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• Nearly 5% of people with CF worldwide carry a nonsense mutation on both alleles resulting in a premature termination codon (PTC). For those patients, no efficient targeted therapy is available yet. Limited information is available on their clinical status. • Our study shows thatPwCF carrying at least one PTC exhibited a significantly faster rate of yearly respiratory decline until ∼ 30 years. • Mortality of children and adolescents with one or two PTC alleles was significantly higher than that of their F508del homozygous pairs. • Infection with Pseudomonas aeruginosa was more frequent in patients carrying 2 PTC when compared to PTC/F508del or F508del homozygous patients. • These data highlight the urgent need to develop targeted interventions for patients carrying nonsense mutations in the CFTR gene. Limited information is available on the clinical status of people with Cystic Fibrosis (pwCF) carrying 2 nonsense mutations (PTC/PTC). The main objective of this study was to compare disease severity between pwCF PTC/PTC, compound heterozygous for F508del and PTC (F508del/PTC) and homozygous for F508del (F508del+/+). Based on the European CF Society Patient Registry clinical data of pwCF living in high and middle income European and neighboring countries, PTC/PTC (n = 657) were compared with F508del+/+ (n = 21,317) and F508del/PTC(n = 4254).CFTR mRNA and protein activity levels were assessed in primary human nasal epithelial (HNE) cells sampled from 22 PTC/PTC pwCF. As compared to F508del+/+ pwCF; both PTC/PTC and F508del/PTC pwCF exhibited a significantly faster rate of decline in Forced Expiratory Volume in 1 s (FEV 1) from 7 years (-1.33 for F508del +/+, -1.59 for F508del/PTC; -1.65 for PTC/PTC, p < 0.001) until respectively 30 years (-1.05 for F508del +/+, -1.23 for PTC/PTC, p = 0.048) and 27 years (-1.12 for F508del +/+, -1.26 for F508del/PTC, p = 0.034). This resulted in lower FEV 1 values in adulthood. Mortality of pediatric pwCF with one or two PTC alleles was significantly higher than their F508del homozygous pairs. Infection with Pseudomonas aeruginosa was more frequent in PTC/PTC versus F508del+/+ and F508del/PTC pwCF. CFTR activity in PTC/PTC pwCF's HNE cells ranged between 0% to 3% of the wild-type level. Nonsense mutations decrease the survival and accelerate the course of respiratory disease in children and adolescents with Cystic Fibrosis. [ABSTRACT FROM AUTHOR]

Objective: To identify factors influencing mycoplasma pneumonia and respiratory diseases as a function of yearly seasons. Methods: Records of respiratory disease cases, as obtained from the respiratory laboratory of the First Affiliated Hospital of China Medical University over the period from November 2013 to October 2018, were retrospectively analyzed. Susceptible factors, as related to the general data from mycoplasma pneumonia cases, included season of the year along with the age and gender of the patients. Results: Statistically significant differences in mycoplasma pneumonia were obtained among the different seasons (2 = 496.24, P <0.05), ages (P < 0.05) and gender (2 = 300.10, P < 0.05). The rate and number of mycoplasma pneumonia cases were highest in the winter and lowest in the summer, with the difference between these two seasons being statistically significant (P < 0.05). Among confirmed positive cases, infection rates of mycoplasma pneumonia in young and middle-aged patients were significantly greater than that in the elderly (P < 0.05) and the incidence in women was significantly greater than that in men (2 = 300.10, P < 0.05). Among the total of all lung diseases sampled, the largest numbers were observed in pediatric cases and the peak period of disease occurrence was over the period from October to January. Conclusion: The incidence of pneumonia shows significant differences as a function of the season of the year, effects which are observed in all ages. [ABSTRACT FROM AUTHOR]

Objectives: To describe safety and feasibility of long-term inhalative sedation (LTIS) in children with severe respiratory diseases compared to patients with normal lung function with respect to recent studies that showed beneficial effects in adult patients with acute respiratory distress syndrome (ARDS). Design: Single-center retrospective study. Setting: 12-bed pediatric intensive care unit (PICU) in a tertiary-care academic medical center in Germany. Patients: All patients treated in our PICU with LTIS using the AnaConDa® device between July 2011 and July 2019. Measurements and Main Results: Thirty-seven courses of LTIS in 29 patients were analyzed. LTIS was feasible in both groups, but concomitant intravenous sedatives could be reduced more rapidly in children with lung diseases. Cardiocirculatory depression requiring vasopressors was observed in all patients. However, severe side effects only rarely occured. Conclusions: In this largest cohort of children treated with LTIS reported so far, LTIS was feasible even in children with severely impaired lung function. From our data, a prospective trial on the use of LTIS in children with ARDS seems justified. However, a thorough monitoring of cardiocirculatory side effects is mandatory. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pneumonia is still a leading cause of illness and death in infants worldwide. Lung ultrasound (LUS) is emerging as an extremely valuable non‐ionizing radiation diagnostic tool in diagnosis and follow up of multiple paediatric pulmonary diseases. Objective: To assess the applicability of LUS in diagnosis and follow up of community acquired pneumonia (CAP) in Egyptian infants younger than 1‐year old. Methods: LUS and chest X‐ray (CXR) were performed in 50 infants presented with clinical symptoms and signs suggestive of CAP within the first 6 hours of admission in our inpatient department, then follow up LUS was performed 5 days after admission. Results: This study showed that LUS was superior to CXR in initial diagnosis of CAP in infants. LUS detected pneumonia in 49 (98%) compared to 36 (72%) infants diagnosed by CXR (P < .05). On follow up, 5 days later, consolidation patch disappeared in 13 (26.5%) infants, diminished in size in 27 (55.1%) infants, remained at the same size in 2 (4.1%) infants and increased in size in 7 (14.3%) infants. Conclusion: This study showed that LUS is superior to CXR in diagnosing infants with CAP who are younger than 1‐year old. It also serves as a safe follow up tool and could support the decision of hospital discharge in this category of patients. Further studies with larger sample size and longer follow up duration are recommended to confirm the results of the present study. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) may cause severe illness in cystic fibrosis (CF) children, but recommendations vary on prophylaxis. CARESS is a prospective registry of children who received palivizumab in 32 Canadian sites from 2005 to 2016. Demographic data were collected at enrollment and respiratory illness-related events recorded monthly. We reviewed respiratory illness hospitalization (RIH) and RSV hospitalization (RSVH) in CF children aged < 24 months versus those prophylaxed for standard indications (SI; prematurity, chronic lung disease [CLD] and congenital heart disease [CHD]), and complex medical disorders (CM). Of 23,228 children analyzed, 19,452 (83.8%) were SI, 3349 (14.4%) were CM, and 427 (1.8%) were CF. CF children were more likely to be Caucasian, heavier at birth and enrollment, and less likely to have a sibling or live in crowded conditions. CF children were similar to the other groups in daycare attendance, history of atopy, and exposure to smoking. RIH incidences were 4.3% (premature), 13.8% CLD, 11.5% CHD, 11.7% CM, and 6.8% CF. RSVH incidence in CF children was similar to that in the SI and CM groups: 1.1, 1.5, and 2.0% groups respectively. Cox regression analyses showed that compared to CF children, the HRs for RSVH in SI (HR 2.0 95% CI 0.5-8.3, p = 0.3) and CM (HR 2.4, 95% CI 0.6-9.8, p = 0.2) did not differ. CF children are equally at risk for RSVH relative to those prophylaxed for other indications. Pending robust evidence from prospective trials, palivizumab could perhaps be considered in the interim, for young CF patients born early during the RSV season with evidence of serious lung disease. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether children born with isolated single umbilical artery (iSUA) at term are at an increased risk for long-term pediatric hospitalizations due to respiratory morbidity.Methods: Design: a population-based cohort study compared the incidence of long-term, pediatric hospitalizations due to respiratory morbidity in children born with and without iSUA at term.Setting: Soroka University Medical Center.Participants: all singleton pregnancies of women who delivered between 1991 and 2013.Main Outcome Measure(s): hospitalization due to respiratory morbidity.Analyses: Kaplan-Meier survival curves were used to estimate cumulative incidence of respiratory morbidity. A Cox hazards model analysis was used to establish an independent association between iSUA and pediatric respiratory morbidity of the offspring while controlling for clinically relevant confounders.Results: The study included 232,281 deliveries. 0.3% were of newborns with iSUA (n = 766). Newborns with iSUA had a significantly higher rate of long-term respiratory morbidity compared to newborns without iSUA (7.6 vs 5.5%, p = 0.01). Using a Kaplan-Meier survival curve, newborns with iSUA had a significantly higher cumulative incidence of respiratory hospitalizations (log rank = 0.006). In the Cox model, while controlling for the maternal age, gestational age, and birthweight, iSUA at term was found to be an independent risk factor for long-term respiratory morbidity (adjusted HR = 1.39, 95% CI 1.08-1.81; p = 0.012).Conclusion: Newborns with iSUA are at an increased risk for long-term respiratory morbidity. [ABSTRACT FROM AUTHOR]

