles of some polymorphism of vitamin D receptor may be involved in an increased risk of LRTI. It is justified to study the impact of measures of vitamin D supplementation adapted to local environments, including the appropriate doses to the mother during pregnancy and/or to the child in the first months of life, on the risk of ALRI, or asthma in later ages.

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OBJECTIVE: Aspiration can cause a variety of pulmonary syndromes, some of which are not well recognized. The objective of this study was to assess the demographic, clinical, radiological, and histopathological correlates of diffuse aspiration bronchiolitis (DAB), a bronchiolocentric disorder caused by recurrent aspiration. METHODS: This was a retrospective study of 20 consecutive patients with DAB seen at the Mayo Clinic in Rochester, Minnesota, between January 1, 1998 and June 30, 2014. RESULTS: The median age of the patients was 56.5 years (range, 22-76 years), and the male/female ratio was 2.3:1.0. In 18 patients, the diagnosis of DAB was based on the results of a lung biopsy; in the 2 remaining patients, it was based on clinical and radiological features, together with documented aspiration observed in a videofluoroscopic swallow study. In 19 patients (95%), we identified predisposing factors for aspiration, including gastroesophageal reflux disease (GERD), drug abuse, and dysphagia. Common presenting features included cough, sputum production, dyspnea, and fever. Twelve patients (60%) had a history of recurrent pneumonia. In all of the patients, chest CT revealed bilateral pulmonary infiltrates consisting of micronodules and tree-in-bud opacities. In the majority of patients, interventions aimed at preventing recurrent aspiration (e.g., anti-GERD therapies) led to improvement in the symptoms of DAB. CONCLUSIONS: Young to middle-aged subjects with recognizable predisposing factors for aspiration and who report a history of recurrent pneumonia are at increased risk for DAB. Although DAB is not well recognized, certain chest CT features are characteristic of the disorder.

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Se realiza una revisión bibliográfica sobre las infecciones respiratorias agudas pediátricas, específicamente sobre bronquiolitis. Se dan a conocer aspectos relacionados con los factores de riesgo, etiología, diagnóstico y tratamiento. Se utiliza como método empírico el análisis documental y bibliográfico (AU)

A literature review on pediatric acute respiratory infections, specifically bronchiolitis is performed. Different aspects of risk factors, etiology, diagnosis and treatment are given . Documentary and bibliographic analysis is used as empirical method(AU)

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OBJETIVO: O estresse oxidativo demonstrou contribuir para a patogênese de doenças pulmonares inflamatórias agudas e crônicas. Nosso objetivo foi avaliar o estado oxidante/antioxidante de crianças com bronquiolite aguda por meio de mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. MÉTODOS: As crianças com bronquiolite aguda encaminhadas para o Departamento de Emergência Pediátrica do hospital universitário entre janeiro e abril 2012 foram comparadas a controles saudáveis de mesma idade. Os pacientes com bronquiolite aguda tiveram essa doença classificada como leve e moderada. O estado oxidante e antioxidante foi avaliado pela mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. RESULTADOS: Foram incluídas 31 crianças com bronquiolite aguda com idade de três meses a dois anos e 37 crianças saudáveis. O estado oxidante total (EOT) foi maior em pacientes com bronquiolite aguda do que no grupo de controle (5,16±1,99 µmol H2O2 em comparação a 3,78±1,78 µmol H2O2 [p = 0,004]). A capacidade antioxidante total (CAT) foi significativamente menor em crianças com bronquiolite que no grupo de controle (2,51±0,37 µmol Trolox equivalente/L em comparação a 2,75±0,39 µmol Trolox Eqv/L) (p = 0,013). Os pacientes com bronquiolite moderada apresentaram níveis de EOT mais elevados que os com bronquiolite leve e os do grupo de controle (p = 0,03, p < 0,001). Os pacientes com bronquiolite moderada apresentaram níveis de IEO mais elevados que os do grupo de controle (p = 0,015). O nível de saturação de oxigênio de pacientes com bronquiolite foi inversamente correlacionado ao nível de EOT (r = -0,476, p < 0,05). CONCLUSÃO: O equilíbrio entre os sistemas oxidante e antioxidante é interrompido em crianças com bronquiolite moderada, indicando que o fator de estresse poderá ter um papel na patogênese da doença.

