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This article examines the incidence of healthcare utilization for allergic and respiratory infectious diseases in children with asthma before and during the COVID-19 pandemic. The study analyzed data from the Korean Childhood Asthma Study (KAS) cohort and the Health Insurance Review and Assessment Service (HIRA) from March 2016 to March 2021. The findings showed significant decreases in hospital visits for allergic and respiratory diseases during the pandemic, with sustained reductions observed for one year. The decline in healthcare utilization may be attributed to factors such as reduced exposure to triggers and apprehension about accessing healthcare services. Further research is needed to explore the long-term effects of the pandemic on healthcare utilization. [Extracted from the article]

• Our results suggest that nonpharmaceutical interventions (NPIs) reduce children's respiratory admissions significantly. • The effect of NPIs is most drastic for pneumonia among children of all ages. • The effect is most drastic for children aged 4-6 and 7-12 years. • NPIs may be used to further prevent admissions for children's respiratory infections. To estimate the impact of nonpharmaceutical interventions (NPIs) targeted at the COVID-19 pandemic on the admission number of respiratory diseases, including pneumonia, acute bronchitis & bronchiolitis, and acute upper respiratory infections (AURIs) for children in China. Continuous hospitalization records aged 0-18 years from January 1, 2016, to December 31, 2020, were collected from 26 tertiary children's hospitals. Interrupted time series analysis with a quasi-Poisson model was conducted with the start time of the COVID-19 pandemic as the interrupted timepoint and the weekly admission numbers of all-cause respiratory disease, pneumonia, acute bronchitis & bronchiolitis, and AURI as the outcome measures. Hospitalizations of childhood neoplasms were analyzed as the reference group. The reduction in admission numbers following NPIs was -55.0% (-57.9 to -51.9%) for all-cause respiratory diseases, -62.7% (-65.7 to -59.5%) for pneumonia, -48.1% (-53.3 to -42.3%) for bronchitis & bronchiolitis, and -24.3% (-28.6 to -19.8%) for AURI. The effect estimates of NPIs on childhood neoplasms was -29.1% (-33.6 to -24.4%). Stratification analysis showed the reduction was most drastic for children at 4-6 and 7-12 years. The admission number for respiratory diseases among children in China decreased drastically after the implementation of NPIs. NPIs with low socio-economic burdens should be suggested even outside the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Wheezing diseases are one of the major chronic respiratory diseases in children. To explore the effects of meteorological and environmental factors on the prevalence of children wheezing diseases, clinical data of children hospitalized with wheezing diseases in Suzhou, China from 2013 to 2017 were collected. Meteorological and environmental factors from 2013 to 2017 were obtained from the local Meteorological Bureau and Environmental Protection Bureau. Relationships between wheezing diseases and meteorological and environmental factors were evaluated using Pearson's correlation and multivariate regression analysis. An autoregressive integrated moving average (ARIMA) model was used to estimate the effects of meteorological and environmental variables on children wheezing diseases. Children wheezing diseases were frequently presented in infants less than 12 months old (1897/2655, 58.28%), and the hospitalization rate was highest in winter (1024/3255, 31.46%). In pathogen-positive specimens, the top three pathogens were respiratory syncytial virus (21.35%), human rhinovirus (16.28%) and mycoplasma pneumoniae (10.47%). The seasonality of wheezing children number showed a distinctive winter peak. Children wheezing diseases were negatively correlated with average temperature (P < 0.001, r = − 0.598). The ARIMA (1,0,0)(0,0,0)12 model could be used to predict temperature changes associated wheezing diseases. Meteorological and environmental factors were associated with the number of hospitalized children with wheezing diseases and can be used as early warning indicators for the occurrence of wheezing diseases and prevalence of virus. [ABSTRACT FROM AUTHOR]

The relationship between fine particulate matter (PM2.5) and respiratory disease outcomes among children aged 0 to 14 years in Lanzhou, China, was evaluated. We utilized a generalized additive model linked by a quasi-Poisson distribution to examine the associations between PM2.5 and paediatric respiratory outpatient visits for time lags of 0 up to 7 days, and stratified by gender, age, and season. Cases of respiratory disease in children were collected from 3 large hospitals for the years 2014–2017 and then linked with air pollutant concentrations from 4 air quality monitoring stations by date. We observed positive and significant associations between PM2.5 and respiratory disease from the lag to lag 7, and from lag01 to lag07, with ER reaching the maximum value at lag07. For each 10 μg/m3 increase in PM2.5 (lag07), the associated increment in respiratory diseases was 2.83% (95% CI 1.80%–3.86%). Males were more sensitive to the adverse effects, and the association was more significant in spring (from March to May) and winter (from December to the next February). Overall, the child group (age 3–6 years) demonstrated a higher risk of respiratory disease after PM2.5 exposure. The associations between ambient PM2.5 and respiratory hospital outpatients among young children became partially attenuated after the adjustment for gaseous pollutants in subgroups. The exposure-response curves were positive and generally nonlinear but flatted at concentrations over 60 μg/m3. This research found a significant association between ambient PM2.5 levels and hospital outpatient visits in child with respiratory diseases in Lanzhou, China. [ABSTRACT FROM AUTHOR]

In this paper, the influence of PM 2. 5 on children's respiratory diseases is taken as the main research focus. Based on the real monitoring data of children's respiratory diseases in Anhui province, the traditional model is modified substantially, leading to the establishment of two mathematical models. First of all, considering that the PM 2. 5 changes over time, a nonautonomous air pollution-related disease model is constructed to study its permanence and extinction. Furthermore, regarding lag days of PM 2. 5 exposure, an air pollution-related disease model with the lag effect is installed and its local and global stabilities and Hopf bifurcation are investigated. Meanwhile, the above two models are numerically simulated, respectively. Our study demonstrates that the threshold conditions of permanence and extinction are obtained by the nonautonomous air pollution-related disease model, and the optimal parameters are obtained through the annual revision of the data by integrating the mathematical model, such that the number of children with respiratory diseases in the future can be checked and predicted. Also our study finds that the lag days of PM 2. 5 exposure have little effect on children with respiratory diseases in the air pollution-related disease model with a lag effect, but the PM 2. 5 has a tremendous influence on the number of patients. Once the lag days are combined with the effect of the PM 2. 5 , it can have a significant impact on the patients' number, e.g. an emergence of periodic oscillations, with an approximate period of 11 days in Anhui Province, due to the Hopf bifurcation. [ABSTRACT FROM AUTHOR]