Pulmonary sequestrations are non-functional masses of lung tissue lacking normal communication with the tracheobronchial tree and systemic-circulation-derived blood supply. The disconnection between the normal airway and pulmonary arterial supply prevents pulmonary sequestrations from participating in respiration while their aberrant circulation increases the potential for hemodynamic imbalance. Extralobar sequestrations are prenatally diagnosed, congenital lesions that may become symptomatic before or after birth, whereas intralobar sequestrations are usually identified during adulthood. This report describes a 2-month-old boy with respiratory distress caused by an anomaly characterized by a systemic artery feeding a large segment of the left lower lobe lacking normal ventilation due to absent bronchial connections. This segment that was surrounded by its own visceral pleura, and separated from the normal lower lobe by a fissure, drained through a large vessel into the left inferior pulmonary vein, causing left-to-left shunting and high output failure. Symptoms disappeared immediately following thoracoscopic division of the aberrant vessels and excision of only the sequestered segment. This case accentuates the hemodynamic imbalance set off by a left-to-left shunt across an atypical sequestration that although intralobar was separated by an accessory fissure from the normal parenchyma and also the benefits of video-assisted thoracoscopic surgery. [ABSTRACT FROM AUTHOR]

Children aged <2 years with chronic lung disease (CLD) have a 10-fold higher risk for respiratory syncytial virus-positive hospitalization (RSVH) compared to healthy term infants. Based on the updated position statements, we compared respiratory-related illness hospitalization (RIH) and RSVH risks in CLD children who received palivizumab during the first year (FY) versus second year (SY) of life in the Canadian Registry of Palivizumab (CARESS). Demographic data were collected at enrolment and RIH events recorded monthly from 2005 to 2015. Eight hundred forty-seven FY and 450 SY children with CLD were identified. SY children had a lower gestational age (27 versus 29 weeks) and required more days of respiratory support (64 versus 43), oxygen therapy (108 versus 55), and length of stay (118 versus 73) during the neonatal course compared to FY children; all p < 0.0005. RIH rates were 12.2 (FY) and 18.2 (SY), and RSVH rates were 2.3 (FY) and 3.9 (SY). Cox regression showed similar hazards for both RIH (hazard ratio 0.9, 95% CI 0.6-1.6, p = 0.812) and RSVH (hazard ratio 1.1, 95% CI 0.4-2.9, p = 0.920).Conclusions: SY and FY children had similar risks for RIH and RSVH. The findings imply that SY children with CLD are correctly selected for palivizumab based on neonatal illness severity and merit prophylaxis. What is Known: • Children with chronic lung disease have a 10-fold higher risk for RSV-positive hospitalization in comparison to healthy term infants and commonly receive palivizumab prophylaxis as a preventative measure against serious RSV-related lower respiratory tract infections. • The American Academy of Pediatrics [ 2 ] and the Canadian Paediatric Society [ 30 ] have recently modified their recommendations for RSV prophylaxis in children with chronic lung disease, limiting palivizumab to either those <32 weeks gestation or those in the first year of life who are oxygen dependent or require medical therapy for the treatment of their condition. What is New: • Children with chronic lung disease receiving an additional course of palivizumab in their second year of life were determined to be at similar risk for both respiratory illness-related hospitalization and RSV-positive hospitalization as palivizumab-naïve children enrolled in the first year of life in the Canadian Registry for palivizumab (CARESS). • CARESS physicians are correctly identifying high-risk children with chronic lung disease in their second year of life, whom they believe will benefit from an additional year of palivizumab prophylaxis, based on neonatal illness severity. [ABSTRACT FROM AUTHOR]

Background. Arterial hypertension is an essential, often underestimated medical problem among school youth. Maintaining a low blood pressure (BP) in children should be an important point of pediatric preventive healthcare. Objectives. In our study, we considered the influence of physiotherapy on the blood pressure level in a group of 233 children aged from 8 to 15 years taking part in a rehabilitation camp for children in the Szklarska Poreba mountain resort (95 children in 2014 and 138 children in 2015). Material and methods. The children selected for the study suffered from asthma or recurrent respiratory infections. Measurements were made before and after physiotherapy. During the camp, the children were examined two times in 2014 and three times in 2015. The database created contained 1,208 scores of systolic and diastolic BP. The control group consisted of 50 children whose BP was measured in the same hours, but during the weekend, which was free of physiotherapy. Moreover, the values of heart rate (HR ) during the first measurement were recorded, both in 2014 and 2015. Results. Systolic BP after physiotherapy was significantly lower than before. This result was achieved in every five measuring sessions. In the control group, BP measured in the afternoon was higher than in the morning. The values of HR were not significantly different. The values of BP before and after physiotherapy between children treated with inhaled glucocorticoids and treated without glucocorticoid were not statistically significant. Conclusions. Our studies showed that morning exercise can significantly reduce blood pressure in children throughout the day, even in those who were treated with inhaled glucocorticoids. [ABSTRACT FROM AUTHOR]

