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De Queiroz Andrade E, Sena CRDS, de Gouveia Belinelo P, Robinson PD, Blaxland A, Sly PD, Murphy VE, Gibson PG, Collison AM, Mattes J. In utero smoking exposure induces changes to lung clearance index and modifies risk of wheeze in infants. Pediatr Pulmonol 2024; 59:1686-1694. [PMID: 38501326 DOI: 10.1002/ppul.26975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/17/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Fetal exposure to tobacco smoking throughout pregnancy is associated with wheezing in infancy. We investigated the influence of in utero smoking exposure on lung ventilation homogeneity and the relationship between lung ventilation inhomogeneity at 7 weeks of age and wheezing in the first year of life. METHODS Maternal smoking was defined as self-reported smoking of tobacco or validated by exhaled (e)CO > 6 ppm. Lung function data from healthy infants (age 5-9 weeks) born to asthmatic mothers and parent-reported respiratory questionnaire data aged 12 months were collected in the Breathing for Life Trial (BLT) birth cohort. Tidal breathing analysis and SF6-based Multiple Breath Washout testing were performed in quiet sleep. Descriptive statistics and regression analysis were used to assess associations. RESULTS Data were collected on 423 participants. Infants born to women who self-reported smoking during pregnancy (n = 42) had higher lung clearance index (LCI) than those born to nonsmoking mothers (7.90 vs. 7.64; p = .030). Adjusted regression analyzes revealed interactions between self-reported smoking and LCI (RR: 1.98, 95% CI: 1.07-3.63, 0.028, for each unit increase in LCI) and between eCO > 6 ppm and LCI (RR: 2.25, 95% CI: 1.13-4.50, 0.022) for the risk of wheeze in the first year of life. CONCLUSION In utero tobacco smoke exposure induces lung ventilation inhomogeneities. Furthermore, an interaction between smoke exposure and lung ventilation inhomogeneities increases the risk of having a wheeze in the first year of life.
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Affiliation(s)
- Ediane De Queiroz Andrade
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Carla Rebeca Da Silva Sena
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Patricia de Gouveia Belinelo
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anneliese Blaxland
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter G Gibson
- Priority Research Centre Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- Respiratory & Sleep Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Adam M Collison
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Joerg Mattes
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Priority Research Centre GrowUpWell, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
- Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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2
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Stoecklin B, Veneroni C, Choi YJ, Pillow JJ, Dellacà RL. Respiratory and chest wall mechanics in very preterm infants. J Appl Physiol (1985) 2024; 136:1499-1506. [PMID: 38634505 DOI: 10.1152/japplphysiol.00561.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
Data on static compliance of the chest wall (Ccw) in preterm infants are scarce. We characterized the static compliance of the lung (CL) and Ccw to determine their relative contribution to static compliance of the respiratory system (Crs) in very preterm infants at 36 wk postmenstrual age (PMA). We also aimed to investigate how these compliances were influenced by the presence of bronchopulmonary dysplasia (BPD) and impacted breathing variables. Airway opening pressure, esophageal pressure, and tidal volume (VT) were measured simultaneously during a short apnea evoked by the Hering-Breuer reflex. We computed tidal breathing variables, airway resistance (R), and dynamic lung compliance (CL,dyn), inspiratory capacity (IC), and Crs, CL, and Ccw. Functional residual capacity was assessed by the multiple breath washout technique (FRCmbw). Breathing variables, compliances, and lung volumes were adjusted for body weight. Twenty-three preterm infants born at 27.2 ± 2.0 wk gestational age (GA) were studied at 36.6 ± 0.6 wk PMA. Median and interquartile range (IQR) Crs/kg is 0.69 (0.6), CL/kg 0.95 (1.0), and Ccw/kg 3.0 (2.4). Infants with BPD (n = 11) had lower Crs/kg (P = 0.013), CL/kg (P = 0.019), and Ccw/kg (P = 0.027) compared with infants without BPD. Ccw/CL ratio was equal between groups. FRCmbw/kg (P = 0.044) and IC/kg (P = 0.005) were decreased in infants with BPD. Infants with BPD have reduced static compliance of the respiratory system, the lungs, and chest wall. Decreased Crs, CL, and Ccw in infants with BPD explain the lower FRC and IC seen in these infants.NEW & NOTEWORTHY Data on chest wall compliance in very preterm infants in the postsurfactant era are scarce. To our knowledge, we are the first group to report data on static respiratory system compliance (Crs), lung compliance (CL), and chest wall compliance (Ccw) in preterm infants with and without bronchopulmonary dysplasia (BPD) in the postsurfactant era.
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Affiliation(s)
- Benjamin Stoecklin
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- King Edward Memorial Hospital, Perth, Western Australia, Australia
- Department of Neonatology, University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Chiara Veneroni
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB, Politecnico di Milano University, Milan, Italy
| | - Y Jane Choi
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - J Jane Pillow
- School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Raffaele L Dellacà
- Dipartimento di Elettronica, Informazione e Bioingegneria-DEIB, Politecnico di Milano University, Milan, Italy
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Fevola C, Dolce D, Tosco A, Padoan R, Daccò V, Claut L, Schgor T, Sepe A, Timpano S, Fabrizzi B, Piccinini P, Taccetti G, Bonomi P, Terlizzi V. Risk of CFTR-related disorders and cystic fibrosis in an Italian cohort of CRMS/CFSPID subjects in preschool and school age. Eur J Pediatr 2024; 183:929-938. [PMID: 38054992 DOI: 10.1007/s00431-023-05359-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
The identification of cystic fibrosis screening-positive, inconclusive diagnosis (CFSPID) in infants is a controversial outcome of newborn screening for cystic fibrosis (CF). Today, despite improvements in the knowledge of CFSPID and the description of several cohorts, little data are available on cohorts with a follow-up period of more than 6 years. In this study, we report the outcomes of an Italian cohort of CFSPID individuals with CFSPID or formerly CFTR-related disorders (CFTR-RD) (CFSPID > CFTR-RD) or diagnosed with CF (CFSPID > CF). This was an observational and multicentre Italian study collecting clinical data on CFSPID born between the period January 1, 2011, and December 13, 2019. A total of 268 participants were included: 243 with persistent CFSPID, 7 with CFSPID > CFTR-RD, and 18 with CFSPID > CF. The trend of sweat chloride (SC) values, percentage of definitive diagnoses, lung function in school-aged children, and development of CF-related complications were evaluated. At the end of the observation period, almost 80% of the individuals with CFSPID did not have a conclusive diagnosis. A total of 29 children (10.8%) transitioned to a diagnosis of CF for pathological SC values (≥ 60 mmol/L) or multi-organ involvement, and 18 (6.7%) to CFTR-RD. Children who were followed up for > 6 years (median age, 7.5 years; range, 6.04-10.5) had normal lung function and were pancreatic sufficient, and the evolution in CF was only present in two cases. CONCLUSION Most Italian preschool and school-aged children with CFSPID did not have a conclusive diagnosis, and progression to CF was unlikely in children > 6 years of age. An annual follow-up could be indicated to identify early evolution in clinical features consistent with a CFTR-RD. WHAT IS KNOWN • Cystic Fibrosis newborn screening identifies also subjects with an inconclusive diagnosis (CFSPID). • Over time a variable percentage of CFSPIDs will be diagnosed as CF. • Little data is available on CFSPIDs with a follow-up period of more than six years. WHAT IS NEW • 80% of Italian preschool and school-age CFSPIDs not have a conclusive diagnosis. • Italian preschool and school-age CFSPIDs have normal lung function and are pancreatic sufficient. • Annual follow-up after 6 years is recommended in CFSPID with abnormal LCI2.5 or with a CF-causing variant in trans with a VVCC.
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Affiliation(s)
- C Fevola
- Department of Pediatric Medicine, Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Center, Viale Gaetano Pieraccini 2, Florence, 50139, Italy
| | - D Dolce
- Department of Pediatric Medicine, Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Center, Viale Gaetano Pieraccini 2, Florence, 50139, Italy
| | - A Tosco
- Paediatric Unit, Department of Translational Medical Sciences, Cystic Fibrosis Regional Reference Center, University of Naples Federico II, Naples, Italy
| | - R Padoan
- Scientific Board Italian CF Registry, Rome, Italy
| | - V Daccò
- Cystic Fibrosis Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - L Claut
- Cystic Fibrosis Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - T Schgor
- Cystic Fibrosis Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A Sepe
- Paediatric Unit, Department of Translational Medical Sciences, Cystic Fibrosis Regional Reference Center, University of Naples Federico II, Naples, Italy
| | - S Timpano
- Cystic Fibrosis Regional Support Center, Department of Pediatrics, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy
| | - B Fabrizzi
- Cystic Fibrosis Regional Reference Center, Mother‑Child Department, United Hospitals, Ancona, Italy
| | | | - G Taccetti
- Department of Pediatric Medicine, Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Center, Viale Gaetano Pieraccini 2, Florence, 50139, Italy
| | | | - V Terlizzi
- Department of Pediatric Medicine, Meyer Children's Hospital IRCCS, Cystic Fibrosis Regional Reference Center, Viale Gaetano Pieraccini 2, Florence, 50139, Italy.
