Background: Bronchoalveolar lavage (BAL) is a useful procedure in the diagnosis and treatment of several respiratory diseases. The right middle lobe or lingula is the preferred location of BAL in diffuse lung disease. The aim of this study was to determine the proper location of BAL in infants and children. Design: This was prospective, observational study at Queen Sirikit National Institute of Child Health between January and December 2017. Materials and Methods: Children, aged 1 month to 15 years, who underwent BAL were enrolled for this study. BAL was performed with the flexible bronchoscope under general anesthesia. The total instilled volume was generally 2–3 ml/kg, divided into 2–6 aliquots. The location of BAL was the most affected area in chest radiography. In diffuse lung disease, BAL was performed in all lobes. The volume and percentage of fluid recovered from various lobes were compared. Statistical Analysis: Statistical analysis was performed using SPSS version 23. The value of P < 0.05 was considered statistically significant. Results: A total of 66 patients with a median age of 1.6 years were enrolled. The total volume recovered was 20% of the instilled volume (interquartile range [IQR] 13.4, 31.8). The volume recovered from the right lung (23%, IQR 13.4, 32.58) was significantly higher than from the left lung (18.9%, IQR 12.5, 30, P = 0.019). There was no significant difference between volume recovered from various lobes. However, there was a trend toward higher volume recovered from the right lower lobe (RLL) (25%, IQR 13.1, 33.75). Conclusions: In infants and children, BAL performed in the right lung and RLL is associated with a higher volume recovered.
背景:支气管肺泡灌洗(BAL)是诊断和治疗多种呼吸系统疾病的有效方法。弥漫性肺疾病的首选部位为右中叶或舌部。本研究的目的是确定婴儿和儿童BAL的正确位置。设计:这是一项前瞻性观察性研究，于2017年1月至12月在诗丽吉王后国家儿童健康研究所进行。材料和方法:1个月至15岁的接受BAL治疗的儿童被纳入本研究。全麻下经柔性支气管镜行BAL。总灌注量一般为2-3 ml/kg，分为2-6等分。胸片上BAL的位置是影响最大的区域。弥漫性肺疾病的肺各叶均行BAL。比较了从各叶中回收的液体体积和百分比。统计分析:采用SPSS version 23进行统计分析。P < 0.05为差异有统计学意义。结果:共纳入66例患者，中位年龄为1.6岁。总回收体积为注入体积的20%(四分位数间距[IQR] 13.4, 31.8)。右肺恢复容积(23%，IQR 13.4, 32.58)显著高于左肺恢复容积(18.9%，IQR 12.5, 30, P = 0.019)。各脑叶恢复的体积无显著差异。然而，右下叶(RLL)有更高体积恢复的趋势(25%，IQR 13.1, 33.75)。结论:在婴儿和儿童中，在右肺和RLL进行BAL与更高的恢复容量相关。
{"title":"Location of bronchoalveolar lavage in children","authors":"Natcha Sakrajai, P. Srisan","doi":"10.4103/prcm.prcm_7_18","DOIUrl":"https://doi.org/10.4103/prcm.prcm_7_18","url":null,"abstract":"Background: Bronchoalveolar lavage (BAL) is a useful procedure in the diagnosis and treatment of several respiratory diseases. The right middle lobe or lingula is the preferred location of BAL in diffuse lung disease. The aim of this study was to determine the proper location of BAL in infants and children. Design: This was prospective, observational study at Queen Sirikit National Institute of Child Health between January and December 2017. Materials and Methods: Children, aged 1 month to 15 years, who underwent BAL were enrolled for this study. BAL was performed with the flexible bronchoscope under general anesthesia. The total instilled volume was generally 2–3 ml/kg, divided into 2–6 aliquots. The location of BAL was the most affected area in chest radiography. In diffuse lung disease, BAL was performed in all lobes. The volume and percentage of fluid recovered from various lobes were compared. Statistical Analysis: Statistical analysis was performed using SPSS version 23. The value of P < 0.05 was considered statistically significant. Results: A total of 66 patients with a median age of 1.6 years were enrolled. The total volume recovered was 20% of the instilled volume (interquartile range [IQR] 13.4, 31.8). The volume recovered from the right lung (23%, IQR 13.4, 32.58) was significantly higher than from the left lung (18.9%, IQR 12.5, 30, P = 0.019). There was no significant difference between volume recovered from various lobes. However, there was a trend toward higher volume recovered from the right lower lobe (RLL) (25%, IQR 13.1, 33.75). Conclusions: In infants and children, BAL performed in the right lung and RLL is associated with a higher volume recovered.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"205 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120989161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pulmonary function abnormalities in nigerian children with sickle cell anemia: Prevalence, pattern, and predictive factors","authors":"M. Al-Mendalawi","doi":"10.4103/PRCM.PRCM_1_19","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_1_19","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126107161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.4103/2543-0343.257935
Hongjie Yu