Objectives: Asthma and intermittent asthma attacks impose a heavy mental and financial burden on families and serum level of resistin influences the incidence of childhood asthma and response to drug therapies. The purpose of this paper was to assess the serum level of resistin in asthmatic children in the division of pulmonary and respiratory diseases at Tabriz Children's hospital. Materials and Methods: This study was conducted on 50 subjects in the control group and 50 subjects in the case group (asthmatic and healthy prepubertal children under 12 years old with a normal (BMI) (5-84th percentile); asthmatic and healthy overweight prepubertal children under 12 years old (85-94th percentile); and obese prepubertal children under 12 years old (BMI ≥95) without any other illnesses. The control group was matched to the case group in terms of age and sex and did not have inflammatory, acute and chronic infectious diseases or a history of medication consumption. Venous blood samples were collected from the subjects after 8 hours of fasting. Serum levels of resistin were measured using Elisa. Results: The level of resistin increased with asthma severity. Increased weight and BMI also led to a significant increase in the severity of asthma. The serum levels of resistin were significantly higher in the subjects of the control group who did not receive drug therapy. Response to drug therapy was significantly poorer in tall, heavier and high-BMI subjects than in other groups. The number of cases with severe persistent asthma was greater in formula-fed and breastmilk/formula-fed babies. History of allergy or asthma in first-degree relatives was significantly higher in the case group than in the control group (P = 0.001). Indoor smoking had a significant effect on the type of asthma (P = 0.001). The history of non-asthmatic allergy had a significant effect on the type of asthma (P = 0.001). Conclusions: Obesity and overweight are among the influential factors in the severity of asthma. The amount of resistin is significantly higher in children with severe persistent asthma and uncontrolled asthma than in healthy children. However, the results showed that smoking may also increase serum resistin in at-risk individuals. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to investigate parental preference of continuous pulse oximetry in infants and children with bronchiolitis. Materials and methods: A cross-sectional prospective study was conducted at Hamad Medical Corporation in Qatar. Parents of infants and children ,24 months old and hospitalized with bronchiolitis were offered an interview survey. Results: A total of 132 questionnaires were completed (response rate 100%). Approximately 90% of participants were 20-40 years of age, and 85% were females. The mean age of children was 7.2±5.8 months. Approximately eight in ten parents supported the idea of continuous pulse oximetry in children with bronchiolitis. Almost 43% of parents believed that continuous pulseoximetry monitoring would delay their children's hospital discharge. Interestingly, approximately 85% of caregivers agreed that continuous pulse oximetry had a good impact on their children's health. In addition, around one in two of the participants stated that good bedside examinations can obviate the need for continuous pulse oximetry. Furthermore, 80% of parents believed that continuous pulse-oximetry monitoring would give the health-care provider a good sense of security regarding the child's health. Finally, being a male parent was associated with signifi- cantly increased risk of reporting unnecessary fatigue, attributed to the sound of continuous pulse oximetry (P=0.031). Conclusion: Continuous pulse-oximetry monitoring in children with bronchiolitis was perceived as reassuring for parents. Involving parents in decision-making is considered essential in the better management of children with bronchiolitis or any other disease. The first step to decrease continuous pulse oximetry will require provider education and change as well. Furthermore, we recommend proper counseling for parents, emphasizing that medical technology is not always essential, but is a complementary mode of managing a disease. [ABSTRACT FROM AUTHOR]

In 2014, the United States experienced an epidemic of acute flaccid myelitis (AFM) cases in children coincident with a nationwide outbreak of enterovirus D68 (EV-D68) respiratory disease. Up to half of the 2014 AFM patients had EV-D68 RNA detected by RT-PCR in their respiratory secretions, although EV-D68 was only detected in cerebrospinal fluid (CSF) from one 2014 AFM patient. Given previously described molecular and epidemiologic associations between EV-D68 and AFM, we sought to develop an animal model by screening seven EV-D68 strains for the ability to induce neurological disease in neonatal mice. We found that four EV-D68 strains from the 2014 outbreak (out of five tested) produced a paralytic disease in mice resembling human AFM. The remaining 2014 strain, as well as 1962 prototype EV-D68 strains Fermon and Rhyne, did not produce, or rarely produced, paralysis in mice. In-depth examination of the paralysis caused by a representative 2014 strain, MO/14-18947, revealed infectious virus, virion particles, and viral genome in the spinal cords of paralyzed mice. Paralysis was elicited in mice following intramuscular, intracerebral, intraperitoneal, and intranasal infection, in descending frequency, and was associated with infection and loss of motor neurons in the anterior horns of spinal cord segments corresponding to paralyzed limbs. Virus isolated from spinal cords of infected mice transmitted disease when injected into naïve mice, fulfilling Koch’s postulates in this model. Finally, we found that EV-D68 immune sera, but not normal mouse sera, protected mice from development of paralysis and death when administered prior to viral challenge. These studies establish an experimental model to study EV-D68-induced myelitis and to better understand disease pathogenesis and develop potential therapies. [ABSTRACT FROM AUTHOR]

Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%-9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Surgery for vascular anomalies can occasionally fail to relieve symptoms, especially when severe tracheobronchial malacia persists. We studied outcomes in children who underwent airway stenting for severe post-surgical airway malacia and tested known clinical and surgical prognostic factors. METHODS: Among 257 children evaluated for tracheobronchial vascular compression, we reviewed the clinical charts for the 59 patients (23%) who underwent surgery. After surgery, children in whom severe malacia and respiratory symptoms persisted underwent airway stenting. RESULTS: Among the 59 patients (boys: 58.1%, median age: 6.4 months, age range: 0.1-182.8 months), 79.7% had major comorbidities, 39% additional upper airway anomalies and 15.2% abnormal bronchial anatomy. Diagnostic imaging identified seven vascular anomalies: innominate artery compression 27.1%, left bronchial compression from the descending aorta and left pulmonary artery 20.3%, lesions associated with right aortic arch 22.0%, double aortic arch 13.6%, bovine arch type 10.2%, aberrant right subclavian artery 5.1% and pulmonary artery sling 1.7%. For severe residual malacia and severe persistent respiratory symptoms, 20 patients (33.9%) had silicone or metallic stents inserted. The most frequent indication for stenting was double aortic arch (P = 0.02 by chi-square test). A clinical prognostic factor for permanent stenting was left bronchial compression from the descending aorta and left pulmonary artery [odds ratio (OR): 14.667, 95% confidence interval (CI): 2.881-74.659], particularly if associated with congenital heart disease (OR: 30.00, 95% CI: 4.349- 206.927). All silicone stents but one were successfully removed; metallic uncovered stents were patent and completely re-epithelialized. CONCLUSIONS: When surgery leaves severe airway obstruction and respiratory symptoms unchanged, children with tracheobronchial malacia can safely undergo airway stenting. [ABSTRACT FROM AUTHOR]

This commentary is on the original article by Hov et al. on pages 537–544 of this issue. [ABSTRACT FROM AUTHOR]