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Verwey C, Ramocha L, Laubscher M, Baillie V, Nunes M, Gray D, Hantos Z, Dangor Z, Madhi S. Pulmonary sequelae in 2-year-old children after hospitalisation for respiratory syncytial virus lower respiratory tract infection during infancy: an observational study. BMJ Open Respir Res 2023; 10:10/1/e001618. [PMID: 37169402 DOI: 10.1136/bmjresp-2023-001618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/28/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common cause of hospitalisation for lower respiratory tract infection (LRTI) in children. RSV LRTI during early childhood may increase susceptibility to recurrent wheezing and asthma. RESEARCH QUESTION The aim of this study was to describe the pulmonary sequelae at 1 and 2 years of age following RSV LRTI hospitalisation during the first year of life in term infants. STUDY DESIGN AND METHODS A longitudinal case-control study was undertaken from April 2016 to December 2019. Cases constituted children hospitalised with PCR-confirmed RSV LRTI during infancy and controls were children not previously hospitalised with LRTI. A questionnaire detailing environmental and medical history, as well as a modified International Study of Asthma and Allergies (ISAAC) questionnaire, was administered, and pulmonary function testing, including oscillometry, tidal breath flow-volume loops and multiple breath wash-out, was performed, at one and two years of age. RESULTS One (n=308) and two-year-old (n=214) cases were more likely than one (n=292) and two-year-old (n=209) controls to have experienced clinical pulmonary symptoms, including wheezing ((55% vs 24%; p<0.001) and (61% vs 16%; p<0.001)), received treatment for wheezing ((17 vs 8%; p<0.001) and (51 vs 6%; p<0.001)) and had any admissions for wheezing ((31 vs 6%; p<0.001) and (46 vs 1.4%; p<0.001)) or any LRTI ((24 vs 2%; p<0.001) and (32 vs 1.4%; p<0.001)), after the initial RSV hospitalisation. RSV LRTI during infancy was associated with an increase in airway resistance by two years (22.46 vs 20.76 hPa.s.l-1 (p=0.022)), along with a decrease in compliance at both one (-4.61 vs -3.09 hPa.s/l (p<0.001)) and two years (-0.99 vs 0.33 hPa.s/l1 (p<0.001)). There was an increased work of breathing at one year, but this was no longer present at two years. INTERPRETATION RSV LRTI during infancy in cases was associated with more clinical and pulmonary function sequelae through to two years of age.
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Affiliation(s)
- Charl Verwey
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
| | - Lesego Ramocha
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
| | - Marius Laubscher
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Vicky Baillie
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Marta Nunes
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Diane Gray
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Zoltán Hantos
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ziyaad Dangor
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
| | - Shabir Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Johannesburg, South Africa
- Faculty of Health Sciences, National Research Foundation: Vaccine Preventable Diseases, Johannesburg, South Africa
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5
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Goth FEM, Green K, Hansen BM, Agertoft L, Jørgensen IM. From neonatal lung function to lung function and respiratory morbidity at 6-year follow-up. Pediatr Pulmonol 2023; 58:566-576. [PMID: 36349430 PMCID: PMC10098878 DOI: 10.1002/ppul.26240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 10/20/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Lung function is traceable from infancy to adulthood. Only a few studies have examined lung function from birth to childhood longitudinally in children born moderate to late preterm. We aimed to investigate how prematurity and lung function in the neonatal period are related to lung function and respiratory morbidity at age 6 in former moderate to late preterm children compared with children born at term. METHODS Lung function was measured in a cohort of moderately to late preterm (n = 48) and term-born (n = 53) infants in the neonatal period by FeNO, and tidal breathing flow-volume loops (TBFVL) and at age 6 (n = 52) by spirometry, whole-body plethysmograph and impulse oscillation combined with a respiratory symptom questionnaire. RESULTS Moderate to late preterm children had a higher TPEF /TE ratio neonatally (42.6% vs. 33.7%, p = 0.02) and a lower % predicted orced expiratory volume in the first second at age 6 (94.4% vs. 101.9%, p = 0.01) compared to term-born children. We found a significant association between the variability of neonatal tidal volume and effective airway resistance at age 6 (β = -0.34, p = 0.03). No association between neonatal FeNO or TBFVL and respiratory morbidity at 6-year follow-up was shown. CONCLUSION Children born moderate to late preterm had lower lung function at age 6 than term-born children. We did not find evidence for the use of neonatal tidal breathing parameters as a predictor for subsequent respiratory morbidity or lung function, however sample size was small.
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Affiliation(s)
- Fanny E M Goth
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kent Green
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark
| | - Bo M Hansen
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lone Agertoft
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Inger M Jørgensen
- Department of Pediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ides KM, De Backer WA, Lanclus M, Leemans G, Dierckx W, Lauwers E, Vissers D, Steckel J, De Backer JW. The effect of posture on airflow distribution, airway geometry and air velocity in healthy subjects. BMC Pulm Med 2022; 22:477. [PMID: 36522658 PMCID: PMC9753395 DOI: 10.1186/s12890-022-02276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gravity, and thus body position, can affect the regional distribution of lung ventilation and blood flow. Therefore, body positioning is a potential tool to improve regional ventilation, thereby possibly enhancing the effect of respiratory physiotherapy interventions. In this proof-of-concept study, functional respiratory imaging (FRI) was used to objectively assess effects of body position on regional airflow distribution in the lungs. METHODS Five healthy volunteers were recruited. The participants were asked during FRI first to lie in supine position, afterwards in standardized right lateral position. RESULTS In right lateral position there was significantly more regional ventilation also described as Imaging Airflow Distribution in the right lung than in the left lung (P < 0.001). Air velocity was significantly higher in the left lung (P < 0.05). In right lateral position there was significantly more airflow distribution in the right lung than in the left lung (P < 0.001). Significant changes were observed in airway geometry resulting in a decrease in imaged airway volume (P = 0.024) and a higher imaged airway resistance (P = 0.029) in the dependent lung. In general, the effect of right lateral position caused a significant increase in regional ventilation (P < 0.001) in the dependent lung when compared with the supine position. CONCLUSIONS Changing body position leads to significant changes in regional lung ventilation, objectively assessed by FRI The volume based on the imaging parameters in the dependent lung is smaller in the lateral position than in the supine position. In right lateral decubitus position, airflow distribution is greater in dependent lung compared to the nondependent lung. TRIAL REGISTRATION The trial has been submitted to www. CLINICALTRIALS gov with identification number NCT01893697 on 07/02/2013.