{"title":"Infection and allergy","authors":"Hongjie Yu","doi":"10.4103/2543-0343.257935","DOIUrl":"https://doi.org/10.4103/2543-0343.257935","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"138 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114817945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regulatory T (Treg) cells play a central role in protecting against the development of allergic asthma and interleukin-10 (IL-10) producing T regulatory type 1 (Tr1) cells contribute to the regulation of asthma. Complement regulatory protein CD46 was shown to stimulate the development of IL-10 producing Tr1 cells. Crosslinking of CD46 during CD4+ T cell priming induces production of large amount of IL-10 and granzyme B. These CD46-induced regulatory T cells (Tr1) does not require pre-existing basal expression of FoxP3. Through local IL-10 and granzyme B secretion, such Tr1 cell could control T-cell-mediated inflammation. In asthmatic patients, we found that diminished IL-10, granzyme B, and CCR 4 expression from CD3/CD46-activated Tr1 cells. CD3/CD46-activated Tr1 cells from asthma patients co-cultured with BEAS-2B cells suppressed dermatophagoides pteronyssinus 2 (Der p 2)-induced nuclear factor-κB/p65 by cell contact inhibition. Decreased interaction of CD3/CD46-activated Tr1 and BEAS-2B cells from asthmatics was associated with downregulation of phosphorylation of protein kinase B expression. Decreased interaction between CD46-mediated Tr1 and lung epithelial cells with less IL-10 and granzyme B production may contribute to airway inflammation in allergic asthma. Der p specific immunotherapy enhances the suppressive function of IL-10 in CD46-mediated Tr1 cell from asthmatic patients and suppresses airway inflammation in these patients. Based on these results, it might be possible to design therapeutic strategies to manipulate complement activated Tr1 cells to achieve allergen tolerance and suppress airway inflammation in patients with allergic asthma.
{"title":"Complements and allergic asthma","authors":"Ching‐Yuang Lin, Y. Tsai","doi":"10.4103/PRCM.PRCM_5_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_5_18","url":null,"abstract":"Regulatory T (Treg) cells play a central role in protecting against the development of allergic asthma and interleukin-10 (IL-10) producing T regulatory type 1 (Tr1) cells contribute to the regulation of asthma. Complement regulatory protein CD46 was shown to stimulate the development of IL-10 producing Tr1 cells. Crosslinking of CD46 during CD4+ T cell priming induces production of large amount of IL-10 and granzyme B. These CD46-induced regulatory T cells (Tr1) does not require pre-existing basal expression of FoxP3. Through local IL-10 and granzyme B secretion, such Tr1 cell could control T-cell-mediated inflammation. In asthmatic patients, we found that diminished IL-10, granzyme B, and CCR 4 expression from CD3/CD46-activated Tr1 cells. CD3/CD46-activated Tr1 cells from asthma patients co-cultured with BEAS-2B cells suppressed dermatophagoides pteronyssinus 2 (Der p 2)-induced nuclear factor-κB/p65 by cell contact inhibition. Decreased interaction of CD3/CD46-activated Tr1 and BEAS-2B cells from asthmatics was associated with downregulation of phosphorylation of protein kinase B expression. Decreased interaction between CD46-mediated Tr1 and lung epithelial cells with less IL-10 and granzyme B production may contribute to airway inflammation in allergic asthma. Der p specific immunotherapy enhances the suppressive function of IL-10 in CD46-mediated Tr1 cell from asthmatic patients and suppresses airway inflammation in these patients. Based on these results, it might be possible to design therapeutic strategies to manipulate complement activated Tr1 cells to achieve allergen tolerance and suppress airway inflammation in patients with allergic asthma.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129652093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pertussis incidence has been increasing despite high early childhood vaccination coverage. Various strategies have been recommended to combat this problem which includes cocooning, booster doses for adolescents and young adults, and more recently maternal intrapartum vaccination. A previous report had highlighted an increase in pertussis in infants. This review was done to evaluate if there has been any change in the prevalence in the subsequent 10 years. Materials and Methods: Retrospective cohort study of admissions for pertussis in patients aged 0–18 years in a single-center tertiary maternal-pediatric hospital in Singapore from January 1, 2008, to October 31, 2017. Results: There were 221 cases identified. The majority were infants <6 months (89%) and of Malay (46%) ethnicity. About 54% were male and 81% were delivered term. Nearly, 69.7% had not received pertussis immunization. 