Severe pneumonia is a major cause of mortality in children. The present study evaluated the diagnostic value of serum C-reactive protein (CRP) levels for cases of severe pneumonia. A total of 862 children, hospitalized for acute respiratory tract infections, were evaluated between September 2008 and February 2011; the serum levels of CRP were measured in all the children. Bacterial identification was performed, while polymerase chain reaction was used to detect the 12 respiratory viruses. Multivariate logistic regression analysis was performed with independent [CRP, proportion of neutrophils (NEUT), body temperature, sputum production, age and dyspnea] and dependent (severe and mild pneumonia) variables for clinical diagnosis, which produced three new variables that represented an individual's predictive value: Pre-1, Pre-2 and Pre-3. A receiver operating characteristic (ROC) curve was generated using the new variables to assess their predictive value for severe pneumonia. Of the 862 patients, 108 individuals were diagnosed with severe pneumonia and 754 individuals had mild pneumonia. Increased levels of CRP were associated with severe pneumonia and bacterial infection (P<0.05). Multivariate logistic regression analysis found that severe pneumonia was associated with the levels of CRP, body temperature, expectoration, age, NEUT and dyspnea (P<0.05). The ROC curve of the regression diagnostics model sequentially presented CRP, CRP and the other five correlative variables (NEUT + body temperature + sputum production + age + dyspnea) and the other five correlative variables used to diagnose severe pneumonia. The area under curve values were determined as 0.550 for Pre-1 [95% confidence interval (CI), 0.490-0.609], 0.897 for Pre-2 (95% CI, 0.861-0.932) and 0.893 for Pre-3 (95% CI, 0.855-0.931). The results revealed that the six correlative variables had improved accuracy in the diagnosis of severe pneumonia. The serum levels of CRP were strongly associated with bacterial infection and severe pneumonia. Therefore, the CRP level, along with other parameters, may be used as early indicators of severe pneumonia development. However, the efficiency of the CRP level alone to diagnose severe pneumonia was found to be limited. [ABSTRACT FROM AUTHOR]

Background In children with acute dyspnoea, the assessment of severity of dyspnoea and response to treatment is often performed by different professionals, implying that knowledge of the interobserver variation of this clinical assessment is important. Objective To determine intraobserver and interobserver variation in clinical assessment of children with dyspnoea. Methods From September 2009 to September 2010, we recorded a convenience sample of 27 acutely wheezing children (aged 3 months-7 years) in the emergency department of a general teaching hospital in the Netherlands, on video before and after treatment with inhaled bronchodilators. These video recordings were independently assessed by nine observers scoring wheeze, prolonged expiratory phase, retractions, nasal flaring and a general assessment of dyspnoea on a Likert scale (0-10). Assessment was repeated after 2 weeks to evaluate intraobserver variation. Results We analysed 972 observations. Intraobserver reliability was the highest for supraclavicular retractions (κ 0.84) and moderate-to-substantial for other items (κ 0.49-0.65). Interobserver reliability was considerably worse, with κ<0.46 for all items. The smallest detectable change of the dyspnoea score (>3 points) was larger than the minimal important change (<1 point), meaning that in 69% of observations a clinically important change after treatment cannot be distinguished from measurement error. Conclusions Intraobserver variation is modest, and interobserver variation is large for most clinical findings in children with dyspnoea. The measurement error induced by this variation is too large to distinguish potentially clinically relevant changes in dyspnoea after treatment in two-thirds of observations. The poor interobserver reliability of clinical dyspnoea assessment in children limits its usefulness in clinical practice and research, and highlights the need to use more objective measurements in these patients. [ABSTRACT FROM AUTHOR]

Background: Reports from the developed nations reveal respiratory tract infections as the leading cause of childhood hospital admissions. Children may be admitted for a variety of respiratory illnesses. Data on the spectrum of pediatric respiratory illnesses admitted in the hospital is scarce. Aim: To determine the pattern of pediatrics respiratory illness admissions, seasonal frequency, underlying risk factors and outcome. Subjects and Methods: A retrospective assessment of respiratory cases admitted in the pediatric ward from 2005 to 2010 was conducted using case notes. Parameters considered included month of presentation, age, sex, immunization and nutritional status, tools of diagnosis and patient outcome. Results were analyzed using the Statistical Package for the Social Sciences with the level of significance P < 0.05. Results: Of the 239 cases admitted, there were more males than females (1.4:1). The commonest case was Bronchopneumonia, 71.6% (171/239 out of which 161 were uncomplicated, 5 had effusions and 6 were associated with measles). Other cases were Pulmonary Tuberculosis, 10.9% (26/239), Lobar pneumonia 8.8% (21/239), Bronchiolitis, 5% (12/239), Aspiration pneumonitis 2.1% (5/239) and Bronchial asthma, 0.8% (2/239). Mortality was 7.5% (18/239) mostly from Bronchopneumonia amongst the 1-5 years old. Mortality was significantly associated with malnutrition (P < 0.001) and poor immunization status (P < 0.01). Conclusion: Bronchopneumonia was found to be the commonest illness with significant mortality and peak occurrence in the rainy season. More emphasis must be laid on anticipatory guidance and prevention by encouraging the immunization, good nutrition and increased attention on children even after 1 year of age. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a major, but often unrecognised, cause of disease and death in young children from countries with high TB incidence rates among adults. It is also relevant to paediatricians in low-incidence countries, such as Australia, because of increased international travel, immigration and refugee resettlement. This manuscript provides a brief overview of the global TB disease burden, the natural history of disease in children, and offers guidance on the prevention, diagnosis and treatment of TB in children. [ABSTRACT FROM AUTHOR]

Adverse health impacts of Asian dust storms (ADS) have been widely investigated and discussed in respiratory disease, but no study has examined the association between ADS events and their impact on eye diseases, especially in children. The impact of ADS events on the incidence of children's conjunctivitis is examined by analyzing the data from children's clinic visits registered in the 41 districts of Taipei area in Taiwan during the period 2002–2007. The structural additive regression modeling approach was used to assess the association between ADS events and clinic visits for conjunctivitis in children with consideration of day-of-the-week effects, temperature, and air quality levels. This study identifies an acute increase in the relative rate for children's conjunctivitis clinic visits during ADS periods with 1.48% (95% CI = 0.79, 2.17) for preschool children (aged <6 years old) and 9.48% (95% CI = 9.03, 9.93) for schoolchildren (aged ≥6 years old), respectively. The relative rates during post-ADS periods were still statistically significant, but much lower than those during ADS periods. The spatial analysis presents geographic heterogeneity of children's conjunctivitis clinic visits where higher relative rates were more likely observed in the most populated districts Compared to previous ADS studies related to respiratory diseases, our results reveals significantly acute impacts on children's conjunctivitis during ADS periods, and much influence on schoolchildren. Vulnerable areas were also identified in high density population. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal and respiratory diseases are major causes of morbidity for young children, particularly for those children attending child day care centers (DCCs). Although both diseases are presumed to cause considerable societal costs for care and treatment of illness, the extent of these costs, and the difference of these costs between children that do and do not attend such centers, is largely unknown. Objective: Estimate the societal costs for care and treatment of episodes of gastroenteritis (GE) and influenza-like illness (ILI) experienced by Dutch children that attend a DCC, compared to children that do not attend a DCC. Methods: A web-based monthly survey was conducted among households with children aged 0–48 months from October 2012 to October 2013. Households filled-in a questionnaire on the incidence of GE and ILI episodes experienced by their child during the past 4 weeks, on the costs related to care and treatment of these episodes, and on DCC arrangements. Costs and incidence were adjusted for socioeconomic characteristics including education level, nationality and monthly income of parents, number of children in the household, gender and age of the child and month of survey conduct. Results: Children attending a DCC experienced higher rates of GE (aIRR 1.4 [95%CI: 1.2–1.9]) and ILI (aIRR: 1.4 [95%CI: 1.2–1.6]) compared to children not attending a DCC. The societal costs for care and treatment of an episode of GE and ILI experienced by a DCC-attending child were estimated at €215.45 [€115.69–€315.02] and €196.32 [€161.58–€232.74] respectively, twice as high as for a non-DCC-attending child. The DCC-attributable economic burden of GE and ILI for the Netherlands was estimated at €25 million and €72 million per year. Conclusions: Although children attending a DCC experience only slightly higher rates of GE and ILI compared to children not attending a DCC, the costs involved per episode are substantially higher. [ABSTRACT FROM AUTHOR]