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Affiliation(s)
- Kris M. Ides
- grid.411414.50000 0004 0626 3418Department of Pediatric Medicine, Antwerp University Hospital, drie eikenstraat 655, 2650 Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,grid.5284.b0000 0001 0790 3681Cosys-Lab, Antwerp University, Flanders Make Lommel, Groenenborgerlaan 171, 2020 Antwerp, Belgium ,Medimprove Multidisciplinairy Private Practice, Groeningenlei 132C, 2550 Kontich, Belgium
| | - Wilfried A. De Backer
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,Medimprove Multidisciplinairy Private Practice, Groeningenlei 132C, 2550 Kontich, Belgium
| | - Maarten Lanclus
- grid.428659.4FLUIDDA Inc, 228 EAST 45TH Street STE 9E, New York, USA
| | - Glenn Leemans
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Wendel Dierckx
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,Medimprove Multidisciplinairy Private Practice, Groeningenlei 132C, 2550 Kontich, Belgium
| | - Eline Lauwers
- grid.476361.1FLUIDDA NV, Groeningenlei 132, 2550 Kontich, Belgium ,grid.411414.50000 0004 0626 3418Department of Pediatric Medicine, Antwerp University Hospital, drie eikenstraat 655, 2650 Edegem, Belgium ,grid.5284.b0000 0001 0790 3681Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Dirk Vissers
- grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Steckel
- grid.5284.b0000 0001 0790 3681Cosys-Lab, Antwerp University, Flanders Make Lommel, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Jan W. De Backer
- grid.428659.4FLUIDDA Inc, 228 EAST 45TH Street STE 9E, New York, USA
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7
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Tuková J, Koucký V, Marková D, Koťátko P, Hladíková M, Šulc J. Symptomatic preterm infants suffer from lung function deficits, regardless of bronchopulmonary dysplasia. Pediatr Pulmonol 2022; 57:3119-3128. [PMID: 36097859 DOI: 10.1002/ppul.26144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/27/2022] [Accepted: 09/08/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The long-term respiratory consequences for children with bronchopulmonary dysplasia (BPD) are well known. However, there is little emphasis on monitoring preterm infants without BPD. Few studies have explored the lung function status of infants with the symptoms of chronic lung disease of prematurity (CLD). OBJECTIVE To evaluate functional lung deficits in preterm infants with CLD, and to assess the perinatal determinants of diminished lung function. METHODS In our cross-sectional study, 132 preterm infants with symptomatic CLD underwent infant pulmonary function testing (iPFT) at a median post-term age of 0.9 years. The iPFT included bodypletysmography, compliance measurement, tidal breath analysis, and rapid thoracoabdominal compression. The relationships between the respective z scores of the iPFT parameters and perinatal characteristics, postnatal treatment, and BPD status were investigated. RESULTS Seventy-three patients (55.3%) were born before the 28th week of gestation, and 92 (69.7%) met the BPD criteria. Functional deficits were detected in 85.8%. The obstructive ventilatory pattern was more prevalent than restrictive (36.3 vs. 12.4%, p < 0.001). Infants with restriction had lower birth weight (BW) and required a longer duration of oxygenotherapy. In a univariate model, the lung function correlated with the duration of invasive mechanical ventilation, gestational week, and BW. In a general linear model, BPD status was not an additional determinant of the iPFT results. CONCLUSION IPFT may reveal significant functional deficits in preterm infants with CLD even without BPD. The current symptoms and perinatal factors may be more important determinants of functional deficits than the BPD status itself.
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Affiliation(s)
- Jana Tuková
- Department of Paediatrics and Inborn Metabolic Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Václav Koucký
- Department of Paediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Daniela Marková
- Department of Paediatrics and Inborn Metabolic Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Petr Koťátko
- Department of Paediatrics and Inborn Metabolic Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Marie Hladíková
- Department of Paediatrics and Inborn Metabolic Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Šulc
- Department of Paediatrics and Inborn Metabolic Diseases, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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8
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De Queiroz Andrade E, Bayfield KJ, Blaxland A, Wong A, De Gouveia Belinelo P, Sly PD, Collison A, Murphy VE, Gibson P, Mattes J, Robinson PD. Exposure to 4% SF 6 during multiple breath washout affects subsequent infant tidal breathing analysis. Pediatr Pulmonol 2022; 57:1089-1091. [PMID: 35049151 DOI: 10.1002/ppul.25820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/20/2021] [Accepted: 12/29/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Ediane De Queiroz Andrade
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Katie J Bayfield
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Anneliese Blaxland
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Alexander Wong
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Patricia De Gouveia Belinelo
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter D Sly
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Adam Collison
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Peter Gibson
- Priority Research Centre Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia.,Respiratory and Sleep Medicine Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Joerg Mattes
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre GrowUpWell, Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia.,Paediatric Respiratory & Sleep Medicine Department, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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9
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Collecting exhaled breath condensate from non-ventilated preterm-born infants: a modified method. Pediatr Res 2022; 91:717-719. [PMID: 33837255 DOI: 10.1038/s41390-021-01474-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022]
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10
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Goth FEM, Schmidt BJ, Juul K, Albertsen P, Agertoft L, Jørgensen IM. Cohort profile: the vitamin A and D and nitric oxide (AD-ON) observational cohort on lung development and symptoms in premature and mature children in North Zealand, Denmark. BMJ Open 2022; 12:e054952. [PMID: 35193916 PMCID: PMC8867307 DOI: 10.1136/bmjopen-2021-054952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The risk of developing asthma-like symptoms and asthma in childhood is influenced by genetics, environmental exposures, prenatal and early postnatal events, and their interactions. The cohort name refers to vitamins A and D, and nitric oxide (NO) spelt backwards and this cohort profile paper aims to present the data collection and aim of the cohort.The overall aim when establishing this cohort was to investigate if childhood lung function can be traced back to early neonatal lung function and fractional exhaled NO (FeNO) and investigate prenatal and postnatal risk factors including maternal and neonatal vitamin A and D levels in preterm and term born children. PARTICIPANTS One thousand five hundred women and their babies born at Nordsjaellands Hospital in Denmark from 2013 to 2014 were included in the AD-ON research biobank prior to birth.Neonates from the AD-ON research biobank, admitted to the Neonatal Intensive Care Unit at Nordsjaellands Hospital, were included in the AD-ON neonatal cohort. The neonatal cohort consisted of 149 neonates hereof 63 preterm and 86 term born. The children in the cohort have been invited to follow-up visits at age 1 and 6 years. FINDINGS TO DATE Published data from this cohort includes a validated and clinically applicable method to measure FeNO in neonates. We found an age-specific pattern of association between respiratory symptoms at age 1 and neonatal FeNO in preterm children. Moreover, we found that the respiratory symptoms risk was associated with postnatal factors (Respiratory Syncytial Virus infection and parental smoking) in preterm infants and prenatal factors (parental asthma and maternal infection during pregnancy) in term born infants. FUTURE PLANS In the future, the children will be examined continuously with 3-year to 5-year intervals until the age of 18. Lung function, allergy tests, environmental exposure measurements and questionnaires will be collected at each follow-up visit.
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Affiliation(s)
- Fanny Edit Maria Goth
- Department of Paediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Science, Copenhagen, Denmark
| | | | - Klaus Juul
- Department of Paediatric Cardiology, Rigshospitalet, Kobenhavn, Denmark
| | - Per Albertsen
- Department of Paediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark
| | - Lone Agertoft
- Department of Pediatrics, H.C. Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Inger Merete Jørgensen
- Department of Paediatrics and Adolescence Medicine, Nordsjaellands Hospital, Hillerod, Denmark
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Science, Copenhagen, Denmark
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11
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Neumann RP, Gerull R, Zannin E, Fouzas S, Schulzke SM. Volumetric Capnography at 36 Weeks Postmenstrual Age and Bronchopulmonary Dysplasia in Very Preterm Infants. J Pediatr 2022; 241:97-102.e2. [PMID: 34687691 DOI: 10.1016/j.jpeds.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/15/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the feasibility of volumetric capnography in spontaneously breathing very preterm infants at 36 weeks postmenstrual age (PMA) and its association with clinical markers of lung disease including the duration of respiratory support and bronchopulmonary dysplasia (BPD). STUDY DESIGN We obtained mainstream volumetric capnography measurements in 143 very preterm infants at 36 weeks PMA. BPD was categorized into no, mild, moderate, and severe according to the 2001 National Heart, Lung and Blood Institute workshop report. Normalized capnographic slopes of phase II (SnII) and phase III (SnIII) were calculated. We assessed the effect of BPD, duration of respiratory support, and duration of supplemental oxygen on capnographic slopes. RESULTS SnIII was steeper in infants with moderate to severe BPD (76 ± 25/L) compared with mild (31 ± 20/L) or no BPD (26 ± 18/L) (P < .001). The association of SnIII with moderate to severe BPD persisted after adjusting for birth weight z-score, respiratory rate, and airway dead space to tidal volume ratio. The diagnostic usefulness of SnIII to discriminate between infants with and without moderate to severe BPD was high (area under the curve, 0.94; 95% CI, 0.89-0.99). CONCLUSIONS Volumetric capnography is feasible in spontaneously breathing preterm infants at 36 weeks PMA and reflects the degree of lung disease. This promising bedside lung function technique may offer an objective, continuous physiological outcome measure for assessment of BPD severity. TRIAL REGISTRATION ClinicalTrials.gov: NCT02083562.