64.2% had exposure to an unwell family member with respiratory symptoms. Cough was the most common presenting complaint (100%). High dependency or intensive care treatment was required in 21 cases (9.5%). Length of stay was significantly longer for infants under 6 months of age compared to those aged 6 months or older (additional 1.63 days, 95% confidence interval 0.57–2.68, P = 0.003). Coinfection was found in 23 cases, associated comorbidities in 22 cases, and both conditions in 3 children. There were 2 deaths and 11 readmissions. Conclusions: Pertussis in young infants in Singapore remains a significant healthcare burden despite current immunization strategies. Routine maternal vaccination to confer passive immunity on the newborn child may be beneficial to address this problem.
{"title":"Pertussis in children in an era of vaccination","authors":"A. Snodgrass, A. Goh","doi":"10.4103/PRCM.PRCM_2_19","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_2_19","url":null,"abstract":"Background: Pertussis incidence has been increasing despite high early childhood vaccination coverage. Various strategies have been recommended to combat this problem which includes cocooning, booster doses for adolescents and young adults, and more recently maternal intrapartum vaccination. A previous report had highlighted an increase in pertussis in infants. This review was done to evaluate if there has been any change in the prevalence in the subsequent 10 years. Materials and Methods: Retrospective cohort study of admissions for pertussis in patients aged 0–18 years in a single-center tertiary maternal-pediatric hospital in Singapore from January 1, 2008, to October 31, 2017. Results: There were 221 cases identified. The majority were infants <6 months (89%) and of Malay (46%) ethnicity. About 54% were male and 81% were delivered term. Nearly, 69.7% had not received pertussis immunization. 64.2% had exposure to an unwell family member with respiratory symptoms. Cough was the most common presenting complaint (100%). High dependency or intensive care treatment was required in 21 cases (9.5%). Length of stay was significantly longer for infants under 6 months of age compared to those aged 6 months or older (additional 1.63 days, 95% confidence interval 0.57–2.68, P = 0.003). Coinfection was found in 23 cases, associated comorbidities in 22 cases, and both conditions in 3 children. There were 2 deaths and 11 readmissions. Conclusions: Pertussis in young infants in Singapore remains a significant healthcare burden despite current immunization strategies. Routine maternal vaccination to confer passive immunity on the newborn child may be beneficial to address this problem.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121519352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Ruangnapa, Sittikiat Sucheewakul, T. Liabsuetrakul, E. McNeil, K. Lim, Wanaporn Anantaseree
Objective: The objective of this study is to compare the performance of a modified Pediatric Risk of Mortality (PRISM) III model with the original PRISM III in prediction of mortality risk in a Thailand pediatric intensive care unit (PICU). Subjects and Methods: Children aged 1 month to 18 years who stayed in the PICU for more than 8 h during November 2013 to December 2016 were included in the study. Results: The medical records of 1175 PICU patients were included in the analysis. The patients were randomly split into two equal groups: a development (n = 588) and a validation (n = 587) sample. A modified PRISM III model was derived from the original PRISM III by omitting arterial blood gas parameters and adding selected clinical variables. The model was developed using a multiple logistic regression model on the development sample and assessed using the area under the curve (AUC) obtained from a receiver operating characteristic curve. The modified PRISM III scores were significantly higher in nonsurvivors (median = 9, interquartile range [IQR] = 4 − 13) compared to survivors (median = 2, IQR = 0 − 5). The modified PRISM III model had similar discriminative performances compared to the original PRISM III in predicting 2-day mortality (AUC: 0.874 vs. 0.873), 7-day mortality (AUC: 0.851 vs. 0.851) and overall mortality (AUC: 0.845 vs. 0.956). The modified PRISM III model was calibrated in the validation sample, and the standardized mortality ratios (SMRs) were similar. Conclusions: The performance of a modified PRISM III model in predicting mortality risk was comparable to the original PRISM III. Both had similar discriminative performance and SMR for overall mortality prediction in a PICU.