OBJECTIVE: Oxidative stress has been shown to contribute to the pathogenesis of acute and chronic lung inflammatory diseases. This article aimed to evaluate the oxidant/antioxidant status of children with acute bronchiolitis through the measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index. METHODS: Children with acute bronchiolitis admitted to the pediatric emergency department of a university hospital between January and April of 2012 were compared with agematched healthy controls. Patients with acute bronchiolitis were classified as mild and moderate bronchiolitis. Oxidative and antioxidative status were assessed by measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index. RESULTS: Thirty-one children with acute bronchiolitis aged between 3 months and 2 years, and 39 healthy children were included. Total oxidative status (TOS) was higher in patients with acute bronchiolitis than the control group (5.16±1.99 µmol H2O2 versus 3.78±1.78 µmol H2O2 [p = 0.004]). Total antioxidant capacity (TAC) was lower in children with bronchiolitis than the control group (2.51±0.37 µmol Trolox eqv/L versus 2.75±0.39 µmol Trolox eqv/L [p = 0.013]). Patients with moderate bronchiolitis presented higher TOS levels than those with mild bronchiolitis and the control group (p = 0.03, p < 0.001, respectively). Patients with moderate bronchiolitis had higher oxidative stress index levels than the control group (p = 0.015). Oxygen saturation level of bronchiolitis patients was inversely correlated with TOS (r = -0.476, p < 0.05). CONCLUSION: The balance between oxidant and antioxidant systems is disrupted in children with moderate bronchiolitis, which indicates that this stress factor may have a role in the pathogenesis of the disease.

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OBJECTIVE: Oxidative stress has been shown to contribute to the pathogenesis of acute and chronic lung inflammatory diseases. This article aimed to evaluate the oxidant/antioxidant status of children with acute bronchiolitis through the measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index. METHODS: Children with acute bronchiolitis admitted to the pediatric emergency department of a university hospital between January and April of 2012 were compared with age-matched healthy controls. Patients with acute bronchiolitis were classified as mild and moderate bronchiolitis. Oxidative and antioxidative status were assessed by measurement of plasma total antioxidant capacity, total oxidant status, and oxidative stress index. RESULTS: Thirty-one children with acute bronchiolitis aged between 3 months and 2 years, and 39 healthy children were included. Total oxidative status (TOS) was higher in patients with acute bronchiolitis than the control group (5.16±1.99 µmol H2O2 versus 3.78±1.78 µmol H2O2 [p=0.004]). Total antioxidant capacity (TAC) was lower in children with bronchiolitis than the control group (2.51±0.37 µmol Trolox eqv/L versus 2.75±0.39 µmol Trolox eqv/L [p=0.013]). Patients with moderate bronchiolitis presented higher TOS levels than those with mild bronchiolitis and the control group (p=0.03, p<0.001, respectively). Patients with moderate bronchiolitis had higher oxidative stress index levels than the control group (p=0.015). Oxygen saturation level of bronchiolitis patients was inversely correlated with TOS (r=-0.476, p<0.05). CONCLUSION: The balance between oxidant and antioxidant systems is disrupted in children with moderate bronchiolitis, which indicates that this stress factor may have a role in the pathogenesis of the disease.

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La infección respiratoria es un importante motivo de internación en pediatría. Ultimamente se identificó a los Metapneumovirus como agentes etiológicos de infecciones respiratorias. Se estudiaron 897 niños internados a los cuales se les realizó el estudio de detección de virus respiratorios, incluyendo Metapneumovirus, por inmunofluorescencia indirecta entre noviembre y diciembre de 2009. Se detectaron 55 pacientes con muestras positivas para virus respiratorios en secreciones nasofaringeas: 33 de ellas fueron positivas para Metapneumovirus. Se analizaron las características epidemiológicas, clínicas y evolutivas de niños con Metapneumovirus en forma retrospectiva. La edad media fue de 45 meses (r =0 a 204) y el 60% eran mayores de un año. Diecisiete de los mayores de un año (85%) presentaron comorbilidades. La bronquiolitis fue la forma clínica más frecuente en los menores de un año [9 (69%) y 8 (61%)] requirieron oxígeno. Todos tuvieron buena evolución. Conclusiones: Metapneumovirus fue causa de internación en los menores de un año y en los mayores con enfermedad de base. La presentación clínica fue similar a la producida por otros virus. Se observó su predominio sobre otros virus como causa de infección respiratoria entre noviembre y diciembre de 2009.