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Affiliation(s)
- Roland P Neumann
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Switzerland.
| | - Roland Gerull
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Switzerland; Department of Neonatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Emanuela Zannin
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano University, Milano, Italy
| | - Sotirios Fouzas
- Pediatric Respiratory Unit, University Hospital of Patras, Greece
| | - Sven M Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Switzerland
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12
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Volumetric capnography pre- and post-surfactant during initial resuscitation of premature infants. Pediatr Res 2022; 91:1551-1556. [PMID: 34023855 PMCID: PMC9197760 DOI: 10.1038/s41390-021-01578-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Volumetric capnography allows for continuous monitoring of expired tidal volume and carbon dioxide. The slope of the alveolar plateau of the capnogram (SIII) could provide information regarding ventilation homogeneity. We aimed to assess the feasibility of measuring SIII during newborn resuscitation and determine if SIII decreased after surfactant indicating ventilation inhomogeneity improvement. METHODS Respiratory function traces of preterm infants resuscitated at birth were analysed. Ten capnograms were constructed for each infant: five pre- and post-surfactant. If a plateau was present SIII was calculated by regression analysis. RESULTS Thirty-six infants were included, median gestational age of 28.7 weeks and birth weight of 1055 g. Average time between pre- and post-surfactant was 3.2 min. Three hundred and sixty capnograms (180 pre and post) were evaluated. There was adequate slope in 134 (74.4%) capnograms pre and in 100 (55.6%) capnograms post-surfactant (p = 0.004). Normalised for tidal volume SIII pre-surfactant was 18.89 mmHg and post-surfactant was 24.86 mmHg (p = 0.006). An increase in SIII produced an up-slanting appearance to the plateau indicating regional obstruction. CONCLUSION It was feasible to evaluate the alveolar plateau pre-surfactant in preterm infants. Ventilation inhomogeneity increased post-surfactant likely due to airway obstruction caused by liquid surfactant present in the airways. IMPACT Volumetric capnography can be used to assess homogeneity of ventilation by SIII analysis. Ventilation inhomogeneity increased immediately post-surfactant administration during the resuscitation of preterm infants, producing a characteristic up-slanting appearance to the alveolar plateau. The best determinant of alveolar plateau presence in preterm infants was the expired tidal volume.
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13
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Williams E, Dassios T, Dixon P, Greenough A. Physiological dead space and alveolar ventilation in ventilated infants. Pediatr Res 2022; 91:218-222. [PMID: 33603211 PMCID: PMC7891488 DOI: 10.1038/s41390-021-01388-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Dead space is the volume not taking part in gas exchange and, if increased, could affect alveolar ventilation if there is too low a delivered volume. We determined if there were differences in dead space and alveolar ventilation in ventilated infants with pulmonary disease or no respiratory morbidity. METHODS A prospective study of mechanically ventilated infants was undertaken. Expiratory tidal volume and carbon dioxide levels were measured. Volumetric capnograms were constructed to calculate the dead space using the modified Bohr-Enghoff equation. Alveolar ventilation (VA) was also calculated. RESULTS Eighty-one infants with a median (range) gestational age of 28.7 (22.4-41.9) weeks were recruited. The dead space [median (IQR)] was higher in 35 infants with respiratory distress syndrome (RDS) [5.7 (5.1-7.0) ml/kg] and in 26 infants with bronchopulmonary dysplasia (BPD) [6.4 (5.1-7.5) ml/kg] than in 20 term controls with no respiratory disease [3.5 (2.8-4.2) ml/kg, p < 0.001]. Minute ventilation was higher in both infants with RDS or BPD compared to the controls. VA in infants with RDS or BPD was similar to that of the controls [p = 0.54]. CONCLUSION Prematurely born infants with pulmonary disease have a higher dead space than term controls, which may influence the optimum level during volume-targeted ventilation. IMPACT Measurement of the dead space was feasible in ventilated newborn infants. The physiological dead space was a significant proportion of the delivered volume in ventilated infants. The dead space (per kilogram) was higher in ventilated infants with respiratory distress syndrome or evolving bronchopulmonary dysplasia compared to term controls without respiratory disease. The dead space volume should be considered when calculating the most appropriate volume during volume-targeted ventilation.
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Affiliation(s)
- Emma Williams
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Anne Greenough
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK.
- NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust, King's College London, London, UK.
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14
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Perikleous E, Fouzas S, Karageorgiou A, Steiropoulos P, Nena E, Chatzimichael A, Tsalkidis A, Paraskakis E. Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis. World J Clin Pediatr 2021; 10:168-176. [PMID: 34868893 PMCID: PMC8603642 DOI: 10.5409/wjcp.v10.i6.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/30/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tidal breathing flow-volume (TBFV) analysis provides important information about lung mechanics in infants.
AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.
METHODS In this cross-sectional study, TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was evaluated.
RESULTS A total of 56 infants (35 boys), aged 7.4 ± 2.8 mo, were included. Of them, 12.5% were exposed to tobacco smoke and 41.1% were breastfed less than 2 mo. There were no differences in baseline TBFV measurements between the breastfeeding groups; however, those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Moreover, there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding (P < 0.001). In multivariate regression analysis, infants who breastfed less (regression coefficient -0.335, P = 0.010) or were exposed to cigarette smoke (regression coefficient 0.353, P = 0.007) showed a greater change in tPEF/tE after bronchodilation, independent of sex, prematurity, and family history of asthma or atopy.
CONCLUSION Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke, have TBFV measurements indicative of obstructive lung disease.
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Affiliation(s)
- Evanthia Perikleous
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Sotirios Fouzas
- Department of Paediatrics, University Hospital of Patras, University of Patras, Patra 26504, Greece
| | - Athina Karageorgiou
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Evangelia Nena
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Aggelos Tsalkidis
- Department of Pediatrics, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupoli 68100, Greece
| | - Emmanouil Paraskakis
- Paediatric Respiratory Unit, Paediatric Department, University of Crete, Heraklion 71500, Greece
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15
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Falk M, Gunnarsdottir K, Baldursdottir S, Donaldsson S, Jonsson B, Drevhammar T. Interface leakage during neonatal CPAP treatment: a randomised, cross-over trial. Arch Dis Child Fetal Neonatal Ed 2021; 106:663-667. [PMID: 33963004 PMCID: PMC8543197 DOI: 10.1136/archdischild-2021-321579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/14/2021] [Accepted: 04/20/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine leakage for two neonatal continuous positive airway pressure (CPAP) interfaces and evaluate leak-corrective manoeuvres. DESIGN The ToNIL (Trial of NCPAP Interface Leakage) study was a randomised, clinical, cross-over trial with data collection between August 2018 and October 2019. The primary outcome was blinded to the treating staff. SETTING One secondary, 8-bed neonatal intensive care unit (NICU) and three larger (>15 beds), academic NICU referral centres. PATIENTS Newborn infants with CPAP were screened (n=73), and those with stable spontaneous breathing, low oxygen requirement, postmenstrual age (PMA) over 28 weeks and no comorbidities were eligible. In total, 50 infants were included (median PMA 33 completed weeks). INTERVENTIONS Leakage was measured for both prongs and nasal mask, before and after leak-corrective manoeuvres. Interface application was performed in a randomised order by a nurse, blinded to the measured leakage. MAIN OUTCOME MEASURES 30 s average leakage, measured in litres per minute (LPM). RESULTS Analyses showed a significantly lower leakage (mean difference 0.86 LPM, 95% CI 0.07 to 1.65) with prongs (median 2.01 LPM, IQR 1.00-2.80) than nasal mask (median 2.45 LPM, IQR 0.99-5.11). Leak-corrective manoeuvres reduced leakage significantly for both prongs (median 1.22 LPM, IQR 0.54-1.87) and nasal mask (median 2.35 LPM, IQR 0.76-4.75). CONCLUSIONS Large leakages were common for both interfaces, less with prongs. Simple care manoeuvres reduced leakage for both interfaces. This is the first report of absolute leakage for nasal interfaces and should encourage further studies on leakage during CPAP treatment.
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Affiliation(s)
- Markus Falk
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden .,Department of Anesthesiology, Östersunds sjukhus, Östersund, Sweden
| | - Kolbrun Gunnarsdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Sonja Baldursdottir
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Snorri Donaldsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Baldvin Jonsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Neonatology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Thomas Drevhammar
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Department of Anesthesiology, Östersunds sjukhus, Östersund, Sweden
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16
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Martins Costa Gomes G, de Gouveia Belinelo P, Starkey MR, Murphy VE, Hansbro PM, Sly PD, Robinson PD, Karmaus W, Gibson PG, Mattes J, Collison AM. Cord blood group 2 innate lymphoid cells are associated with lung function at 6 weeks of age. Clin Transl Immunology 2021; 10:e1296. [PMID: 34306680 PMCID: PMC8292948 DOI: 10.1002/cti2.1296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Offspring born to mothers with asthma in pregnancy are known to have lower lung function which tracks with age. Human group 2 innate lymphoid cells (ILC2) accumulate in foetal lungs, at 10‐fold higher levels compared to adult lungs. However, there are no data on foetal ILC2 numbers and the association with respiratory health outcomes such as lung function in early life. We aimed to investigate cord blood immune cell populations from babies born to mothers with asthma in pregnancy. Methods Cord blood from babies born to asthmatic mothers was collected, and cells were stained in whole cord blood. Analyses were done using traditional gating approaches and computational methodologies (t‐distributed stochastic neighbour embedding and PhenoGraph algorithms). At 6 weeks of age, the time to peak tidal expiratory flow as a percentage of total expiratory flow time (tPTEF/tE%) was determined as well as Lung Clearance Index (LCI), during quiet natural sleep. Results Of 110 eligible infants (March 2017 to November 2019), 91 were successfully immunophenotyped (82.7%). Lung function was attempted in 61 infants (67.0%), and 43 of those infants (70.5% of attempted) had technically acceptable tPTEF/tE% measurements. Thirty‐four infants (55.7% of attempted) had acceptable LCI measurements. Foetal ILC2 numbers with increased expression of chemoattractant receptor‐homologous molecule (CRTh2), characterised by two distinct analysis methodologies, were associated with poorer infant lung function at 6 weeks of age.” Conclusion Foetal immune responses may be a surrogate variable for or directly influence lung function outcomes in early life.