{"title":"Validation of a modified pediatric risk of mortality III model in a pediatric intensive care unit in Thailand","authors":"K. Ruangnapa, Sittikiat Sucheewakul, T. Liabsuetrakul, E. McNeil, K. Lim, Wanaporn Anantaseree","doi":"10.4103/PRCM.PRCM_11_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_11_18","url":null,"abstract":"Objective: The objective of this study is to compare the performance of a modified Pediatric Risk of Mortality (PRISM) III model with the original PRISM III in prediction of mortality risk in a Thailand pediatric intensive care unit (PICU). Subjects and Methods: Children aged 1 month to 18 years who stayed in the PICU for more than 8 h during November 2013 to December 2016 were included in the study. Results: The medical records of 1175 PICU patients were included in the analysis. The patients were randomly split into two equal groups: a development (n = 588) and a validation (n = 587) sample. A modified PRISM III model was derived from the original PRISM III by omitting arterial blood gas parameters and adding selected clinical variables. The model was developed using a multiple logistic regression model on the development sample and assessed using the area under the curve (AUC) obtained from a receiver operating characteristic curve. The modified PRISM III scores were significantly higher in nonsurvivors (median = 9, interquartile range [IQR] = 4 − 13) compared to survivors (median = 2, IQR = 0 − 5). The modified PRISM III model had similar discriminative performances compared to the original PRISM III in predicting 2-day mortality (AUC: 0.874 vs. 0.873), 7-day mortality (AUC: 0.851 vs. 0.851) and overall mortality (AUC: 0.845 vs. 0.956). The modified PRISM III model was calibrated in the validation sample, and the standardized mortality ratios (SMRs) were similar. Conclusions: The performance of a modified PRISM III model in predicting mortality risk was comparable to the original PRISM III. Both had similar discriminative performance and SMR for overall mortality prediction in a PICU.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129878466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.4103/2543-0343.249003
R. Triasih
{"title":"Outcomes and prediction","authors":"R. Triasih","doi":"10.4103/2543-0343.249003","DOIUrl":"https://doi.org/10.4103/2543-0343.249003","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126013936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstructive sleep-disordered breathing (SDB) affects up to 11% of children and forms a continuum of severity ranging from primary snoring to obstructive sleep apnea. Children with SDB exhibit significant neurocognitive and cardiovascular dysfunction, which is associated with repetitive hypoxia and sleep fragmentation that characterize the condition. We reviewed the recent literature pertaining to the effect of SDB on the brain in children. These include studies that utilized near-infrared spectroscopy to determine cerebral oxygenation and structural and functional magnetic resonance imaging (MRI) of the brain. Studies have identified that the effect of SDB on cerebral oxygenation in children is minimal and not clinically significant. There are conflicting reports on the association between the measures of cerebral oxygenation and peripheral arterial oxygen saturation (SpO2), and further research needs to be conducted to elucidate the relationship between peripheral SpO2, cerebral oxygenation, and SDB in children. MRI studies have reported significant structural and functional changes to the brains of children with SDB, in brain regions associated with neurocognition, behavior, and autonomic function. These include reduced white and gray matter and structural changes to a multitude of brain areas including, but not limited to, the hippocampus, cortex, amygdala, insula, thalamus, cerebellum, and basal ganglia. These studies utilize a variety of MRI techniques to address different research questions, but contribute to the gradually developing picture of the adverse effects of SDB on the brain in children.