Hospitalized children < 2 years of age in Amman, Jordan, admitted for fever and/or respiratory symptoms, were tested for Middle East respiratory syndrome coronavirus (MERS-CoV): MERS-CoV by real-time RT-PCR ( rRT-PCR). This was a prospective year-round viral surveillance study in children <2 years of age admitted with acute respiratory symptoms and/or fever from March 2010 to September 2012 and enrolled from a government-run hospital, Al-Bashir in Amman, Jordan. Clinical and demographic data, including antibiotic use, were collected. Combined nasal/throat swabs were collected, aliquoted, and frozen at −80°C. Specimen aliquots were shipped to Vanderbilt University and the Centers for Disease Control and Prevention (CDC), and tested by rRT-PCR for MERS-CoV. Of the 2433 subjects enrolled from 16 March 2010 to 10 September 2012, 2427 subjects had viral testing and clinical data. Of 1898 specimens prospectively tested for other viruses between 16 March 2010 and 18 March 2012, 474 samples did not have other common respiratory viruses detected. These samples were tested at CDC for MERS-CoV and all were negative by rRT-PCR for MERS-CoV. Of the remaining 531 samples, collected from 19 March 2012 to 10 September 2012 and tested at Vanderbilt, none were positive for MERS-CoV. Our negative findings from a large sample of young Jordanian children hospitalized with fever and/or respiratory symptoms suggest that MERS-CoV was not widely circulating in Amman, Jordan, during the 30-month period of prospective, active surveillance occurring before and after the first documented MERS-CoV outbreak in the Middle East region. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate if different childhood obstructive sleep apnea (OSA) subtypes, namely rapid eye movement (REM)-related, nonrapid eye movement (NREM)-related and stage-independent OSA would exert different effects on ambulatory blood pressure (ABP). Methods: Data from our previous school-based cross-sectional study were reanalyzed. Subjects who had an obstructive apnea–hypopnea index (OAHI) between 1 and 10 events per hour and a total REM sleep duration of >30min were included in our analysis. REM-related and NREM-related OSA were defined as a ratio of OAHI in REM sleep (OAHIREM) to OAHI in NREM sleep (OAHINREM) of >2 and <0.5, respectively. The others were classified as stage-independent OSA. Results: A total of 162 subjects were included in the analysis. In the mild OSA (OAHI, 1–5events/h) subgroup, no significant differences in any ABP parameters were found between OSA subtypes. On the other hand, in subjects with moderate OSA (OAHI, 5–10events/h), the REM-related OSA subtype had a significantly lower daytime systolic blood pressure (SBP) z score (−0.13±0.90 cf 1.15±0.67; P =.012) and nighttime SBP z score (0.29±1.06 cf 1.48±0.88, P =.039) than the stage-independent OSA subtype. Linear regression analyses revealed that OAHINREM but not OAHIREM was significantly associated with both daytime (P =.008) and nighttime SBP (P =.042) after controlling for age, gender, and body size. Conclusion: Children with obstructive events mainly in REM sleep may have less cardiovascular complications than those with stage-independent OSA. [ABSTRACT FROM AUTHOR]

Background Understanding the importance of respiratory viruses in children with cystic fibrosis (CF) has been limited because of challenges using clinic- or hospital-based diagnostic testing. We conducted a pilot study to assess feasibility of home self- (or parent-) collection of nasal swabs (NS). Methods Cystic fibrosis patients aged 6–18 years with new respiratory illness participated. In clinic, a deep nasal flocked swab was collected by research staff and compared with an anterior foam NS obtained after instillation of saline spray. At home, up to 2 self-collections of paired foam NS (with and without saline) were collected and mailed for real-time polymerase chain reaction (PCR) testing. Results Paired swabs were collected from 28 patients: 18 sets in clinic (deep nasal vs saline foam NS) and 43 sets at home (saline vs dry foam NS) with 9 (50%) and 35 (81%) virus detections, respectively. Home-collected NS were obtained closer to illness onset, with a mean difference in symptom days of −2.3 between home and clinic collections (95% confidence interval [CI] −3.5, −1.2; P < .001). Rhinovirus comprised 73% of virus detections; the difference in mean PCR cycle threshold values for rhinovirus between swabs collected at home versus clinic was −3.8 (95% CI −6.8, −0.9; P = .014), indicating significantly higher viral load for home-collected swabs. Conclusions Home-collected foam NS had a higher positivity rate compared with clinic-collected swabs, likely because collection was closer to illness onset. Home self-collection is feasible and well tolerated for timely respiratory virus diagnosis and provides a novel approach for clinical diagnostics and surveillance of respiratory virus infections among CF patients. [ABSTRACT FROM PUBLISHER]

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) now provides an important alternative diagnostic modality in patients with intrathoracic tuberculosis lymphadenopathy. The procedure is well tolerated in the outpatient setting, provides access to the mediastinal and hilar lymph node locations commonly in tuberculosis and also allows bronchial washing to be performed at the same procedure. However, there is no report of EBUS-TBNA applied to children to diagnose tuberculosis. We report a case of EBUS-TBNA applied to children who had intrathoracic tuberculosis lymphadenopathy. [ABSTRACT FROM AUTHOR]

Highlights: [•] Ictal bradypnea is present in temporal lobe epilepsy in children. [•] Absence seizures have a various effect on respiratory rate. [•] Interictally, respiratory rate is altered in absence epilepsy but not in temporal lobe epilepsy. [Copyright &y& Elsevier]