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Affiliation(s)
- Gabriela Martins Costa Gomes
- Priority Research Centre GrowUpWell® - Hunter Medical Research Institute The University of Newcastle Newcastle NSW Australia
| | - Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell® - Hunter Medical Research Institute The University of Newcastle Newcastle NSW Australia
| | - Malcolm R Starkey
- Priority Research Centre GrowUpWell® - Hunter Medical Research Institute The University of Newcastle Newcastle NSW Australia.,Priority Research Centre for Healthy Lungs - Hunter Medical Research Institute University of Newcastle Newcastle NSW Australia.,Department of Immunology and Pathology Central Clinical School Monash University Melbourne VIC Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell® - Hunter Medical Research Institute The University of Newcastle Newcastle NSW Australia
| | - Philip M Hansbro
- Priority Research Centre for Healthy Lungs - Hunter Medical Research Institute University of Newcastle Newcastle NSW Australia.,Centenary UTS Centre for Inflammation Centenary Institute Sydney NSW Australia
| | - Peter D Sly
- Child Health Research Centre University of Queensland Brisbane QLD Australia
| | - Paul D Robinson
- Department of Respiratory Medicine The Children's Hospital at Westmead Sydney NSW Australia
| | | | - Peter G Gibson
- Priority Research Centre for Healthy Lungs - Hunter Medical Research Institute University of Newcastle Newcastle NSW Australia.,Sleep Medicine Department John Hunter Hospital Newcastle NSW Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell® - Hunter Medical Research Institute The University of Newcastle Newcastle NSW Australia.,Paediatric Respiratory & Sleep Medicine Department John Hunter Children's Hospital Newcastle NSW Australia
| | - Adam M Collison
- Priority Research Centre GrowUpWell® - Hunter Medical Research Institute The University of Newcastle Newcastle NSW Australia
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17
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Lai SH, Tsai MH, Hua MC, Yeh KW, Yao TC, Huang JL, Liao SL. Distinct lung function and bronchodilator responses between term and preterm young children with recurrent wheezing. Pediatr Neonatol 2021; 62:394-399. [PMID: 33962900 DOI: 10.1016/j.pedneo.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/09/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Recurrent or unresolved wheezing is a common complaint in certain young children populations, especially those born preterm. Using infant lung function testing, we aimed to distinguish the differences between term and preterm young children with recurrent wheezing. METHODS Children under 2 years of corrected age were enrolled if they had 3 or more wheezing episodes during the enrollment period. Healthy term controls of comparable age were also recruited for reference. Measurements of lung function were made, including tidal breathing, passive respiratory mechanics, and forced tidal and raised-volume expiration. For children with recurrent wheezing, raised-volume forced expiration was repeated after an adequate delivery of bronchodilator nebulization was achieved. RESULTS In total, 68 young children (40 with recurrent wheezing and 28 healthy controls) were recruited. Among children with recurrent wheezing, 23 preterm children (preterm group), and 17 term children (term group) were enrolled. Compared with healthy controls, both the term and preterm groups had lower lung function as measured by absolute values and z scores. The term group performed worse than the preterm group with regard to forced vital capacity, forced expiratory volume at 0.5 s (FEV0.5), and peak expiratory flow. Following bronchodilator nebulization, the term group had significantly higher increases in FEV0.5 and forced mid-expiratory flow than the preterm group. CONCLUSION Young children with recurrent wheezing, especially term infants, demonstrated lower lung function than healthy controls. Moreover, the term group evidenced greater responsiveness to bronchodilators than the preterm group. The distinct bronchodilator responses may offer further information to guide the diagnosis and treatment of young children with recurrent wheezing.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan; Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study, Keelung, Taiwan.
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18
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Breuer O, Cohen-Cymberknoh M, Picard E, Bentur L, Bar-Yoseph R, Shoseyov D, Tsabari R, Kerem E, Hevroni A. The Use of Infant Pulmonary Function Tests in the Diagnosis of Neuroendocrine Cell Hyperplasia of Infancy. Chest 2021; 160:1397-1405. [PMID: 34029568 DOI: 10.1016/j.chest.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infant pulmonary function tests (iPFTs) in subjects with neuroendocrine cell hyperplasia of infancy (NEHI) have demonstrated significant expiratory airflow obstruction and air trapping. RESEARCH QUESTION Can indexes from iPFTs be used in the diagnosis of NEHI? STUDY DESIGN AND METHODS This is an observational case-control study evaluating iPFT results from a registry of patients assessed at the Hadassah Hebrew University Medical Center between 2008 and 2018. We used the Kruskal-Wallis H test to compare iPFT results in infants with NEHI with those in two infants in a disease control group (infants evaluated for recurrent wheezing and infants evaluated owing to prematurity) and those in a spirometry control group of infants with normal expiratory airflow. Receiver operating characteristic (ROC) curves were used to assess the diagnostic accuracy of the iPFT indexes. RESULTS We evaluated iPFT data in 481 infants (15, NEHI; 292, wheezing; 128, premature; and 46, control group). Infants with NEHI had significantly increased trapped air volumes (median functional residual capacity measured with baby-body plethysmograph [FRCpleth] was 199% predicted; median ratio of residual volume to total lung capacity was 59% predicted) when compared with results in all evaluated groups of infants (P < .001), including multiple pairwise comparisons. Airflow limitation was demonstrated in infants with NEHI when compared with the infants in the spirometry control group but was similar to that in the two infants in the disease control group. FRCpleth had the best discriminatory ability for NEHI diagnosis, with an FRCpleth ≥ 150% predicted demonstrating a ROC of 0.91 (95% CI, 0.82-1.00), sensitivity of 86.7% (95% CI, 59.5%-98.3%), and specificity of 95.5% (95% CI, 93.2%-97.3%). INTERPRETATION Findings on iPFTs of markedly increased air trapping, out of proportion to the degree of airflow limitation, are characteristic of infants with NEHI. iPFT results demonstrating an FRCpleth ≥ 150% predicted are highly specific for NEHI and may aid in early diagnosis. Further research is required to confirm these findings in a prospective cohort and to understand the pathophysiologic explanation for these findings.
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Affiliation(s)
- Oded Breuer
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lea Bentur
- Pediatric Pulmonary Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - David Shoseyov
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eitan Kerem
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avigdor Hevroni
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Pediatric Pulmonary Unit, Kaplan Medical Center, Rehovot, Israel
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19
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Lavizzari A, Zannin E, Ophorst M, Ciuffini F, Gangi S, Farolfi A, Colnaghi M, Dellacà RL, Mosca F. Tidal Breathing Measurements in Former Preterm Infants: A Retrospective Longitudinal Study. J Pediatr 2021; 230:112-118.e4. [PMID: 33253731 DOI: 10.1016/j.jpeds.2020.11.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate, in infants born preterm with or without bronchopulmonary dysplasia (BPD), the trajectory of tidal breathing flow-volume (TBFV) parameters in the first 2 years of life; the association between TBFV parameters and perinatal risk factors; and the predictive value of TBFV parameters for rehospitalizations due to respiratory infections and wheeze. STUDY DESIGN We retrospectively analyzed TBFV measurements performed at 0-6, 6-12, and 12-24 months of corrected age in 97 infants <32 weeks of gestation and <1500 g. We assessed the association between TBFV parameters and perinatal risk-factors using linear regressions and the predictive capacity for subsequent respiratory morbidity using logistic regressions. We used the area under the curve and likelihood ratio test (LRT) to compare nested models. RESULTS Time to peak tidal expiratory flow/expiratory time ratio (tPTEF/tE) was lower than normal for the first 2 years of corrected age. Longer duration of oxygen supplementation, intubation, and respiratory support were associated with reduced tPTEF/tE at all time points. For each z-score increase in tPTEF/tE, the OR for rehospitalizations decreased by 0.70. tPTEF/tE added significantly to BPD classifications alone in predicting rehospitalizations (area under the receiver operating characteristic curve = 0.81 vs 0.76, P value for LRT = .0012), and wheeze (area under the receiver operating characteristic curve = 0.76 vs 0.71, P value for LRT <.001). CONCLUSIONS Infants born preterm, with and without BPD, display persistent airway obstruction during the first 2 years of life. tPTEF/tE may identify infants at greater risk of severe respiratory morbidity.