{"title":"Obstructive sleep-disordered breathing in children: Impact on the developing brain","authors":"L. Walter, Rosemary C Horne","doi":"10.4103/PRCM.PRCM_16_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_16_18","url":null,"abstract":"Obstructive sleep-disordered breathing (SDB) affects up to 11% of children and forms a continuum of severity ranging from primary snoring to obstructive sleep apnea. Children with SDB exhibit significant neurocognitive and cardiovascular dysfunction, which is associated with repetitive hypoxia and sleep fragmentation that characterize the condition. We reviewed the recent literature pertaining to the effect of SDB on the brain in children. These include studies that utilized near-infrared spectroscopy to determine cerebral oxygenation and structural and functional magnetic resonance imaging (MRI) of the brain. Studies have identified that the effect of SDB on cerebral oxygenation in children is minimal and not clinically significant. There are conflicting reports on the association between the measures of cerebral oxygenation and peripheral arterial oxygen saturation (SpO2), and further research needs to be conducted to elucidate the relationship between peripheral SpO2, cerebral oxygenation, and SDB in children. MRI studies have reported significant structural and functional changes to the brains of children with SDB, in brain regions associated with neurocognition, behavior, and autonomic function. These include reduced white and gray matter and structural changes to a multitude of brain areas including, but not limited to, the hippocampus, cortex, amygdala, insula, thalamus, cerebellum, and basal ganglia. These studies utilize a variety of MRI techniques to address different research questions, but contribute to the gradually developing picture of the adverse effects of SDB on the brain in children.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122254870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Advances in care of children with sickle cell anaemia (SCA) have increased their chances of survival to adolescence and adulthood though this is often associated with multi-organ system pathologies including lung dysfunctions. This study aimed to determine the prevalence, pattern and factors associated with pulmonary function abnormalities in Nigerian children with SCA. Methods: Pulmonary functions of 104 children with SCA in steady state and 104 age- and sex-matched haemoglobin AA controls aged 6 to 16 years at the Wesley Guild Hospital, Ilesa Nigeria, were assessed using Spirolab III (Medical International Research, Italy) spirometer following standard protocol. Socio-demographic characteristics, nutritional status and pulmonary function parameters of these children were compared, and the predictive factors of pulmonary function abnormalities in SCA children were determined using binary logistic regression. Results: SCA children had lower lung volumes and capacities and higher prevalence of pulmonary function abnormalities compared to controls, and a restrictive ventilatory pattern (22.1%) was the most predominant form. Adolescent age, previous acute chest syndrome (ACS), repeated painful crises and multiple hospitalisations in the previous year were significantly associated with pulmonary function abnormalities (P < 0.05). Only adolescent age group (odds ratio [OR] = 3.738; 95% confidence interval [CI] = 1.480–9.440; P = 0.005) and previous ACS (OR = 8.500; 95% CI = 2.044–12.959; P = 0.044) independently predicted pulmonary function impairments among the SCA children. Conclusion: SCA predisposes children to pulmonary dysfunction, particularly during adolescent years and in those with ACS, multiple crises and hospitalisations. Routine pulmonary function assessment in these children will facilitate early recognition and prompt management.