Respiratory infection is a common cause for hospital admission in children. Recently, the metapneumovirus has been identified as a causative agent of respiratory infection. Between Novem-ber and December 2009, 897 pediatric inpatients were studied for respiratory viruses, including the metapneumovirus, using indirect immunofluorescence techniques. Of all patients, 55 had positive nasopharyngeal samples for respiratory viruses; 33 were positive for the metapneumovirus. The epidemio-logical and clinical features and outcome of the children with metapneumovirus were retrospectively analyzed. Mean age was 45 months (r = 0 to 204) and 60% was older than one year. Seventeen of the children older than one year (85%) presented with comorbidities. Bronchiolitis was the most com-mon clinical presentation in children younger than one year. Nine (69%) and eight (61%) children, respectively, required oxygen therapy. Outcome was good in all patients. Conclu-sions: Metapneumovirus was the cause of hospital admission in children under one year of age and in children older than one year with an underlying disease. Symptoms were similar to those produced by other viruses. Between November and December 2009, the metapneumovirus was more commonly observed than other viruses as a cause of respiratory infection.

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OBJECTIVE: To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil. METHODS: We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. RESULTS: All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. CONCLUSIONS: Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.

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OBJETIVO: Relatar quatro casos de bronquiolite decorrente de exposição a aroma artificial de manteiga em uma fábrica de biscoitos no Brasil. MÉTODOS: Descrevemos os achados clínicos, espirométricos e tomográficos nos quatro pacientes, assim como achados de biópsia pulmonar em um dos pacientes. RESULTADOS: Os quatro pacientes eram homens jovens, não fumantes, e desenvolveram obstrução persistente ao fluxo aéreo (relação VEF1/CVF reduzida e VEF1 de 25-44% do previsto) após 1-3 anos de exposição a diacetil, sem a utilização de equipamentos de proteção individual, em uma fábrica de biscoitos. A TCAR mostrou achados indicativos de bronquiolite. Em um paciente, a biópsia pulmonar cirúrgica mostrou bronquiolite obliterante associada a células gigantes. CONCLUSÕES: A bronquiolite decorrente de exposição a flavorizantes artificiais deve ser considerada em trabalhadores com obstrução ao fluxo aéreo no Brasil.

OBJECTIVE: To report the cases of four patients with bronchiolitis caused by exposure to artificial butter flavoring at a cookie factory in Brazil. METHODS: We described the clinical, tomographic, and spirometric findings in the four patients, as well as the lung biopsy findings in one of the patients. RESULTS: All four patients were young male nonsmokers and developed persistent airflow obstruction (reduced FEV1/FVC ratio and FEV1 at 25-44% of predicted) after 1-3 years of exposure to diacetyl, without the use of personal protective equipment, at a cookie factory. The HRCT findings were indicative of bronchiolitis. In one patient, the surgical lung biopsy revealed bronchiolitis obliterans accompanied by giant cells. CONCLUSIONS: Bronchiolitis resulting from exposure to artificial flavoring agents should be included in the differential diagnosis of airflow obstruction in workers in Brazil.

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OBJECTIVES: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants. METHODS: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed. RESULTS: Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4% <14 at enrollment were 4.4 times those of infants whose mothers had CD4% ≥29 (p=0.003). The odds of LRTI in infants with a CD4+ count (cells/mm(3)) <750 at hospital discharge were 16.0 times those of infants with CD4+ ≥750 (p=0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age. CONCLUSIONS: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed.

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