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Affiliation(s)
- Anna Lavizzari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.
| | - Emanuela Zannin
- Politecnico di Milano University Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB Laboratorio di Tecnologie Biomediche - TBMLab, Milan, Italy
| | - Marijke Ophorst
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Francesca Ciuffini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Silvana Gangi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Andrea Farolfi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Mariarosa Colnaghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Raffaele Lorenzo Dellacà
- Politecnico di Milano University Dipartimento di Elettronica, Informazione e Bioingegneria - DEIB Laboratorio di Tecnologie Biomediche - TBMLab, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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20
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de Gouveia Belinelo P, Collison AM, Murphy VE, Robinson PD, Jesson K, Hardaker K, de Queiroz Andrade E, Oldmeadow C, Martins Costa Gomes G, Sly PD, Usemann J, Appenzeller R, Gorlanova O, Fuchs O, Latzin P, Gibson PG, Frey U, Mattes J. Maternal asthma is associated with reduced lung function in male infants in a combined analysis of the BLT and BILD cohorts. Thorax 2021; 76:996-1001. [PMID: 33632766 DOI: 10.1136/thoraxjnl-2020-215526] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 12/22/2022]
Abstract
RATIONALE Asthma in pregnancy is associated with respiratory diseases in the offspring. OBJECTIVE To investigate if maternal asthma is associated with lung function in early life. METHODS Data on lung function measured at 5-6 weeks of age were combined from two large birth cohorts: the Bern Infant Lung Development (BILD) and the Australian Breathing for Life Trial (BLT) birth cohorts conducted at three study sites (Bern, Switzerland; Newcastle and Sydney, Australia). The main outcome variable was time to reach peak tidal expiratory flow as a percentage of total expiratory time(tPTEF:tE%). Bayesian linear hierarchical regression analyses controlling for study site as random effect were performed to estimate the effect of maternal asthma on the main outcome, adjusting for sex, birth order, breast feeding, weight gain and gestational age. In separate adjusted Bayesian models an interaction between maternal asthma and sex was investigated by including an interaction term. MEASUREMENTS AND MAIN RESULTS All 406 BLT infants were born to mothers with asthma in pregnancy, while 193 of the 213 (91%) BILD infants were born to mothers without asthma. A significant interaction between maternal asthma and male sex was negatively associated with tPTEF:tE% (intercept 37.5; estimate: -3.5; 95% credible interval -6.8 to -0.1). Comparing the model posterior probabilities provided decisive evidence in favour of an interaction between maternal asthma and male sex (Bayes factor 33.5). CONCLUSIONS Maternal asthma is associated with lower lung function in male babies, which may have lifelong implications on their lung function trajectories and future risk of wheezing and asthma.
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Affiliation(s)
- Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Adam M Collison
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn Jesson
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Hardaker
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ediane de Queiroz Andrade
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Gabriela Martins Costa Gomes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Peter D Sly
- Centre for Children's Health Research, University of Queensland, South Brisbane, Queensland, Australia
| | - Jakob Usemann
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Rhea Appenzeller
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Oliver Fuchs
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Peter G Gibson
- Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Urs Frey
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland .,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia .,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
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21
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Çelik E, Uysal P. Pulmonary function testing with tidal breath analyze technique is useful in predicting persistant small airway damage in infants with acute bronchiolitis. Pediatr Allergy Immunol 2021; 32:60-66. [PMID: 32628273 DOI: 10.1111/pai.13318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/03/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to technical difficulties, lung function in infants is less studied. This prospective cross-sectional study investigated breathing parameters by using tidal breath analysis (TBA) technique in hospitalized infants with the first-time acute bronchiolitis (AB). METHODS This study enrolled 111 infants aged 1 month-2 years: 61 with AB and 50 healthy controls. Lung function was assessed using TBA technique on the first day of hospitalization and repeated at the 7th and 30th days after the treatment. RESULTS The parameters of tPTEF, tPTEF:tE, VT/kg, and tI/tE ratio were still significantly lower at the 30th day of the disease. tPTEF:tE ratio was inversely correlated with hospitalization duration and severity of disease and strongly correlated with VPTEF:VE (r = .876, P < .001) in infants with AB. CONCLUSION Due to restoration of pulmonary function dynamics in the lower respiratory tract was a long-lasting process, TBA is a useful and easy method for pulmonary function among infants and may help clinicians to predict persistent small airway damage.
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Affiliation(s)
- Elif Çelik
- General Pediatrics Unit, Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Pınar Uysal
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
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22
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Anık A, Öztürk S, Erge D, Akcan AB, Türkmen MK, Uysal P. Tidal breath in healthy term newborns: An analysis from the 2nd to the 30th days of life. Pediatr Pulmonol 2021; 56:274-282. [PMID: 33137239 DOI: 10.1002/ppul.25125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 09/26/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Few data are available concerning normative lung function parameters measured in unsedated neonates. AIM To evaluate lung function changes in neonates. METHODS In this prospective cohort study, tidal breath parameters were measured using the MasterScreen PAED system and standardized protocols. Measurements were performed on 60 (30 male) term, healthy, unsedated neonates on the postnatal 2nd and 30th days. RESULTS Expiratory time (TE; p < .001; Cohen's d = 0.561), exhaled volume to peak tidal expiratory flow (VPTEF; p < .001; Cohen's d = 0.789), minute ventilation (p < .001; Cohen's d = 0.926), tidal volume (VT; p < .001; Cohen's d = 1.835), expiratory flow when 75%, 50%, and 25% of tidal volume remaining in the lungs (TEF75 [p < .001; Cohen's d = 1.070], TEF50 [p < .001; Cohen's d = 0.824], TEF25 [p < .001; Cohen's d = 0.568]), and inspiratory time (Ti; p < .001; Cohen's d = 0.654) were higher on Day 30 compared to Day 2, while time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE; p = .006; Cohen's d = 0.371), the volume until peak tidal expiratory flow to total expiratory volume (VPTEF/VE; p = .001; Cohen's d = 0.447), and respiration rate (RR; p = .001; Cohen's d = 0.432) were lower, and Ti/TE was unchanged. Positive correlation was observed between length and VT (r = .347; p = .008) on Day 2 and (r = .338; p = .008) on Day 30. CONCLUSIONS The present study reveals the physiological changes occurring in lung functions in healthy term neonates during the neonatal period.
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Affiliation(s)
- Ayşe Anık
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Sercan Öztürk
- Department of Pediatrics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Duygu Erge
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Abdullah B Akcan
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Münevver K Türkmen
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Pınar Uysal
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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23
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Hinder M, Drevhammar T, Donaldsson S, Boustred M, Crott M, Tracy MB. T-piece resuscitators: What you set is often not what gets delivered or measured. Arch Dis Child Fetal Neonatal Ed 2021; 106:110-111. [PMID: 33082152 DOI: 10.1136/archdischild-2020-320457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Murray Hinder
- Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia .,Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Drevhammar
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Snorri Donaldsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Matthew Boustred
- School of Biomedical Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Crott
- School of Biomedical Engineering, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Brian Tracy
- Neonatal Intensive Care Unit, Westmead Hospital, Westmead, New South Wales, Australia.,Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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24
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Wang Q, Liu Q, Zang J, Wang J, Chen J. Risk factors affecting postoperative pulmonary function in congenital diaphragmatic hernia. Ann Surg Treat Res 2020; 98:206-213. [PMID: 32274369 PMCID: PMC7118320 DOI: 10.4174/astr.2020.98.4.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/21/2019] [Accepted: 01/11/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose It is well known that congenital diaphragmatic hernia (CDH) in infants impacts pulmonary function rehabilitation after surgery. However, the risk factors of postoperative pulmonary function are still unclear. In this research, we analyzed the potential risk factors of postoperative pulmonary function in CDH patients in order to improve the clinical management of CDH patients. Methods Thirty-three cases CDH infants followed were enrolled from November 2016 to September 2018. Clinical data were reviewed. Tidal breathing pulmonary function testing was performed after surgery. Correlation between pulmonary function and clinical characteristics was evaluated using multivariate analysis of variance. Results Pulmonary dysfunction was detected in 87.9% patients (29 of 33). The defect size was found to be significantly larger in patients with obstructed and mixed ventilatory disorders (P = 0.001). Diagnosis of gestational age (GA) was also significantly earlier compared to restrictive ventilatory disorders (P = 0.001). Larger defect size, and earlier prenatal diagnosis of GA were detected in severe obstructive ventilatory disorders (P = 0.007, P = 0.001, retrospectively). Conclusion Most patients had various degrees of pulmonary dysfunction after surgery. Patients with larger defect size and earlier diagnosis time might be vulnerable to severe obstructive and mixed ventilatory disorders.