Introduction: Children with chronic respiratory disease (CRD) are at increased risk of iron deficiency and anemia, which is under-diagnosed. Aim: To describe the iron (Fe) status in children with CRD and to evaluate the effects of its prophylactic indication. Method: Prospective study of children with CRD and adequate Fe intake in the diet. At baseline we measured hemogram, C-reactive protein and Fe profile. Subsequently, those with normal plasma hemoglobin (Hb) were not supplemented with Fe (Group A) and those with iron deficiency anemia or at risk of developing it (group B) were supplemented. We evaluated them 3 months later and, after supplementing all, at 4th month. Results: Of 40 patients, median 30 months old (0.5 to 178), 60% were male, 80% eutrophic. Ventilation or oxygen were required in 45%. Diagnoses: 50% Chronic Lung Damage, 17.5% airway diseases, 10% Bronchopulmonary Dysplasia, 7.5% Cystic Fibrosis and 13.5% other. At baseline 20% were anemic (mostly ferropenic) and 12.5% had an abnormal iron profile. At all, 25 children completed the study: in group A, serum ferritin decreased to 3th month (-22.9 ± 30) and incremented to 4th month (+12.8 ± 26) μg/L (p = 0.013), without difference in Hb. Group B had a rise in Hb (91 ± 12 to 102 ± 12% of the mean for age, p = 0.04). Conclusion: Anemia and ferropenia are frequent in children with CRD. Decrease of their iron reserves can be prevented if they are supplemented. We suggest monitoring properly and treating early or supplement them prophylactically. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between longterm exposure to air pollution and lung function among Chinese schoolchildren in Southern China (Hong Kong). Methods We conducted a cross-sectional study among 3168 schoolchildren (aged 8-10 years) in 3 districts in Hong Kong. Annual means of ambient PM10 ( particulate matter <10 μm), SO2, NO2 and O3 from 1996 to 2003 were used to estimate the individual exposure of the subjects. Children's lung function was measured for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow between 25% and 75% of FVC (FEF25-75) and forced expiratory flow at 75% of FVC (FEF75). Analysis of covariance was performed separately by gender to estimate the impact of air pollution on lung function, with adjustment for socioeconomic characteristics, respiratory morbidities, height and weight, physical activity level, indoor air contaminants and shortterm exposure to the air pollutants. Results After controlling for potential confounding factors, FEV1, FEF25-75 and FEF75 for boys in a highpollution district (HPD) were significantly lower than those in a low-pollution district (LPD) by 3.0%, 7.6% and 8.4%, respectively. No significant differences were found for girls. Results from the comparison between a moderate-pollution district (MPD) and the HPD were similar. There were no differences between children in the LPD and MPD, except that a higher FEF75 was found in boys in the MPD. PM10 is the primary pollutant responsible for the lung function deficit. Asthmatic children were more vulnerable to exposure to air pollution. Conclusions Long-term exposure to higher ambient air pollution levels was associated with lower lung function in Chinese schoolchildren, especially among boys. Adverse effects were observed on large and small airways, with a stronger effect on the latter. [ABSTRACT FROM AUTHOR]

The Ostrava Region in the Czech Republic is a heavily polluted industrial area. Concentrations of PM10, PM2.5, and benzo[a]pyrene (B[a]P) significantly exceed limit values. To investigate the impact of these levels on human health, epidemiological, molecular epidemiology, and in vitro studies were done in 2008-2011. Morbidity of children was followed in 10 pediatric districts. In the most polluted district, children suffered higher incidence of acute respiratory diseases in the first year of life, and higher prevalence of asthma bronchiale. Gene expression was studied in children from Ostrava and from a control rural area. Genes specific to asthma bronchiale differed, suggesting a different molecular phenotype in children in the polluted region compared to children in the control area. A molecular epidemiology study showed adverse effect of the Ostrava exposures, but also an increased expression of XRCC5, which probably protects these exposed subjects against the degree of genetic damage that would otherwise be expected. In vitro studies clearly related concentration of B[a]P from PM2.5 extracts to induced PAH-DNA adducts. These studies clearly demonstrate that under the present local environmental conditions, the health of the population is severely impaired and will likely remain so for a significant period of time. [ABSTRACT FROM AUTHOR]

The article reports on the outbreak of Mycoplasma pneumoniae respiratory illness among school-aged children in two rural counties in West Virginia in October 2011. Some of the public health interventions taken to contain the outbreak include providing hand sanitizer in schools and informing health care providers of macrolide resistance. It describes the transmission of M. pneumoniae.

Purpose: The evaluation of the risk factors in patients deceased in Pediatric Intensive Care Unit (PICU) during January 1 to December 31, 2009. Material and method: This is a retrospective study in which we evaluated the risk factors of the 29 deceased patients admitted in PICU. We followed the age groups, gender, environment, prior treatments, number of hospitalization days, the patient flow, the associated comorbidities, the mothers’ age and the anatomico pathological concordances. Results: From all 29 deceased patients, 34.48% were between 3–12 months, the average age being 27.3 months. 79.31% came from rural areas. The number of deaths was almost equally distributed between sexes. Etiological, nosological, location-related and complication-related consistencies were found. The main cause of death was the respiratory disease. In the cold season, the number of deaths was increased. Most children were admitted in Pediatric Clinic I from other clinics, were hospitalized for more than 72 hours and presented at least one comorbidity. Conclusions: The main risk factors that concluded in children’s death were: association with at least one comorbidity, the age group of less than 1 year, as well as the patient’s flow through multiple sections. The main cause of death was respiratory infection. Etiological, nosological, location-related and complication-related consistencies were present. [ABSTRACT FROM AUTHOR]

Abstract: Background: Whether or not indoor mold growth causes acute childhood respiratory illness is controversial. Objective: To determine the influence of indoor fungus on the incidence of acute respiratory illness episodes during the first two years of life. Methods: Fungal indicators were measured in homes of children followed by daily symptom diaries and twice monthly telephone contact up to two years. Participants: 357 children born in Prince Edward Island, Canada. Results: Generally, fungal contamination was not excessive with a geometric mean mold surface area (MSA) of 1012cm2 (geometric standard deviation (GSD) 24.2). The annual mean illness episodes per child were 6.85 (Standard Deviation (SD) 2.80). The incidence of respiratory illness episodes was not significantly related to any of the mold indicators: Analysis of variance (ANOVA) derived F-statistic (p values) was 0.14 (0.7090) for mold surface area. Conclusions: In homes not selected by degree of fungal contamination, fungal burden was generally not excessive and was not found to be a risk factor for acute respiratory illness episodes during the first two years of life. [Copyright &y& Elsevier]

Objective: To document the epidemiological, clinical, histological and radiological characteristics of aggressive vascular abnormalities of bone in children. Study design: Correspondents of the French Society of Childhood Malignancies were asked to notify all cases of aggressive vascular abnormalities of bone diagnosed between January 1988 and September 2009. Results: 21 cases were identified; 62% of the patients were boys. No familial cases were observed, and the disease appeared to be sporadic. Mean age at diagnosis was 8.0 years [0.8-16.9 years]. Median follow-up was 3 years [0.3- 17 years]. The main presenting signs were bone fracture (n = 4) and respiratory distress (n = 7), but more indolent onset was observed in 8 cases. Lung involvement, with lymphangiectasies and pleural effusion, was the most frequent form of extraosseous involvement (10/21). Bisphosphonates, alpha interferon and radiotherapy were used as potentially curative treatments. High-dose radiotherapy appeared to be effective on pleural effusion but caused major late sequelae, whereas antiangiogenic drugs like alpha interferon and zoledrenate have had a limited impact on the course of pulmonary complications. The impact of bisphosphonates and alpha interferon on bone lesions was also difficult to assess, owing to insufficient follow-up in most cases, but it was occasionally positive. Six deaths were observed and the overall 10-year mortality rate was about 30%. The prognosis depended mainly on pulmonary and spinal complications. Conclusion: Aggressive vascular abnormalities of bone are extremely rare in childhood but are lifethreatening. The impact of anti-angiogenic drugs on pulmonary complications seems to be limited, but they may improve bone lesions. [ABSTRACT FROM AUTHOR]

Asthma is the most common chronic disease of childhood. It is known that asthma prevalence has increased significantly especially in children in last 20 years. To stop this increase in asthma, causes and prevention measures should be known better. For the management of the illness, control of environmental and trigger factors causing asthma attack are extremely important. Asthmatic children and family should be informed by health staff about changes in their life and measures to prevent the attacks. Through this information asthmatic children and their families can be supported for a better quality of life. [ABSTRACT FROM AUTHOR]

The article discusses the presentation, assessment and management of the common causes of airway obstruction in children as seen in the tertiary level. It mentions that endoscopic techniques are now the most common method of airway management, replacing the traditional tracheostomy insertion. Treatment strategies and principles are also highlighted.