Background: Children with respiratory morbidities are at increased risk of developing adverse respiratory events while undergoing deep sedation. Dexmedetomidine possesses sedative properties with minimal respiratory depression. This report aimed to determine the usability of dexmedetomidine in children with significant respiratory morbidities who require deep sedation.Methods: Medical records of children with ASA classification III who had at least three characteristics of respiratory morbidities and who received dexmedetomidine sedation for magnetic resonance imaging (MRI) between January 2014 and May 2015 were retrospectively reviewed. Dexmedetomidine was administered as a bolus of 1 μg/kg over 10 min followed by 1 μg/kg/h infusion. If necessary, an additional bolus dose was given and the infusion rate was increased to 2 μg/kg/h. Respiratory morbidities, haemodynamic parameters, total dexmedetomidine dose, adverse cardiorespiratory events and sedation characteristics were analysed.Results: Nineteen out of 642 children who underwent MRI were eligible for evaluation. Seventeen children (89%) had at least four characteristics of respiratory morbidities. The median [IQR] age was 9 months [3.5-14]. All patients completed MRI scans while breathing spontaneously via the native airway. No episodes of adverse respiratory events or haemodynamic instability were observed. Children who were administered a lower dexmedetomidine dose and had a shorter sedation time were more likely to be younger than 1 year of age.Conclusion: These data demonstrate that dexmedetomidine deep sedation was well-tolerated in children with significant respiratory morbidities. Moreover, children younger than 1 year of age were administered lower dexmedetomidine dose than children older than 1 year of age for the same sedation level.Trial Registration: ClinicalTrials.gov identifier NCT02555605. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the hypothesis that elective early-term delivery increases the risk of childhood lower respiratory tract disorder hospitalization.Methods: Children born via early-term elective inductions were compared to full- or late-term elective inductions in a retrospective cohort study using Washington State birth certificate and hospital discharge data. Outcomes were the odds of lower respiratory disorder hospitalization before age five and cause specific odds ratios for asthma, bronchiolitis, bronchitis, and pneumonia. In addition, a subgroup analysis excluding infants with perinatal complications was conducted.Results: Electively induced early-term children were at significantly increased risk of hospitalization before age five for lower respiratory disorders compared to similar full- or late-term children (adjusted OR: 1.31, 95% CI: 1.11-1.55). Bronchiolitis was the only cause-specific outcome with a statistically significant increase in odds of hospitalization, though comparable increases were found for the less common diagnoses of asthma (adjusted OR: 1.39, 95% CI: 0.93-2.08) and pneumonia (adjusted OR: 1.27, 95% CI: 0.99-1.64). Excluding infants with perinatal complications did not alter the results.Conclusions: There was an association between electively induced early-term delivery and hospitalization for lower respiratory tract disorders before age five. This reinforces policies discouraging elective early-term delivery. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to determine the diagnostic validity of digital chest auscultation to improve the differentiation of chest sounds associated with pneumonia in children. Methods This is a prospective case--control study at two hospitals in Nepal. Cases had World Health Organization-defined pneumonia and were classified as radiologically confirmed or nonconfirmed based on radiographic findings. Controls had no respiratory complaints. The presence of crepitations in recorded lung sounds defined pneumonia. Radiologically confirmed pneumonia was the reference standard. Results Sensitivity and specificity of digital auscultation were 56% (95% confidence interval [CI], 40-70%) and 73% (95% CI, 70-76%), respectively. Conclusion Digital auscultation in conjunction with standardized grading of digital lung sounds has the potential to improve the specificity of pneumonia diagnosis, but further development of objective interpretation of lung sounds is needed. [ABSTRACT FROM AUTHOR]

Background Airway inflammation plays a major role in the progression of chronic lung diseases. The features of airway inflammation are not well defined among patients with cases of bronchiolitis obliterans (BO) that began in childhood. Objectives To investigate the sputum cell and cytokine profiles of stable cases of BO regarding lung function and the involvement of small airway disease (SAD). Methods Twenty patients with BO (median age = 14.5, range = 7–23 years) and 22 healthy controls (median age = 16.5 years, range = 7–24 years) were investigated. Lung function parameters and bronchial reversibility testing as well as sputum cell and cytokine profiles (IL-1β, IL-6, IL-8, TNF-α, IL-5, IFN-γ, and NFκB regulation) were analysed using quantitative RT-PCR and cytometric bead assay (CBA) in induced sputum. Results Patients with BO had significantly lower lung function values, including FVC, forced expiratory volume (FEV1), the Tiffeneau index (FEV1/VC) , and MEF25, but increased functional residual capacity (RV/TLC) values. Bronchial reversibility was found in five patients (25%). Moreover, airway inflammation (as indicated by total cells, neutrophils, IL-1β, IL-6, IL-8, TNF-α, and NFκB) was significantly increased among patients with BO compared with controls. Conclusions BO is predominantly a neutrophilic disease of the small bronchioles featuring elevated levels of pro-inflammatory cytokines leading to tissue remodelling and fibrosis of the small airways. Future therapies for patients with BO should more efficiently target the small airways. [ABSTRACT FROM AUTHOR]

Diffuse parenchymal lung diseases in children (chDPLD) or interstitial lung diseases in children (chILD) represent a heterogeneous group of respiratory disorders that are mostly chronic and associated with high morbidity and mortality. However, the incidence of chDPLD is so low that most pediatricians lack sufficient knowledge of chDPLD, especially in China. Based on the clinico- radiologic- pathologic (CRP) diagnosis, we tried to describe (1) the characteristics of chDPLD and (2) the ratio of each constituent of chDPLD in China. Data were evaluated, including clinical, radiographic, and pathologic results from lung biopsies. We collected 25 cases of chDPLD, 18 boys and 7 girls with a median age of 6.0 years, from 16 hospitals in China. The most common manifestations included cough (n = 24), dyspnea (n = 21), and fever (n = 4). There were three cases of exposure-related interstitial lung disease (ILD), three cases of systemic disease-associated ILD, nineteen cases of alveolar structure disorder-associated ILD, and no cases of ILD specific to infancy. Non-specific interstitial pneumonia (n = 9) was the two largest groups. Conclusion: Non-specific interstitial pneumonia is the main categories of chDPLD in China. Lung biopsy is always a crucial step in the final diagnosis. However, clinical and imaging studies should be carefully evaluated for their value in indicating a specific chDPLD. [ABSTRACT FROM AUTHOR]

Background Arsenic exposure via drinking water increases the risk of chronic respiratory disease in adults. However, information on pulmonary health effects in children after early life exposure is limited.Methods This population-based cohort study set in rural Matlab, Bangladesh, assessed lung function and respiratory symptoms of 650 children aged 7–17 years. Children with in utero and early life arsenic exposure were compared with children exposed to less than 10 µg/l in utero and throughout childhood. Because most children drank the same water as their mother had drunk during pregnancy, we could not assess only in utero or only childhood exposure.Results Children exposed in utero to more than 500 µg/l of arsenic were more than eight times more likely to report wheezing when not having a cold [odds ratio (OR) = 8.41, 95% confidence interval (CI): 1.66–42.6, P < 0.01] and more than three times more likely to report shortness of breath when walking on level ground (OR = 3.86, 95% CI: 1.09–13.7, P = 0.02) and when walking fast or climbing (OR = 3.19, 95% CI: 1.22–8.32, P < 0.01]. However, there was little evidence of reduced lung function in either exposure category.Conclusions Children with high in utero and early life arsenic exposure had marked increases in several chronic respiratory symptoms, which could be due to in utero exposure or to early life exposure, or to both. Our findings suggest that arsenic in water has early pulmonary effects and that respiratory symptoms are a better marker of early life arsenic toxicity than changes in lung function measured by spirometry. [ABSTRACT FROM AUTHOR]

CF affects one of 2000 Caucasians, and approximately 25% are found to have CFLD for which OLT may be indicated. Timing of transplantation, contraindications, and survival are still widely debated. We report the outcomes of OLT for pediatric patients with CFLD from the largest children's hospital in the United States. Our records since September 1998 were analyzed for all patients undergoing OLT for CFLD. Nine patients were then compared to similar patients in the UNOS/ OPTN database (n = 155). Survivals were calculated with the Kaplan- Meier method and compared using the log-rank test. All statistics were performed in SPSS 15.0. We performed OLT on nine pediatric patients with CFLD, with age ranging from nine to 17 yr at the time of transplant. Mean survival was 69.2 months; patient and allograft survivals at one and five yr were 88.9%, with one death at day 21 due to Aspergillus fumigatus sepsis. Two patients underwent concurrent multi-organ transplantation. One patient required double lung transplantation four yr after isolated OLT. Comparison to the UNOS/ OPTN database revealed a trend toward improved survival. Patients with CF can achieve favorable outcomes after OLT, as we report excellent survivals for pediatric patients with CFLD. [ABSTRACT FROM AUTHOR]

