Background: Acute lower respiratory infections (ALRIs) are leading causes of hospitalisation in children. Birth\ndefects occur in 5% of live births in Western Australia (WA). The association between birth defects and ALRI\nhospitalisation is unknown.\nMethods: We conducted a retrospective cohort study of 245,249 singleton births in WA (1996-2005). Population-based\nhospitalisation data were linked to the WA Register of Developmental Anomalies to investigate ALRI hospitalisations in\nchildren with and without birth defects. We used negative binomial regression to estimate associations between birth\ndefects and number of ALRI hospitalisations before age 2 years, adjusting for known risk factors.\nResults: Overall, 9% of non-Aboriginal children and 37% of Aboriginal children with birth defects had at least one\nALRI admission before age 2 years. Aboriginal children (IRR 2.3, 95% CI: 1.9-2.8) and non-Aboriginal children (IRR 2.0,\n95% CI: 1.8-2.2) with birth defects had higher rates of hospitalisation for an ALRI than children with no birth defects.\nRates of ALRI hospitalisation varied by type of defect but were increased for all major birth defects categories, the\nhighest rate being for children with Down syndrome (IRR 8.0, 95% CI: 5.6-11.5). The rate of ALRI hospitalisation was\n3 times greater in children with multiple birth defects than in those with isolated defects.\nConclusions: Children with birth defects experience higher rates of hospitalisation for ALRIs before age 2 years than\nchildren with no birth defects. Optimal vaccination coverage and immunoprophylaxis for specific categories of birth\ndefects would assist in reducing hospitalisation rates for ALRI.
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