Background. Active commuting to school provides regular exercise, which can improve asthma symptoms. Little is known about how children with asthma travel to school. Objective. To identify travel patterns and parental perceptions surrounding mode of travel to school among children with asthma. Methods. Crosssectional study of 176 children with asthma aged 5 to 15 years. Parents completed questionnaires assessing mode of travel to school, physical activity, asthma control, physician counseling, and factors influencing parental decisions. Data analysis included descriptive and bivariate statistics. Results. Few (16%) children with asthma actively commute to school. Active travelers lived closer to school, and "distance" was the most frequently reported factor influencing a parent's decision regarding travel mode to school. Parents reported few concerns about pollution and little physician counseling on active travel. Conclusion. Few children with asthma actively travel to school. Asthma-specific concerns do not appear to guide parental decisions on travel mode to school. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional study which investigates the relationship of living near roadways to children's respiratory health illness particularly among elementary schoolchildren. A cross- sectional prevalence design was used in the study wherein questionnaires were given to the parent or guardian of children enrolled in grades 1 through 8 in the Windsor, Ontario. Results show that roadways are associated with that respiratory health in children.

Chest pain is a frequently encountered problem in childhood. In this study we aimed to asses the relationship between exertional chest pain and asthma by using the peek expiratory flow rate measurements. For this study, 64 otherwise healthy children with chest pain (chest pain group), 9-16 years of age (mean 11.9) and 58 healthy (control group), 8-11 years (mean 11.5) were compared with the use of peak flow-meter. Ages, weights, heights, systolic-diastolic blood pressures, pulses recorded. Preexertional and postexertional peak flow measurements (PEFR) at 2, 5 and 10 minutes determined. There was a decrease more than 15% in PEFR measures in 7 (10.9%) of chest pain group and in 1 (1.7%) of control group children (p<0.05). According to the results of this study, one may think that exercise induced asthma play an important role in the pathogenesis of exertional chest pain and history taking with PEFR measurements are important in this assessment. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to reduce the number of hospitalizations in a population of children enrolled in the Einstein Program of the Paraisópolis Community, in São Paulo, Brazil, particularly hospitalizations caused by respiratory diseases. Methods: All hospitalizations of this paediatric population enrolled in the Einstein Program of the Paraisópolis Community Outpatient Clinic were followed up between 2002 and 2004. The following four strategies to reduce or control respiratory diseases with an impact on hospitalizations were established: specific protocol, educational activities, vaccination against pneumococci and vaccination against influenza. Results: In 2002, 1025 hospitalizations due to all causes were recorded. This number significantly decreased to 862 hospitalizations in 2004 after implementation of the program, corresponding to a reduction of 15.9% (p < 0.0001). Hospitalizations due to respiratory diseases decreased by 23.37% (p < 0.02), and those due to cases of wheezing bronchitis fell by 51.61% (p < 0.001). Conclusion: The strategies chosen and implemented in the Einstein Program of the Paraisópolis Community Outpatient Clinic over the first 6 months of 2003 were effective in reducing the number of children's hospital admissions due to respiratory disease. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical application of long-term non-invasive ventilation (NIV) in infants with life-threatening ventilatory failure with regard to: diagnosis, age at initiation, indication for and duration of treatment, clinical outcome and mortality and adverse effects. Patients and methods: The medical records of 18 infants treated in a home setting during a 7-year period were reviewed. The criteria for ventilatory support were: (a) transcutaneous partial pressures of carbon dioxide (TcPCO2) >6.5 kPa and oxygen (TcPO2) < 8.5 kPa and (b) decreased cough ability and/or recurrent chest infections. Results: The median age at initiation was 4 months (range 1–12). NIV was initiated because of hypoventilation in 12 infants and because of reduced cough ability and/or recurrent infections in six infants. Tracheotomy was eventually needed in two infants. The median duration of treatment was 24 months (range 1–84). NIV produced significant improvements, with median TcPCO2 falling from 9.9 to 6.1 kPa, and median TcPO2 rising from 9.8 to 11.1 kPa. Conclusion: NIV can be successfully and safely used in infants with prolonged life-threatening ventilatory failure, potentially avoiding intubation and tracheotomy. [ABSTRACT FROM AUTHOR]

Neuroglial heterotopias are rare congenital masses that are thought to represent encephaloceles that become sequestered on the extracranial side of the skull base. Although most often adjacent to bony skull base defects, they lack communication to the subarachnoid space. They contain mature neuroglial tissue and specialized central nervous system elements, such as a functioning choroid plexus. A case is presented of neonatal airway obstruction due to neuroglial heterotopia in the nasopharynx. The patient's clinical course and treatment are discussed, along with their radiology and histology. The relevant scientific literature is reviewed. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To assess the effectiveness of home visits advising mothers about breast feeding and weaning in reducing symptoms of respiratory morbidity at the age of 12 months. Methods: A randomized field trial was conducted with mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (2001/2002). The intervention group received dietary advice during the first year based on a Brazilian national health policy for primary care, which is based on WHO guidelines. Morbidity data was assessed in 397 children at 12 months. Results: A total of 23.3% of the children in the intervention group and 39.7% of the controls had one or more of the following symptoms during the month preceding assessment: cough, stuffy nose, runny nose, or breathlessness. The risk of respiratory morbidity symptoms was 41% lower for the intervention group (RR: 0.59; 95% CI: 0.43–0.81). The number of families needed to be visited to avoid one children presenting symptoms of respiratory morbidity (Number Needed to Treat) was 6.1. The intervention-group status was also associated with a longer duration of exclusive (RR:1.59; 95% CI: 1.21–2.07; p =0.001) and total breastfeeding (RR: 1.25; 95% CI:1.02–1.55; p =0.032) later introduction of solid foods (RR:1.11; 95% CI: 1.02–1.21; p =0.023), and a lower proportion of current medication use (RR:0.56; 95% CI:0.34–0.91;p =0.016). Conclusion: A nutrition education program during the first year of life has a positive impact on reducing respiratory symptoms in infants. [Copyright &y& Elsevier]