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Affiliation(s)
- Qianqian Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Quanhua Liu
- Department of Pediatric Respiration, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyu Zang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Jun Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Jie Chen
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Pediatric Surgery, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
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25
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Lai SH, Chiang MC, Chu SM, Hsu JF, Yao TC, Tsai MH, Hua MC, Chiu CY, Yeh KW, Huang JL, Liao SL. Evolution and Determinants of Lung Function until Late Infancy among Infants Born Preterm. Sci Rep 2020; 10:490. [PMID: 31949250 PMCID: PMC6965604 DOI: 10.1038/s41598-019-57359-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/06/2019] [Indexed: 01/08/2023] Open
Abstract
To investigate the evolution of lung function in preterm infants with and without bronchopulmonary dysplasia (BPD) and to determine the perinatal characteristics associated with indexes of lung function in later infancy. Longitudinal lung function assessments were performed at approximately 6, 12, 18, and 24 months of corrected age in preterm infants. Perinatal characteristics were further analyzed to ascertain the determinants of lung function indexes. Although all preterm infants (n = 121; 61 without BPD and 60 with BPD) exhibited decreased lung function in early infancy (6 months of age), after body length was adjusted for, only infants with BPD exhibited poor performance. Furthermore, the lung function of infants with mild to moderate BPD caught up gradually, but the generally poor lung function performance of infants with severe BPD, especially in forced expiratory flow, persisted until later age (24 months). Regarding perinatal characteristics, the z-score of body length at the time of examination and total number of days on positive-pressure ventilation are the major determinants of lung function in later infancy.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Chou Chiang
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.
- Department of Pediatrics, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan.
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan.
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26
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Normative Data of Infant Pulmonary Function Testing: A Prospective Birth Cohort Study from India. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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27
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Kosma P, Palme-Kilander C, Bottai M, Ljungberg H, Hallberg J. Forced expiratory flows and volumes in a Swedish cohort of healthy term infants. Pediatr Pulmonol 2020; 55:185-189. [PMID: 31682334 DOI: 10.1002/ppul.24562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/29/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The use of pulmonary function tests (PFTs) in infants has increased during the last decades, making the need for equipment- and ethnic-specific reference data mandatory for appropriate interpretation of the results. AIM Our aim was to investigate how well the already published reference equations for infant spirometry fit a healthy population of Swedish infants. METHOD We performed forced tidal and raised volume expiratory maneuvers in healthy infants using Jaeger BabyBody equipment. RESULTS PFT data were collected from 91 healthy infants aged between 3 months to 2 years at 143 occasions. Mean (standard deviation) z-scores were 0.68(1.33) for maximal flow at functional residual capacity (V'max FRC), -0.15(0.96) for forced vital capacity (FVC), 0.40(1.33) for the forced expired volume in the initial 0.5 seconds (FEV0.5 ) and 0.52(0.93) for the ratio FEV0.5 /FVC, respectively. Z-scores for all indices but FEV0.5 /FVC were highly dependent on length. CONCLUSIONS We have shown that the use of previously published reference equations may result in an age-related misinterpretation of lung function measure in a Swedish infant population.
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Affiliation(s)
- Paraskevi Kosma
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Henrik Ljungberg
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Hough JL, Shearman AD, Jardine L, Caldararo D, Schibler A. Effect of randomization of nasal high flow rate in preterm infants. Pediatr Pulmonol 2019; 54:1410-1416. [PMID: 31286694 DOI: 10.1002/ppul.24418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the effect of nasal high flow (NHF) cannula on end-expiratory level (EEL), continuous distending pressure (CDP) and regional ventilation distribution in preterm infants. DESIGN A prospective observational clinical study with randomly applied NHF rates. PATIENTS AND SETTING Preterm infants requiring continuous positive airway pressure (CPAP) respiratory support in a Neonatal Intensive Care Unit. INTERVENTIONS Infants were measured on randomly applied flow rates at 2, 4, and 6 L/min of NHF and compared with bubble CPAP. MEASUREMENTS AND RESULTS Regional ventilation distribution and EEL were measured using electrical impedance tomography (EIT) and respiratory inductance plethysmography (RIP) in 24 preterm infants (31.19 ± 1.17 weeks corrected age). Changes in CDP were measured from the esophagus via the nasogastric tube. Physiological variables were also recorded. There were no differences in ventilation distribution, EEL or CDP between CPAP and NHF (P > .05). However, the physiological variables of FiO2 (P = .01) and SpO2 /FiO2 (P < .01) were improved on CPAP compared with NHF. CONCLUSION NHF applied in random order with flow rates between 2 to 6 L/min was equally as good as CPAP in maintaining EEL and ventilation distribution in stable preterm infants. Overall oxygenation was better on CPAP compared to NHF.
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Affiliation(s)
- Judith L Hough
- Program for Optimising Outcomes for Mothers and Babies at Risk, Mater Research Institute, The University of Queensland, South Brisbane, Australia.,Discipline of Physiotherapy, School of Allied Health, Australian Catholic University, Banyo, Australia.,Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, South Brisbane, Australia
| | - Andrew D Shearman
- Program for Optimising Outcomes for Mothers and Babies at Risk, Mater Research Institute, The University of Queensland, South Brisbane, Australia
| | - Luke Jardine
- Program for Optimising Outcomes for Mothers and Babies at Risk, Mater Research Institute, The University of Queensland, South Brisbane, Australia
| | - Deborah Caldararo
- Program for Optimising Outcomes for Mothers and Babies at Risk, Mater Research Institute, The University of Queensland, South Brisbane, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Mater Research Institute, The University of Queensland, South Brisbane, Australia
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29
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Robinson PD, Latzin P, Ramsey KA, Stanojevic S, Aurora P, Davis SD, Gappa M, Hall GL, Horsley A, Jensen R, Lum S, Milla C, Nielsen KG, Pittman JE, Rosenfeld M, Singer F, Subbarao P, Gustafsson PM, Ratjen F. Preschool Multiple-Breath Washout Testing. An Official American Thoracic Society Technical Statement. Am J Respir Crit Care Med 2019; 197:e1-e19. [PMID: 29493315 DOI: 10.1164/rccm.201801-0074st] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Obstructive airway disease is nonuniformly distributed throughout the bronchial tree, although the extent to which this occurs can vary among conditions. The multiple-breath washout (MBW) test offers important insights into pediatric lung disease, not available through spirometry or resistance measurements. The European Respiratory Society/American Thoracic Society inert gas washout consensus statement led to the emergence of validated commercial equipment for the age group 6 years and above; specific recommendations for preschool children were beyond the scope of the document. Subsequently, the focus has shifted to MBW applications within preschool subjects (aged 2-6 yr), where a "window of opportunity" exists for early diagnosis of obstructive lung disease and intervention. METHODS This preschool-specific technical standards document was developed by an international group of experts, with expertise in both custom-built and commercial MBW equipment. A comprehensive review of published evidence was performed. RESULTS Recommendations were devised across areas that place specific age-related demands on MBW systems. Citing evidence where available in the literature, recommendations are made regarding procedures that should be used to achieve robust MBW results in the preschool age range. The present work also highlights the important unanswered questions that need to be addressed in future work. CONCLUSIONS Consensus recommendations are outlined to direct interested groups of manufacturers, researchers, and clinicians in preschool device design, test performance, and data analysis for the MBW technique.