Haemophilus influenzae (Hi) causes more than 3 million cases of serious disease, mainly meningitis and pneumonia in children less than 5 years old with approximately 386,000 deaths each year worldwide. The presence or absence of a polysaccharide capsule is an important distinguishing characteristic of H. influenzae species. The polysaccharide capsule can be serologically classified into six serotypes (a to f). Invasive Hi diseases in children were almost exclusively caused by serotype b (Hib). To the best of our knowledge, the real burden of Hib pneumonia in Egypt is not clarified. Yet, few studies are published and concerned with Hib sepsis among neonates or Hib meningitis in children. We aimed in this study to identify the frequency of Hib pneumonia among Egyptian children below five years by the use of real-time polymerase chain reaction (PCR) technique, with insight on antimicrobial resistance of Hib strains in the Egyptian community. One hundred patients with community-acquired pneumonia were investigated for Hib by both real-time PCR and bacterial culture. Haemophilus influenzae type b was diagnosed in 31% of the examined population by PCR, with sensitivity of 100% (95% CI: 0.86-1), specificity 100% (65% CI: 0.93-1), positive predictive value (PPV) 100% (95% CI: 0.83-1), and negative predictive value (NPV) 100% (95% CI: 0.93-1). Blood culture was positive in 12 patients only, with a sensitivity of 38% (95% CI: 0.22- 0.57), a specificity of 100% (65% CI: 0.93-1), PPV 100% (95% CI: 0.69-1), and NPV 77% (95% CI: 0.68-0.86). Isolated Hib strains were sensitive to ceftriaxon in 91% of cases, followed by ampicillins in 31% and cotrimoxazole in 17%. Three patients had multidrug resistant strains of Hib. Conclusion: Haemophilus influenzae type b infection is still an important and frequent pathogen causing community-acquired pneumonia in Egypt with changeable antibiotic sensitivity pattern. PCR represented a sensitive and rapid tool for the diagnosis of Hib pneumonia. Governmental plans to eradicate Hib in our community with the introduction of Hib conjugate vaccine in the national immunization program became indispensable. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective: Chest MRI is increasingly used to assess pulmonary diseases, but its utility compared with high-resolution computed tomography (HRCT) has never been evaluated in children using specific performance outcomes. The aim of this study was to assess the accuracy and reliability of MRI compared with HRCT in children with non-cystic fibrosis (CF) chronic lung disease. Methods: Fifty subjects aged 5.9-20 years, with primary ciliary dyskinesia ( n = 17), primary immunodeficiency ( n = 17) or recurrent pneumonia ( n = 16), underwent chest HRCT and MRI. The prevalence of lung abnormalities on HRCT was evaluated, and sensitivity, specificity, accuracy and positive and negative likelihood ratios for MRI versus HRCT were calculated. MRI and HRCT scans were also assessed using a modified Helbich score. Results: Bronchiectasis, mucous plugging, peribronchial wall thickening, consolidation, bullae, abscesses and emphysema were detected by HRCT in 72, 68, 66, 60, 10, 8 and 8% of subjects, respectively. Sensitivity, specificity, accuracy and positive and negative likelihood ratios for MRI were good or excellent for most of the changes that were assessed. Median total Helbich scores for HRCT and MRI were 10 (range 0-20) and 10 (range 0-18), respectively. There was good-to-excellent agreement between the two techniques for all scores (r ≥ 0.8). A Bland-Altman plot confirmed this agreement between total scores (bias value: 0.2 ± 1.18; 95% limits of agreement of mean difference: −2.12-2.52). Conclusions: Chest MRI was equivalent to HRCT to determine the extent of lung disease in children with non-CF lung disease. The findings support the use of chest MRI as an alternative to HRCT in diagnostic pathways for paediatric chronic lung disorders. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Infants and children with chronic lung disease of prematurity (CLDP) are at increased risk for morbidity and mortality from respiratory viral infections. Exposure to respiratory viruses may be increased in the day care environment. The risk of respiratory morbidity from day care attendance in the CLDP population is unknown. We therefore sought to determine if day care attendance is a significant risk factor for increased respiratory morbidity and symptoms in infants and children with CLDP. METHODS: Between January 2008 and October 2009, parents of infants and children with CLDP were surveyed. Information on pennatal history, sociodemographic information, day care attendance, and indicators of respiratory morbidity, including emergency department (ED) visits, hospitalizations, systemic corticosteroid use, antibiotic use, and respiratory symptoms, was collected on children <3 years of age. Logistic regression models were constructed to examine associations between exposure to day care and respiratory morbid ities. RESULTS: Data were collected from 111 patients with CLDP. The average gestational age was 26.2 ± 2.0 weeks. Day care attendance was associated with significantly higher adjusted odds for ED visits (odds ratio [OR]: 3.74 [95% confidence interval (Cl): 1.41-9.91]; P< .008), systemic corticosteroid use (OR: 2.22 [Cl: 1.10-4.491; p < .026), antibiotic use (OR: 2.40 [Cl: 1.08-5.301; p < .031), and days with trouble breathing (OR: 2.72 [Cl: 1.30-5.69]; P< .008). Although there was an increased OR for hospitalization (OR: 3.22 [Cl: 0.9710.72]; P < .057), this did not reach statistical significance. CONCLUSIONS: We found that day care attendance is associated with increased respiratory morbidities in young children with CLDP. Physicians should consider screening for and educating caregivers aboutthe risks of day care attendance by young children with CLDP. [ABSTRACT FROM AUTHOR]

Normal lung development follows a series of orchestrated events. Premature birth interrupts normal in utero lung development, which results in significant alterations in lung function and physiology. Increasingly, there are reports documenting the broad range of complications experienced by infants aged 34 to 36 weeks' gestational age (GA). Our objective was to summarize the evidence demonstrating respiratory system vulnerability in infants aged 34 to 36 weeks' GA and to review the developmental and physiologic principles that underlie this vulnerability. A comprehensive search for studies that reported epidemiologic data and respiratory morbidity was conducted on the PubMed, Medline, Ovid Biosis, and Embase databases from 2000 to 2009 by using medical subject headings "morbidity in late preterm infants," "preterm infants and lung development," `prematurity and morbidity," and "prematurity and lung development." Because the number of studies exclusive to infants aged 34 to 36 weeks' GA was limited, selected studies also included infants aged 32 to 36 weeks' GA. Of the 24 studies identified, 16 were retrospective population-based cohort studies; 8 studies were observational. These studies consistently revealed that infants born at 32 to 36 weeks' GA, including infants of 34 to 36 weeks' GA, experience substantial respiratory morbidity compared with term infants. Levels of morbidity were, attimes, comparabletothose observed in very preterm infants. The developmental and physiologic mechanisms that underlie the increased morbidity rate and alterations in respiratory function are discussed. We also present evidence to demonstrate that the immaturity of the respiratory system of infants 34 to 36 weeks' GA at birth results in increased morbidity in infancy and leads to deficits in lung function that may persist into adulthood. [ABSTRACT FROM AUTHOR]