CONTEXT. China's rapid economic development has come at the cost of severe environmental degradation, most notably from coal combustion. Outdoor air pollution is associated with >300 000 deaths, 20 million cases of respiratory illness, and a health cost of >500 billion renminbi (>3% of gross domestic product) annually. The young are particularly susceptible to air pollution, yet there has been only limited recognition of its effects on children's health and development. DATA SOURCES/DATA EXTRACTION. To fill this gap, we reviewed relevant published environ- mental studies, biomedical and molecular/epidemiologic research, and economic and policy analyses. RESULTS. China relies on coal for ~70% to 75% of its energy needs, consuming 1.9 billion tons of coal each year. In addition to CO2, the major greenhouse gas, coal burning in China emits vast quantities of particulate matter, polycyclic aromatic hydrocarbons, sulfur dioxide, arsenic, and mercury. Automobiles emit nitrogen dioxide and benzene in addition to particulate matter and polycyclic aromatic hydrocarbons. Seventy percent of Chinese households burn coal or biomass for cooking and heating, which contaminates indoor air. Adverse effects of combustion-related air pollution include reduced fetal and child growth, pulmonary disease including asthma, developmental impairment, and increased risk of cancer. A prospective molecular epidemiologic study of newborns in Chongqing has demonstrated direct benefits to children's health and development from the elimination of a coal-burning plant. CONCLUSIONS. Recognition of the full health and economic cost of air pollution to Chinese children and the benefits of pollution reduction should spur increased use of renewable energy, energy efficiency, and clean-fuel vehicles. This is a necessary investment for China's future. [ABSTRACT FROM AUTHOR]

Background: NHLBI guidelines classify asthma in children as intermittent, mild persistent, moderate persistent, and severe persistent asthma based on baseline symptoms and pulmonary function. However, this may not capture the spectrum of asthma in children, since even mild baseline disease can have significant effects on quality of life. Our objective was to describe a population of children with mild asthma admitted to the ICU with severe exacerbations. Methods: We examined data from all children with asthma who were admitted to the ICU with an acute exacerbation between April 1997, and December 2006. Children were defined as having mild asthma if their disease was classified as intermittent or mild persistent according to NHLBI criteria. Results: Of the 298 children admitted to the ICU with asthma, 164 (55%) were classified as having mild baseline asthma. Compared with children with more severe baseline asthma, mild asthmatic children were younger and less likely to have been previously admitted to the hospital for asthma. Other demographics, including admission severity of illness, gender, and prevalence of overweight, were similar in the two groups. There were no differences between the groups in ICU length of stay, hospital length of stay or types of therapies received. Thirteen children with mild asthma were intubated, although less frequently than those with more severe disease. Conclusions: Children with mild asthma have severe exacerbations. This suggests that chronic asthma severity does not necessarily predict asthma phenotypes during acute exacerbations. [ABSTRACT FROM AUTHOR]

Objectives To explore the relationship of easy to collect handwashing indicators with socioeconomic status and reported respiratory disease among children <5 years of age. Methods We added several handwashing indicators to a population-based, cross-sectional study of respiratory illness in Dhaka, Bangladesh. We constructed a wealth index using 12 household characteristics analysed with principal component analysis to assess socioeconomic status. Results Of 6970 households, 92% had a bar of body soap, 41% had a place with water to wash hands inside the house, and 40% had soap present at the most convenient place to wash hands. Handwashing indicators were more common among households with higher socioeconomic status. Within each wealth quintile a place to wash hands within the household was strongly associated with the presence of soap at the handwashing location (odds ratios 13–70). In general estimated equation models that controlled for socioeconomic status, the presence of a place inside the house with water to wash hands was the only handwashing indicator significantly associated with a child in the household who reported cough or difficulty breathing in the preceding 7 days (adjusted odds ratio 0.95, 95% confidence interval 0.93–0.98, P < 0.001). Conclusion Handwashing indicators were strongly influenced by socio-economic status and so would not be an independent measure of handwashing behaviour. Handwashing promotion efforts in urban Dhaka that include specific efforts to provide handwashing facilities inside the house are more likely to improve handwashing behaviour than interventions that ignore this component. [ABSTRACT FROM AUTHOR]

Air quality has seriously deteriorated as a consequence of population growth and urbanisation and respiratory diseases increased among residents of urban areas in Chiang Mai Province, Thailand. An International Study of Asthma and Allergies in Childhood (ISAAC) study was conducted among children attending schools located in the selected sites to assess the potential impacts of air pollution on health. The results showed that the prevalence of asthma was similar in all of the schools (approximately 5%; p = 1.000) but that the prevalence of rhinitis [24.3% (CI = 19.4-30.1) vs. 15.7% (CI = 10.3-23.0); p = 0.029] and atopic dermatitis [12.5% (CI = 9.1-16.8) vs. 7.2% (CI = 3.7-12.6); p = 0.093)] was higher in the urban schools, which were exposed to more pollution. Logistic regression analysis identified factors that may be involved, including air pollution, some components of the diet and contact with animals. [ABSTRACT FROM AUTHOR]

Summary: Backround: Meconium aspiration syndrome is a disease of the newborn mature or post mature. The acute pulmonary consequences can be extremely severe. In the few studies of the long-term pulmonary sequelae, it seems that certain children surviving meconium aspiration syndrome keep an obstructive syndrome. The aim of our study was to assess long term respiratory residual damage from meconium aspiration syndrome. Methods: During a seven-year period going from 1994 to 2000, we reviewed the files of children hospitalized in neonatology departement of Sfax for meconium aspiration syndrome. The children who were convoked (group M: n =27), underwent spirometry, followed by an exercise stress. An age matched control group (group C: n =23) of healthy children was investigated in the same way. Results: The group M comprised 15 boys and 12 girls aged four to 11, an average of 7±1.9 years. With the study of the respiratory function, we did not find an obstructive syndrome. Spirometry revealed a total pulmonary capacity in an average of 133±55.65% of theoretical (group M) versus 105.5±27.96% of theoretical (group C) (P <0,01), testifying to alveolar hyperinflation. Spirometry fulfilled 5, 10 and 15min after exercise showed a FEV1 reduction of respectively 8.5 versus 2 (P <0.05); 9.5 versus 3 (P <0.01) and 10.5 versus 4 (P <0.05). Conclusion: Children surviving meconium aspiration syndrome tend to develop alveolar hyperinflation and airway hyperreactivity to exercise. [Copyright &y& Elsevier]

This article presents a seminar on croup which is the barking cough that young children get that frightens many parents. The disease mainly affects very young children with boys more likely to get it than girls. Symptoms tend to worsen at night and fluctuate with the child's agitation level. Most croup cases are caused by an upper-airway infection. The author offer advice on how to diagnose croup to what signs to look for if the patient is suffering from a more serious disease. Treatment options are presented with the most popular being corticosteroids and epinephrine via nebuliser.