{"title":"Pulmonary function abnormalities in Nigerian children with sickle cell anaemia: Prevalence, pattern and predictive factors","authors":"B. Kuti, S. Adegoke","doi":"10.4103/PRCM.PRCM_13_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_13_18","url":null,"abstract":"Background: Advances in care of children with sickle cell anaemia (SCA) have increased their chances of survival to adolescence and adulthood though this is often associated with multi-organ system pathologies including lung dysfunctions. This study aimed to determine the prevalence, pattern and factors associated with pulmonary function abnormalities in Nigerian children with SCA. Methods: Pulmonary functions of 104 children with SCA in steady state and 104 age- and sex-matched haemoglobin AA controls aged 6 to 16 years at the Wesley Guild Hospital, Ilesa Nigeria, were assessed using Spirolab III (Medical International Research, Italy) spirometer following standard protocol. Socio-demographic characteristics, nutritional status and pulmonary function parameters of these children were compared, and the predictive factors of pulmonary function abnormalities in SCA children were determined using binary logistic regression. Results: SCA children had lower lung volumes and capacities and higher prevalence of pulmonary function abnormalities compared to controls, and a restrictive ventilatory pattern (22.1%) was the most predominant form. Adolescent age, previous acute chest syndrome (ACS), repeated painful crises and multiple hospitalisations in the previous year were significantly associated with pulmonary function abnormalities (P < 0.05). Only adolescent age group (odds ratio [OR] = 3.738; 95% confidence interval [CI] = 1.480–9.440; P = 0.005) and previous ACS (OR = 8.500; 95% CI = 2.044–12.959; P = 0.044) independently predicted pulmonary function impairments among the SCA children. Conclusion: SCA predisposes children to pulmonary dysfunction, particularly during adolescent years and in those with ACS, multiple crises and hospitalisations. Routine pulmonary function assessment in these children will facilitate early recognition and prompt management.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115913284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediatric interventional flexible bronchoscopy (IFB) procedures are difficult to standardize because of a lack of consensus across different countries. The current literature are scant with retrospective case series or case reports in single center only. The main aim of IFB is to keep an enough and patent central airway lumen. The prerequisites are secure environment, skillful technique, appropriate instruments, clear airway vision, and maintenance of cardiopulmonary status of patients. Noninvasive ventilation (NIV) with pharyngeal oxygen with intermittent nose-closure and abdomen-compression or Soong's ventilation is the preferred method in the author's center as it provides a simple and reliable ventilation support during IFB. Pulmonologists should be trained in basic IFB procedures such as tracheobronchial intubation, bronchoalveolar lavage, balloon dilatation, laser ablation, cryotherapy, or even stent placement and maintenance. Pulmonologists should achieve and maintain high skill levels during their career. There is a rapidly evolving IFB role for in the intensive care units (ICUs) because of critical and cardiopulmonary compromised patients. IFB procedures require intense training and a multidisciplinary approach for patient care. With developing technology, the role of IFB is destined to grow. The IFB modality of using short-length bronchoscopes, supported with a NIV and ICU facilities is a viable, instant, and effective management in pediatric patients. Successful IFB could result in rapid weaning of respiratory supports in ICU without the need for transport to the operation theater and more invasive procedure.
{"title":"Pediatric interventional flexible bronchoscopy","authors":"W. Soong","doi":"10.4103/PRCM.PRCM_12_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_12_18","url":null,"abstract":"Pediatric interventional flexible bronchoscopy (IFB) procedures are difficult to standardize because of a lack of consensus across different countries. The current literature are scant with retrospective case series or case reports in single center only. The main aim of IFB is to keep an enough and patent central airway lumen. The prerequisites are secure environment, skillful technique, appropriate instruments, clear airway vision, and maintenance of cardiopulmonary status of patients. Noninvasive ventilation (NIV) with pharyngeal oxygen with intermittent nose-closure and abdomen-compression or Soong's ventilation is the preferred method in the author's center as it provides a simple and reliable ventilation support during IFB. Pulmonologists should be trained in basic IFB procedures such as tracheobronchial intubation, bronchoalveolar lavage, balloon dilatation, laser ablation, cryotherapy, or even stent placement and maintenance. Pulmonologists should achieve and maintain high skill levels during their career. There is a rapidly evolving IFB role for in the intensive care units (ICUs) because of critical and cardiopulmonary compromised patients. IFB procedures require intense training and a multidisciplinary approach for patient care. With developing technology, the role of IFB is destined to grow. The IFB modality of using short-length bronchoscopes, supported with a NIV and ICU facilities is a viable, instant, and effective management in pediatric patients. Successful IFB could result in rapid weaning of respiratory supports in ICU without the need for transport to the operation theater and more invasive procedure.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"513 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131703771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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