AbstractDespite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the updated recommendations of a European panel of expert neonatologists who had developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. These updated guidelines are based upon published evidence up to the end of 2009. Strong evidence exists for the role of a single course of antenatal steroids in RDS prevention, but the potential benefit and long-term safety of repeated courses are unclear. Many practices involved in preterm neonatal stabilisation at birth are not evidence-based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in the management of RDS, but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be lifesaving, but can cause lung injury, and protocols should be directed at avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure or nasal ventilation. For babies with RDS to have best outcomes, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate tissue perfusion.Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Cutaneous tuberculosis constitutes a minor proportion of the clinical manifestations of tuberculosis. A study on the incidence of cutaneous tuberculosis in children and adolescents was conducted at Rajah Muthiah Medical College and Hospital (RMMCH), Annamalai Nagar, between 1992 and 1998. A total of 54 patients were en- countered during the period of study, of which lupus vulgaris (LV) constituted 25 cases, (46.2%), scrotuloderma (SCF) contributed to 12 cases (22.2%), and the rest, i.e, 17 cases, (31.6%) were tuberculosis verrucosa cutis (TBVC). The various clinical features and other investigational parameters are discussed. [ABSTRACT FROM AUTHOR]

Background. Exercise-induced asthma (EIA) is an attack of asthma that is provoked following strenuous exercises. Both clinical and laboratory observations indicate that short (4 to 10 min intense periods of exercise) are the most likely to trigger asthmatic symptoms. To diagnose EIA in children, a fall of more than 15% in forced expiratory volume in one second (FEV1) after a strenuous exercise or a fall of more than 35% of forced expiratory flow between 25 and 75% of the forced vital capacity (FEF25-75) are commonly used. Aims. The aim of this study was to distinguish EIA from non-EIA children by means of FEV1 and FEF25-75 changes measured after a strenuous exercise. Methods. Thirty-six prepubescent asthmatics participated in this study. After an 8-minute exercise at a constant workload, the children were divided into EIA- and non-EIA groups, considering separately on the one hand the fall in FEV1 and on the other hand the fall in FEF25-75. Results. With the FEV1 method, 15 children (41.6%) had EIA symptoms and 21 children had not. When using the FEF25-75 method, 14 children (38.8%) had symptoms of EIA and 22 had not. Some children were not in the same subgroup regarding the two aforementioned definitions. A discriminatory analysis done on FEV1 and FEF25-75 before and after exercise showed that, respectively 8.33% and 2.78% of the children did not remain in the initial subgroup. This might be explained by the characteristics of the FEF25-75 investigation. FEF25-75 is thought to reflect the status of the small bronchi and is, therefore, not dependent on goodwill. Conclusions. The results of this study suggest that FEF25-75 appears to be a better discriminating parameter in children's EIA diagnosis than FEV1. [ABSTRACT FROM AUTHOR]

Introduction: Acute respiratory tract infections (ARI) in children are often treated with antibiotics even without evidence of bacterial infection. Serum procalcitonin (PCT) is elevated in bacterial but not in viral infections.Patients and Methods: We performed a retrospective analysis of children in the PID-ARI.net study on respiratory infections to address the question of whether plasma PCT could potentially distinguish between bacterial infections requiring antibiotic therapy and viral ARI. We analysed data on 327 children who had been included in the German PID-ARI.net study and in whom nasopharyngeal aspirates had been analysed with a 19-valent multiplex reverse transcription-polymerase chain reaction-enzyme-linked immunosorbent assay for viral and atypical bacterial pathogens. Serum PCT was determined using a quantitative immunoassay (BRAHMS Kryptor PCTsensitive, Henningsdorf, Germany). We then focussed specifically on those children who were treated with antibiotics and therefore had been suspected of having bacterial infection but who had a serum PCT level lower than 0.1 ng/ml.Results: Out of 327 children, 132 had serum PCT levels below 0.1 ng/ml. Of these 132, 38 children had been treated with antibiotics. After exclusion of 26 patients (with critical illnesses, antibiotics on admission or for reasons other than ARI), 12 children remained for further evaluation. Of these 12 children, four had atypical pneumonia; four others had positive virus testing, and, in the last four, the aetiology of ARI remained unknown; evidence of bacterial infection could not be detected in any.Conclusions: Taken the results of this retrospective analysis, serum PCT values below 0.1 ng/ml might be a marker to identify children with acute respiratory tract infection in whom antibiotic treatment could be withheld. However, only a prospective intervention trial will prove the general safety of this limit. [ABSTRACT FROM AUTHOR]

Background: This study compared the plethysmographic lung volumes of children with sighing dyspnea with healthy children and tested the hypothesis that sighing children suffer from hyperinflation or gas trapping as a cause of dyspnea. Methods: From January 2006 to December 2006, pediatric patients with sighing dyspnea presenting to the pulmonary clinic of a tertiary children’s hospital who had no apparent cardiopulmonary diseases were prospectively enrolled; normal healthy children were invited to participate for comparison. Baseline pre-bronchodilator spirometry and post-inhaled bronchodilator spirometry were measured for the determination of bronchodilator response. Plethysmographic lung volumes were determined solely for total lung capacity, residual volume (RV) and functional residual capacity (FRC) without the use of inhaled bronchodilator according to standard procedure. Results: Eighteen sighing children (10 boys) and 10 healthy subjects (six boys) were included in the present study. They had a median age of 13 years (range, 8–15 years) and 13 years (range, 8–17 years), respectively. The mean baseline forced vital capacity (FVC) of subjects with dyspnea was 79.4 ± 16.7% of predicted, while that of the normal control children was 88.4 ± 6.7%, which was not statistically significantly different. Forced expiratory volume in 1 s (FEV1), FEV1/FVC % of predicted were within normal limits and indicated no bronchodilator response. RV and RV/total lung capacity (TLC) were elevated in children with sighing dyspnea that were not measured by spirometry, but TLC and FRC measured on plethysmography (FRCpleth) were not increased. Conclusions: RV and RV/TLC were higher in children with sighing dyspnea that were not measured by spirometry, but TLC and FRCpleth were not increased. The causal link between dysfunctional breathing patterns and changes in static lung volumes was not able to be determined in the present study. The possibility of heterogeneity of patients with sighing dyspnea obscures the significance of lung volume discrepancy in this population; further subdivision of children with sighing dyspnea in a larger cohort of patients is required. [ABSTRACT FROM AUTHOR]

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]

Background: Development of T-cells based-Interferon gamma (IFNc) assays has offered new possibilities for the diagnosis of latent tuberculosis infection (LTBI) and active disease in adults. Few studies have been performed in children, none in France. With reference to the published data on childhood TB epidemiology in the Paris and Ile de France Region, we considered it important to evaluate the performance of IGRA (QuantiFERON TB Gold In TubeH, QF-TB-IT) in the diagnosis and the follow-up through treatment of LTBI and active TB in a cohort of French children. Methodology/Principal Findings: 131 children were recruited during a prospective and multicentre study (October 2005 and May 2007; Ethical Committee St Louis Hospital, Paris, study number 2005/32). Children were sampled at day 0, 10, 30, 60 (except Healthy Contacts, HC) and 90 for LTBI and HC, and a further day 120, and day 180 for active TB children. Median age was 7.4 years, with 91% of the children BCG vaccinated. LTBI and active TB children undergoing therapy produced significant higher IFNc values after 10 days of treatment (p = 0.035). In addition, IFNc values were significantly lower at the end of treatment compared to IFNc values at day 0, although the number of positive patients was not significantly different between day 0 and end of treatment. Conclusions/ Significance: By following quantitative IFNc values in each enrolled child with LTBI or active TB and receiving treatment, we were able to detect an increase in the IFNc response at day 10 of treatment which might allow the confirmation of a diagnosis. In addition, a decline in IFNc values during treatment makes it possible for clinicians to monitor the effect of preventive or curative therapy. [ABSTRACT FROM AUTHOR]