Background: Home care support is beneficial for children needing mechanical ventilation, when clinically stable. Methods: A retrospective analysis was carried out of the long-term home ventilation management of a pediatric population with chronic respiratory failure composed of 20 ventilator-dependent children categorized according to age, diagnosis and ventilation support. Age groups consisted of 10% under 1 year, 30% between 2 and 5 years, 30% between 6 and 12 years, and 30% older than 12 years. Diagnostic categories included myopathic disorder, n = 5; congenital central hypoventilation syndrome, n = 6; chest wall disorder, n = 5; cystic fibrosis, n = 1; pulmonary hypertension, n = 1; and diaphragmatic paralysis, n = 2. Results: Sixty-five percent were ventilated using non-invasive mode (NIMV): eight with nasal mask, five with full-face mask, and two children in NIMV also used negative pressure mode; 35% were ventilated using tracheostomy, one of them also used a diaphragmatic pacer. Seventy percent needed nocturnal ventilatory support, (20% 12–18 h, 10% full-day). A total of 18 children were included in the home care and follow-up program. Two children died: one because of worsening of his chronic disease and one because of septic shock. Conclusion: Although home care ventilation is not yet widely diffused, it represents a valid alternative to long hospitalization for children with stable chronic respiratory failure. [ABSTRACT FROM AUTHOR]

Sleep-related upper airway obstruction in children is recognized as a common health problem. If diagnosis and treatment are delayed, the consequences of sleep-disordered breathing in children can be severe. Understanding of obstructive sleep apnea and associated syndromes (UARS - upper airway resistance syndrome) in children is growing, but many questions remain unanswered. This article focuses on: definition, symptoms, complications, diagnosis and treatment (surgical and nonsurgical) of childhood OSAS. [ABSTRACT FROM AUTHOR]

Aims: We compared the radiological features and outcome of WHO defined severe pneumonia among HIV infected and exposed uninfected children randomised to receive penicillin or oral amoxicillin in Durban, South Africa. Methods: Of 425 children aged between 3 and 59 months with WHO defined severe pneumonia, 366 had anonymous HIV testing performed. Outcome was assessed by failure to improve at 48 h after enrolment or deterioration within 14 days. Chest radiographs were evaluated according to WHO defined radiological criteria for pneumonia and internationally standardised radiological criteria. Findings were stratified for HIV status. Results: 82 (22.4%) children were HIV infected, 40 (10.9%) were HIV exposed and 244 (66.7%) were HIV uninfected. The day 14 outcome in children <12 months of age was significantly worse in HIV-1 infected than HIV uninfected children (OR 2.8 (95% CI 1.35 to 3.5), p=0.002), while HIV-1 infected and uninfected children aged ⩾12 months had equivalent outcomes. Parental penicillin and oral amoxicillin had equivalent response rates in all HIV groups. According to the WHO radiological classification, children who failed WHO standard antimicrobial treatment had significantly higher "other consolidates/infiltrates" than "endpoints for consolidation" in the HIV infected group (OR 5.45 (95% CI 1.58 to 21.38), p<0.002), while the reverse was true for HIV exposed uninfected children (OR 4.13 (95% CI 0.88 to 20.57), p<:0.036). Conclusions: The WHO standard treatment guideline for severe pneumonia is inadequate for HIV-1 infected infants. The increased prevalence of "other consolidates/infiltrates" among HIV-1 infected children who failed standard treatment supports the addition of co-trimoxazole to WHO standard treatment. [ABSTRACT FROM AUTHOR]

Cough - the main symptom of respiratory diseases - is a frequent reason for parents to seek medical attention. There is a group of children who are suffering from recurrent or long lasting cough with onset during upper airway infection without tendency to disappear after upper airway infection recovery. The aim of the present study was to test the cough sensitivity (CS) in children with common cold from pre-disease testing, testing during the common cold period and finally testing performed after the recovery of common cold symptoms. 43 healthy children with normal pulmonary functions (FEVI/FVC{80%), with no history of atopy mad normal plasma IgE levels, were recruited for the study. The children had completed three times testing of the cough sensitivity (pre disease, disease period, after recovery testing), measured by one breath capsaicin test, pulmonary functions testing, and during the disease period they had completed questionnaire covering the intensity of nasal symptoms via numeric analogue scale and nasal swabs were obtained for microbiological assessment. We have found that CS both in coughers and non - coughers have showed the same tendency. CS was normal during the healthy period then was increased during the common cold period and finally it was again about the normal value after the recovery of nasal symptoms. The mean capsaicin C2 concentration in coughers is (in order from healthy to disease and recovery) 2.00 (1.5-2.5} vs 0.42 [0.23-0.61) vs 1.9 (1.4-2.3}, p < 0.001 and for C5 3,01 (2,78-3.24) vs 2.06 (1.83 2.29) vs 2.9 (2.7-3.2} p < 0.001. In non coughers the mean capsaicin C2 value is (in the same order) 1.9 (1,35-2.25) vs 0.65 (0.36-0.89) vs 2.1 (1.4-2.3), p < 0.001 and for C5 3.01 (2.65-3.44) vs 1.9 (1.73-2.29) vs 2.9 (2.44-3.2) p < 0.001. Conclusion: CS in children alter the recovery of common cold symptoms had returned to pre-disease values very quickly, hut some of the children are still coughing in spite of normal CS, This problem has to be elucidated, but objective assessment of 24 hours cough status of the child is indispensable. [ABSTRACT FROM AUTHOR]

Abstract: Several studies have reported an increasing incidence of childhood parapneumonic empyemas in various countries. Aim of the study: The aim of our study was to estimate the annual incidence of complicated community-acquired pneumonias in children during a 9-year period in a French area and to describe the epidemiological and clinical characteristics of these complications. Population and methods: We have listed the children from 28 days to 15 years old, hospitalized in the 2 children hospitals of the Isere district for a community-acquired pneumonia complicated with a pleural empyema or a pulmonary abscess from 1995 to 2003. Results: During the study period, 90 children were hospitalized for a complicated pneumonia including 83 pleural empyemas and 7 isolated lung abscess. The average number of cases was 4 per year from 1995 to 1998 then increased since 1999 to reach 34 cases in 2003, according to a linear model (P <0,001). The incidence of the complicated pneumonia, plotted to the paediatric population of the area has gone up from 0.5 per 100000 to 13 per 100000 children between 1995 and 2003. Conclusion: The incidence of the complicated pneumonias in children increased since 1999 in a French area. Additional investigations are necessary to identify the causes of this increase. [Copyright &y& Elsevier]

Background: Little is known on the predictive value of sensitization to specific aeroallergens in children with respect to asthma and hay fever incidence in young adulthood. We followed the incidence of asthma and hay fever in children (mean age 11 years) over 9 years, and analyzed the predictive value of sensitization to five common aeroallergens. Methods: Three consecutive surveys were conducted in East German school children. Specific IgE antibodies to birch and timothy grass pollen, house dust mite, cat, and cladosporium were measured. In 1207 out of the 2453 children, the 9-year incidence of asthma and hay fever was assessed by reported doctors’ diagnoses. For sensitization, diagnostic parameters were determined and logistic regression analyses controlled for relevant confounders. Results: A total of 176/78 incident hay fever/asthma cases occurred equaling a cumulative incidence of 1.93/0.86% per year. Incident asthma was associated with previous sensitization to cat [risk ratio (RR) 3.49, 1.57–7.74] and grass pollen (RR 1.79, 1.01–3.19), whereas incident hay fever was associated with each allergen, with grass pollen (RR 6.00, 4.04–8.90) and cat (RR 5.36, 2.87–9.99) exhibiting the strongest associations. When mutually adjusting for all allergens, sensitization to cat remained significantly associated with asthma and hay fever. The latter was also associated with sensitization to grass pollen. The highest positive predictive values for asthma and hay fever were obtained for cat sensitization (10/49 = 20.4% and 23/49 = 46.9%). Conclusions: Childhood sensitization to cat and grass pollen predicts the incidence of asthma and hay fever in young adulthood. The predictive capacity differs by allergen and manifestation of atopy. [ABSTRACT FROM AUTHOR]