Background & objectives: As the dosages recommended for children are based on weight, empirical and derived by extrapolation from the studies in adults, pyrazinamide (PZA) pharmacokinetics in children is likely to be different from adults. Limited information exists regarding the pharmacokinetics of PZA in paediatric patients of primary progressive disease (PPD) of lungs. This study aims to look at the changed pharmacokinetics of pyrazinamide in children with PPD of lungs by using reverse phase high-pressure liquid chromatography (HPLC). Methods: A total of 40 children (age range 5 to 13 yr) of PPD were receiving pyrazinamide (30 mg/kg/day). On 11th day of short course antitubercular therapy, blood samples (two per day from 11th to 13th day) were collected at 0 h (pre-dose), 1, 2, 3, 4, 8 and 24 h after pyrazinamide administration and concentration of pyrazinamide was estimated by reverse phase high-pressure liquid chromatography. The mean peak serum concentration, the time to reach mean peak serum concentration, total clearance, concentration at time zero, volume of distribution, terminal elimination rate constant, elimination half-life, total area under serum concentration-time curve were measured. Results: The mean serum concentrations of pyrazinamide were found higher than its minimum inhibitory concentration (20 µg/ml) required to inhibit the growth of tubercle bacilli from 1 to 8 h continuously. Interpretation & conclusions: Our results suggest that a dose of 30 mg/kg/day achieves much higher concentration of pyrazinamide as compared to its minimum inhibitory concentration (20) µg/ml). Therefore, lowering of pyrazinamide dosage is suggested in children for better patient compliance along with reduction in cost, side-effects and toxicity without compromising its efficacy. [ABSTRACT FROM AUTHOR]

Background: Childhood is the most important age for asthma development. Recent reports indicate that the prevalence of asthma in children has plateaued after having increased for decades. Aims: To study prevalence and risk factor patterns of asthma by age and by time. Methods: In 1996, all children in grade 1–2 (age 7–8) in three cities in Northern Sweden were invited to an expanded International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. A total of 3430 children (97%) participated yearly until 2000 (age 11–12). A subset ( n = 2454) was invited to skin-prick testing in 1996 and 2000 with 88% and 90% participation. In 2006, another cohort ( n = 2704) was identified and studied by identical methods with 96% participation. A total of 1700 children (90% of invited) were skin-prick tested. Results and comments: From age 7–8 to 11–12, the prevalence of physician-diagnosed asthma increased, 5.7%–7.7% ( P < 0.01) while current wheeze decreased, 11.7%–9.4% ( P < 0.01), indicating a less diverse spectrum of symptoms with age. The yearly remission from asthma was 10% (lasting remission 5%), largely determined by allergic sensitisation. Allergic sensitisation (OR 5) and a family history of asthma (OR 3) were important risk factors for asthma at age 7–8 and 11–12. However, several other significant risk factors at age 7–8 (low birth weight, respiratory infections and house dampness) lost importance until age 11–12. Maternal and paternal asthma were equally important risk factors (OR 3–4) at age 7–8. Sibling asthma was only a marker of parental disease. Future perspectives: Through comparison with the 2006 cohort, trends in prevalence and in risk factors from 1996 to 2006 will be studied. Please cite this paper as: Bjerg A and Rönmark E. Asthma in school age: prevalence and risk factors by time and by age. The Clinical Respiratory Journal 2008; 2: 123–126. [ABSTRACT FROM AUTHOR]

Introduction: Mycoplasma pneumoniae is undoubtedly one of the most common atypical pathogens causing pneumonia in children. The aim of the study was analysis of frequency and clinical picture of pneumonia caused by Mycoplasma pneumoniae. Materials and methods: The study involved 253 children with pneumonia caused by Mycoplasma pneumoniae, hospitalized in the 2nd and 3rd Department of Paediatric, Polish Mother's Memorial Hospital - Research Institute in Lodz, Poland, in the years 2003-2007. The studied group comprised 111 infants (group I), 66 children from 2 to 3 years of age (group II), 43 children at the age of 4 to 7 years (group III), and 33 children at the age of 8 to 18 years (group IV). Results: In the analyzed period, 4783 children were hospitalized due to pneumonia in both departments. Mycoplasma pneumoniae etiology was diagnosed in total in 253 (5.3%) children, including 111 (3.6%), 66 (5.4%), 43 (12.2%), and 33 (33%) children belonging to group I, II, III, and IV, respectively. The most common clinical feature was cough, observed in 84.7%, 90.9%, 88.4%, and 84,8% of children from group I, II, III, and IV, respectively. In children below 3 years of age, cough was often accompanied by dyspnea, noted in 75.7% of infants, 65.1% of children at the age of 2 to 3 years, 23.3% of children from 4 to 7 years of age, and 21.2% children at the age of 8 to 18. Next, the following were observed: signs of pharyngitis, rhinitis, raised body temperature, enlargement of lymph nodes, indigestion, and skin lesions. On physical examination, auscultatory signs were noted in 79.1% of the children. In laboratory analyses, concentration of C-reactive protein and white blood cell count were slightly increased in 25.3% and 21.3% of the children, respectively. Conclusions: Mycoplasma pneumoniae is a common etiological agent of pneumonia, observed not only in older children, but also in infants. The clinical course of pneumonia caused by Mycoplasma pneumoniae is non-characteristic, with most serious course observed in babies, suffering from paroxysms of tiresome cough and breathlessness. [ABSTRACT FROM AUTHOR]

Analysis of ambient air quality data monitored at Colombo Fort monitoring unit clearly revealed that PM10 is the dominant air pollutant in the Colombo atmosphere. Further investigation showed that PM10 has strong associations with three types of respiratory illnesses, especially among children. Among these associations, the disease category which includes bronchitis, emphysema and other chronic obstructive pulmonary diseases showed a prominent association with a correlation coefficient of 0.717 at 99% confidence. In addition, an application of health impact assessment software developed by WHO revealed that nearly 20% of Asthma patients recorded at LRH (the Lady Ridgeway Hospital for Children) in 2005 could be attributed to exposure to PM10 in Colombo. It was observed that nearly 60% of the respiratory cases occurred at reasonably lower concentrations (below 80 μ gm- 3) thus, future management plans aiming toward positive health impacts should focus on shifting the entire PM10 pollution distribution towards lower ends. [ABSTRACT FROM AUTHOR]

Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention. This review updates a prior meta-analysis and investigates whether risk varies by etiological agent and pneumonia severity among children aged less than 5 years who are exposed to unprocessed solid fuels. Searches were made of electronic databases (including Africa, China and Latin America) without language restriction. Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents. From 5317 studies in the main electronic databases (plus 307 African and Latin American, and 588 Chinese studies, in separate databases), 25 were included in the review and 24 were suitable for meta-analysis. Due to substantial statistical heterogeneity, random effects models were used. The overall pooled odds ratio was 1.78 (95% confidence interval, CI: 1.45–2.18), almost unchanged at 1.79 (95% CI: 1.26–2.21) after exclusion of studies with low exposure prevalence (< 15%) and one high outlier. There was evidence of publication bias, and the implications for the results are explored. Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified. Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia. Despite heterogeneity, this analysis demonstrated sufficient consistency to conclude that risk of pneumonia in young children is increased by exposure to unprocessed solid fuels by a factor of 1.8. Greater efforts are now required to implement effective interventions. [ABSTRACT FROM AUTHOR]

Childhood pneumonia is the leading single cause of mortality in children aged less than 5 years. The incidence in this age group is estimated to be 0.29 episodes per child-year in developing and 0.05 episodes per child-year in developed countries. This translates into about 156 million new episodes each year worldwide, of which 151 million episodes are in the developing world. Most cases occur in India (43 million), China (21 million) and Pakistan (10 million), with additional high numbers in Bangladesh, Indonesia and Nigeria (6 million each). Of all community cases, 7–13% are severe enough to be life-threatening and require hospitalization. Substantial evidence revealed that the leading risk factors contributing to pneumonia incidence are lack of exclusive breastfeeding, undernutrition, indoor air pollution, low birth weight, crowding and lack of measles immunization. Pneumonia is responsible for about 19% of all deaths in children aged less than 5 years, of which more than 70% take place in sub-Saharan Africa and south-east Asia. Although based on limited available evidence, recent studies have identified Streptococcus pneumoniae, Haemophilus influenzae and respiratory syncytial virus as the main pathogens associated with childhood pneumonia. [ABSTRACT FROM AUTHOR]

Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. Because most children are not imaged prior to onset of clinical symptoms, the appearance of early Mycoplasma infection has not been extensively studied. We present the case of an 11-year-old boy with large pulmonary masses incidentally detected during spine MRI evaluation for scoliosis. Eight days later, the patient developed acute respiratory symptoms, and the masses seen previously had evolved into a diffuse bronchiolitis. Diagnostic testing identified Mycoplasma pneumoniae as the likely etiology. We briefly review chest CT findings of infection by Mycoplasma and compare them to this unusual presentation of Mycoplasma pneumonia with subclinical imaging findings. [ABSTRACT FROM AUTHOR]

Abstract: Human metapneumovirus (hMPV) was discovered in 2001 as a causative agent of respiratory disease in young children, immunocompromised individuals and the elderly. Clinical signs of hMPV infection range from mild respiratory illness to bronchiolitis and pneumonia. Two main genetic lineages of hMPV that circulate worldwide were found to be antigenically different, but antibodies against the F protein, the major determinant of protection, were shown to be cross-protective. Since the discovery of hMPV in 2001, several research groups have developed vaccine candidates that may be used to protect different risk groups against hMPV-induced respiratory disease. The studies in rodent and non-human primate models look promising, but none of the vaccine candidates has been tested yet in human volunteers. Here we give an overview of the immunogenicity and protective efficacy of a variety of live attenuated, virus vectored, inactivated virus and subunit vaccines that have been tested in animal models. [Copyright &y& Elsevier]

OBJECTIVE. Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children. METHODS. We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Medline, and Embase 1990 to March 2006. Data were extracted on clinical issues, methodologic characteristics, and results of the reviews. Methodologic quality was assessed with the Overview Quality Assessment Questionnaire and with additional questions on heterogeneity. Separate reporting on children in mixed adult-pediatric population reviews was assessed. Methodologic quality of systematic reviews published in peer-reviewed journals was compared with Cochrane reviews. RESULTS. A total of 23 systematic reviews were included: 14 were published in the Cochrane Library, and 9 were published in peer-reviewed journals. Eight reviews included children only, and 15 were mixed-population reviews. The majority of reviews defined the study population as having "acute asthma" without a more precise definition, and 16 different health outcomes were reported. The overall quality according to the Overview Quality Assessment Questionnaire was good, with Cochrane reviews showing minimal flaws and journal reviews showing minor flaws (median scores: 7 vs 5). Results on children were reported separately in 8 of 15 mixed-population reviews. Clinical heterogeneity was explored in only 2 of 23 reviews, and the methods used to identify and address heterogeneity were diverse. CONCLUSIONS. The methodologic quality of both the Cochrane and journal reviews on the management of acute asthma in children seems good, with Cochrane reviews being more rigorous. However, their usefulness for clinical practice is hampered by a lack of clear definitions of included populations, clinically important health outcomes, and separate reporting on children in mixed reviews. A major threat to these reviews' validity is the insufficient identification and handling of heterogeneity. [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]

Background: Efforts to improve the care of patients with asthma and allergic conditions is in some developing countries being overwhelmed by the burden of tuberculosis, HIV/AIDS and other infectious diseases. Innovative approaches are required to ensure that these diseases are not neglected. Methods: The Practical Approach to Lung Health in South Africa is an example of a syndromic integrated algorithm-based diagnostic and management tool for priority chronic respiratory diseases and tuberculosis. It was developed for the needs of nurse care practitioners in poorly-resourced and predominantly rural clinics and includes allergic diseases and asthma. Its diagnostic accuracy and effectiveness at improving the care offered to patients with asthma and rhinitis has been confirmed in two large studies performed in primary care clinics. Discussion and conclusion: An integrated approach to the management of allergic diseases alongside other priority lung diseases may hold the key to ensuring that the needs of patients with these diseases gain and maintain recognition, and that health resources are appropriately allocated in developing countries. [ABSTRACT FROM AUTHOR]

Acute lower respiratory infection due to adenovirus is an important cause of chronic lung disease (CLD) in infants. The objectives of this paper is to describe growth in the height and weight of children with post-viral chronic lung disease (PVCLD) and to relate it with associated variables (invasive mechanical ventilation, chronic hypercapnia, oxygen therapy at home and steroid treatment). Ninety-nine patients with diagnosis of PVCLD with one or more years of follow-up were included in the study. The median duration of follow-up was 3.10 years. The median age at onset of the disease was 0.50 years. According to the growth in height, there were 48 children with normal growth (Type A) and 50 with slow growth (Type B) followed by catch-up growth ( N=45) or normal growth velocity ( N=5); only one patient showed persistent slow growth. Chronic hypercapnia was a risk factor significantly associated to slow growth, with odds ratio, OR: 5.03; and 95% confidence interval, CI: 1.83/13.83. Patients with higher weight for height at the end of the slow-growth period showed greater gains in height during the following period ( r=0.46). Growth in children with PVCLD is heterogeneous but, in the majority of individual cases, it can be considered satisfactory. Chronic hypercapnia was associated with slow growth. [ABSTRACT FROM AUTHOR]

Using data from the1996, 1998, and 2000 Medical Expenditure Panel Survey, this study assessed controller medication use in a national representative sample of school-aged children with persistent asthma. Children 5 to 17 years of age with persistent asthma were identified in accordance with the Health Employer Data and Information Set specifications. Nonuse of controllers and excess use of relievers were common. In addition, controller medications were significantly less likely to be purchased for younger children, black and Hispanic children, and white children whose mothers had at least a college education. Efforts to improve childhood asthma management are needed, especially for those children. [ABSTRACT FROM AUTHOR]

The focus of this study is to evaluate a brief parent-report instrument, the Severity of Chronic Asthma (SCA) scale, that conforms to the national guidelines for assessing asthma. Convergent validity was found between the SCA and other measures related to asthma severity including an illness severity scale (How Bad is the Asthma?), asthma management scales for parents and children, and the pediatric quality-of-life scale. The SCA is a multidimensional scale with appropriate evidence of reliability and validity that may be a heuristic and effective measure in both clinical practice and research endeavors. [ABSTRACT FROM AUTHOR]

Background: Screening of children in household contact with smear-positive tuberculosis (TB) is universally recommended but seldom practiced in resource-poor settings. It has huge potential to reduce the burden of TB disease in children, particularly if streamlined to focus on those at greatest risk. Aims: To assess the prevalence of infection and disease amongst children aged ≤ 5 yrs in household contact with smear-positive TB. To identify which source case characteristics are risk factors for infection. Methods: A prospective, hospital-based audit was conducted over a 17-mth period in Southern Malawi. Smearpositive adults were identified and encouraged to bring their children to the outpatient clinic, in accordance with the national TB programme guidelines. Full assessment was performed, including tuberculin skin test. Results: 195 children aged ≤ 5 yrs who were contacts of 161 source cases were assessed. Prevalences of TB infection and disease were high (45% and 23%, respectively). The likelihood of a child being infected was significantly greater with increasing smear-positivity of the source case, and also if the source case were female (OR 2.25, 95% CI 1.19–4.27, p=0.01). Conclusions: The high prevalence of TB infection and disease in child contacts attending this hospital-based clinic supports the current policy of contact-screening in Malawi. However, community-based studies are needed to provide a more accurate assessment of prevalence and risks for child contacts. [ABSTRACT FROM AUTHOR]

Presents the abstract of several studies on respiratory disorders in children. "Successful Hematopoietic Stem Cell Transplantation for Niemann-Pick Disease Type B"; "Genetic Modifiers of Lung Disease in Cystic Fibrosis"; "Neurological and Neuromuscular Disease as a Risk Factor for Respiratory Failure in Children Hospitalized With Influenza Infection."

The article presents the cohort study conducted to determine the effects of nitrogen dioxide exposure and house dust mite allergen (HDM) to asthmatic children from primary schools in Adelaide, Australia. The children were asked to keep a daily symptoms diary in a period of 12 weeks in winter 2000. Nitrogen dioxide in the classroom, heated with electrically or with vented gas heaters, was measured and so was the home nitrogen dioxide from gas cooking. Dust, on the other hand, was collected from the mattress, sheets and bedcovers using a vacuum cleaner over a 1-minute period. Analysis of the data showed that exposure to both nitrogen dioxide and HDM can exacerbate asthma symptoms in children.

Summary Bronchopulmonary dysplasia is a chronic lung disease that affects premature babies and contributes to their morbidity and mortality. Improved survival of very immature infants has led to increased numbers of infants with this disorder. This increase puts a heavy burden on health resources since these infants need frequent re-admission to hospital in the first 2 years after birth and, even as adolescents, have lung-function abnormalities and persistent respiratory symptoms. Unlike the original description of the disease in 1967, premature infants can develop chronic oxygen dependency without severe, acute respiratory distress; this "new bronchopulmonary dysplasia" could be the result of impaired postnatal lung growth. Whether such infants subsequently have catch-up lung growth, especially if given corticosteroids postnatally, is unknown. No safe and effective preventive therapy has been identified, but promising new treatments directed either at reducing lung injury or improving lung growth are under study. [ABSTRACT FROM AUTHOR]

Objectives: To describe the demographic, clinical and management aspects of an outbreak of tuberculosis (TB) within a paediatric Pacific Island community in Auckland, New Zealand, in 2002–2003. Methods: The index and source case are described along with details of the extensive contact tracing that was undertaken in this community. Results: A total of 24 children were diagnosed with TB over an 11-month period. All cases were found to be epidemiologically linked to the one source case, mother of the index case. This total included 22 children with pulmonary disease, 1 case of miliary disease (index case) and 1 of cervical adenitis. Only 58% had symptoms at diagnosis and only 5 presented to medical attention with symptoms, the remainder had symptoms disclosed after contact tracing occurred. The Mycobacterium tuberculosis isolate was fully sensitive and all children (excluding the child with miliary disease) received short course directly observed therapy. One child developed hepatotoxicity requiring modification of his drug regimen. Conclusions: Children are at high risk of developing active disease after exposure to TB. The study describes the minimal symptoms manifested in many of the children with significant radiological changes consistent with pulmonary TB. This highlights the need to consider Mantoux testing and chest X-rays for children presenting with persistent respiratory symptoms in high-risk populations. Issues of contact tracing and adherence were also a problem in this population. [ABSTRACT FROM AUTHOR]

The gastric aspirate shake test (GST) was evaluated in 77 newborns with respiratory distress for predicting hyaline membrane disease (HMD) at KEM Hospital, Pune, India. Methods: Over 0.5 ml of gastric fluid was obtained within 30 min of birth and mixed with an equal volume of normal saline for 10 sec; 1 ml of 95% ethanol was then added and the mixture agitated for 10 sec. After standing for 15 min, the air–liquid interface was examined for bubbles. Results: All 21 infants with a negative GST developed HMD. However, 12 infants with an intermediate and nine with a positive test also developed HMD. None of the infants with other respiratory disorders, e.g. transient tachypnoea and pneumonia, had a negative GST. A negative GST had a specificity of 100%, sensitivity of 70% and positive predictive value of 100% for developing HMD. Conclusion: GST is a useful test for predicting HMD and might be of particular value in developing countries. [ABSTRACT FROM AUTHOR]

Studies protective lung strategies during artificial ventilation in children. Advantages and disadvantages of artificial ventilation; Manual ventilation by bag; Lengthening of the endinspiratory pause during volume- controlled ventilation using a square wave.

Presents citations and clinicians' notes on pediatrics. "Respiratory Illness Associated With Influenza and Respiratory Syncytial Virus Infection," by D. M. Fleming, R. S. Pannell, A. J. Elliot et al.; "Prevalence of Respiratory Symptoms in Under 5s: 1993 to 2001," by M. F. Linehan, M. L. Hazell, T. L. Frank et al.; "The Radiology of Chronic Lung Disease in Children," by U. G. Rossi, C. M. Owens.

On the basis of the well recognised role of inflammation in the pathogenesis of asthma, anti-inflammatory therapy, in the form of inhaled corticosteroids, has become the mainstay of treatment in patients with persistent asthma. Budesonide inhalation suspension (BIS) is a nonhalogenated corticosteroid with a high ratio of local anti-inflammatory activity to systemic activity. Furthermore, BIS is approved in >70 countries for the maintenance treatment of bronchial asthma in both paediatric and adult patients (approval is limited to paediatric patients in the US and France). Randomised, double-blind, placebo-controlled trials conducted in >1000 children have demonstrated the efficacy of BIS in children with persistent asthma of varying degrees of severity. In children frequently hospitalised with uncontrolled asthma, initiation of BIS therapy can reduce the need for emergency intervention. Moreover, limited data suggest that BIS is effective for the treatment of acute exacerbations of asthma in children and may reduce the need for short courses of oral corticosteroids. BIS is well tolerated in children, with an adverse event profile similar to that of placebo, and no clinically relevant changes in adrenal function have been demonstrated during the course of short- and long-term (1-year) studies. Small but statistically significant reductions in growth velocity have been demonstrated with BIS over 1 year of treatment. However, available evidence suggests that growth effects are transient in children receiving budesonide and that these children eventually achieve full adult height. [ABSTRACT FROM AUTHOR]