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30
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Usemann J, Suter A, Zannin E, Proietti E, Fouzas S, Schulzke S, Latzin P, Frey U, Korten I, Anagnostopoulou P, Gorlanova O, Frey U, Latzin P, Proietti E, Usemann J. Variability of Tidal Breathing Parameters in Preterm Infants and Associations with Respiratory Morbidity during Infancy: A Cohort Study. J Pediatr 2019; 205:61-69.e1. [PMID: 30416016 DOI: 10.1016/j.jpeds.2018.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test whether low variability of tidal volume (VT) and capnographic indices are predictive of subsequent respiratory morbidity in preterm infants. STUDY DESIGN In a birth cohort of 133 preterm infants, lung function was performed at 44 weeks postmenstrual age. Associations between the coefficient of variation (CV) of VT (CVVT) and of expired CO2 volume per breath (CVVE,CO2) with rehospitalization, wheeze, and inhalation therapy during infancy were assessed using logistic regression. Area under the curve (AUC) analysis was used to assess whether outcome prediction using bronchopulmonary dysplasia (BPD) classification was enhanced by CVVT or CVVE,CO2. RESULTS For each IQR decrease in CVVT (range, 4%-35%) and CVVE,CO2 (range, 5%-40%), the OR for rehospitalization increased by 2.25 (95% CI, 1.21-4.20) and 2.31 (95% CI, 1.20-4.45), respectively. The predictive value of BPD for rehospitalization was improved when CVVT or CVVE,CO2 was added to the model, with the AUC increasing from 0.56 to 0.66 in both models. No association was found for the other outcomes. CONCLUSIONS Compared with BPD classification alone, including near-term variability of tidal breathing parameters improves the prediction of rehospitalization in infancy. These findings may inform parent counseling and monitoring strategies in preterm infants.
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Affiliation(s)
- Jakob Usemann
- University Children's Hospital Basel, Basel, Switzerland; Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Andrea Suter
- University Children's Hospital Basel, Basel, Switzerland
| | - Emanuela Zannin
- University Children's Hospital Basel, Basel, Switzerland; Departiment of Electronics, Information, and Bioengineering, Polytechnic University of Milan, Milan, Italy
| | - Elena Proietti
- University Children's Hospital Basel, Basel, Switzerland; Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sotirios Fouzas
- Pediatric Respiratory Unit, University Hospital of Patras, Patras, Greece
| | - Sven Schulzke
- University Children's Hospital Basel, Basel, Switzerland
| | - Philipp Latzin
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
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31
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Olaniyan T, Dalvie MA, Röösli M, Naidoo R, Künzli N, de Hoogh K, Parker B, Leaner J, Jeebhay M. Asthma-related outcomes associated with indoor air pollutants among schoolchildren from four informal settlements in two municipalities in the Western Cape Province of South Africa. INDOOR AIR 2019; 29:89-100. [PMID: 30339304 DOI: 10.1111/ina.12511] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/31/2018] [Accepted: 10/13/2018] [Indexed: 06/08/2023]
Abstract
The health impact of indoor air pollution in informal settlement households has not been extensively studied in South Africa. This cross-sectional study investigated the association between asthma and common indoor exposures among schoolchildren from four informal settlements located in two municipalities in the Western Cape Province. A total of 590 children, aged 9-11 years, were recruited. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered to caregivers. Pulmonary function assessment included spirometry and fractional exhaled nitric oxide (FeNO). Phadiatop test for atopy was done. The prevalence of doctor-diagnosed asthma was 3.4% (n = 20) among whom only 50% were on treatment. The prevalence of current wheeze was 12.9%, and 17.6% had airway obstruction (FEV1 < lower limit of normal), while 10.2% had airway inflammation (FeNO > 35 ppb). In adjusted logistic regression models, dampness, visible mold growth, paraffin use for cooking, and passive smoking were associated with a twofold to threefold increased risk in upper and lower airway outcomes. The strongest association was that of visible mold growth with rhinitis (adjusted odds ratio-aOR 3.37, 95% CI: 1.69-6.71). Thus, there is a need for improved diagnosis of childhood asthma and Indoor Air Quality in informal settlement households.
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Affiliation(s)
- Toyib Olaniyan
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Rajen Naidoo
- University of Kwazulu-Natal, Durban, South Africa
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bhawoodien Parker
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa
| | - Joy Leaner
- Department of Environmental Affairs and Developmental Planning, Western Cape Government, Cape Town, South Africa
| | - Mohamed Jeebhay
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Occupational Medicine, University of Cape Town, Cape Town, South Africa
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33
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Schmidt BJ, Reim PS, Jensen AK, Albertsen P, Greisen G, Jørgensen IM. Tidal breath eNO measurements in a cohort of unsedated hospitalized neonates-A method validation. Pediatr Pulmonol 2018; 53:762-771. [PMID: 29701312 DOI: 10.1002/ppul.24019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/03/2018] [Indexed: 11/09/2022]
Abstract
AIM Exhaled Nitric oxide (eNO) is an inflammatory marker. In 2002 Hall et al. [J Appl Physiol. 92:59-66] established an infant eNO measurement method, fulfilling four criteria of feasibility: simple, non-invasive, without impact on the natural breathing pattern, and accounting for flow by NO output (V'NO). Although tidal breathing is accepted as an eNO measurement method in uncooperative patients, it is seldom used outside research labs. The variability and lack of validated methods have restrained from exploring the area in preterm and term neonates the last years. This study aimed to validate clinically feasible longitudinal online tidal eNO and V'NO in a real-life birth cohort of un-sedated, hospitalized preterm, and term neonates. METHOD We included 149 newborns, GA 28-42 weeks. Each scheduled for six repeated, non-invasive, on-line eNO measurements with Ecomedics CLD 88sp and NO-free air. We used three 60-second-eNO measurements. The method was adapted to fit preterm and term neonates with unstable respiration, without excluding sighs and surrounding breaths. RESULT Protocol measurements with a maximum mutual difference of 1 ppb succeeded in 85-99%, increasing with postnatal age. We performed mixed model analyses in three hierarchical measurement levels. Despite the irregular breathing of newborns, the predictions of individual eNO levels in the average infant was a 0.05 SD. Exhaled NO was flow-dependent (P = 0.028); V'NO but not eNO was associated with preterm birth (P < 0.001) and >24 h CPAP treatment (P = 0.0316). CONCLUSION We validated clinically, non-invasive, online eNO measurements in neonates. The method was well tolerated and exhibited low subject-specific-prediction-variance and high success rates.
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Affiliation(s)
- Birgitte J Schmidt
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pauline S Reim
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas K Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Per Albertsen
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Greisen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neonatology, Rigshospitalet, Copenhagen, Denmark
| | - Inger M Jørgensen
- Department of Pediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hilleroed, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Kentgens AC, Guidi M, Korten I, Kohler L, Binggeli S, Singer F, Latzin P, Anagnostopoulou P. Infant multiple breath washout using a new commercially available device: Ready to replace the previous setup? Pediatr Pulmonol 2018; 53:628-635. [PMID: 29418075 DOI: 10.1002/ppul.23959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 01/08/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Multiple breath washout (MBW) is a sensitive test to measure lung volumes and ventilation inhomogeneity from infancy on. The commonly used setup for infant MBW, based on ultrasonic flowmeter, requires extensive signal processing, which may reduce robustness. A new setup may overcome some previous limitations but formal validation is lacking. AIM We assessed the feasibility of infant MBW testing with the new setup and compared functional residual capacity (FRC) values of the old and the new setup in vivo and in vitro. METHODS We performed MBW in four healthy infants and four infants with cystic fibrosis, as well as in a Plexiglas lung simulator using realistic lung volumes and breathing patterns, with the new (Exhalyzer D, Spiroware 3.2.0, Ecomedics) and the old setup (Exhalyzer D, WBreath 3.18.0, ndd) in random sequence. RESULTS The technical feasibility of MBW with the new device-setup was 100%. Intra-subject variability in FRC was low in both setups, but differences in FRC between the setups were considerable (mean relative difference 39.7%, range 18.9; 65.7, P = 0.008). Corrections of software settings decreased FRC differences (14.0%, -6.4; 42.3, P = 0.08). Results were confirmed in vitro. CONCLUSION MBW measurements with the new setup were feasible in infants. However, despite attempts to correct software settings, outcomes between setups were not interchangeable. Further work is needed before widespread application of the new setup can be recommended.
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Affiliation(s)
- Anne-Christianne Kentgens
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Respiratory Medicine and Allergy, Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Marisa Guidi
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Insa Korten
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lena Kohler
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Severin Binggeli
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Singer
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Division of Respiratory Medicine, University Children's Hospital of Zurich, Zurich, Switzerland
| | - Philipp Latzin
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pinelopi Anagnostopoulou
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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A Novel Approach to the Identification of Compromised Pulmonary Systems in Smokers by Exploiting Tidal Breathing Patterns. SENSORS 2018; 18:s18051322. [PMID: 29693559 PMCID: PMC5981858 DOI: 10.3390/s18051322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 11/16/2022]
Abstract
Smoking causes unalterable physiological abnormalities in the pulmonary system. This is emerging as a serious threat worldwide. Unlike spirometry, tidal breathing does not require subjects to undergo forceful breathing maneuvers and is progressing as a new direction towards pulmonary health assessment. The aim of the paper is to evaluate whether tidal breathing signatures can indicate deteriorating adult lung condition in an otherwise healthy person. If successful, such a system can be used as a pre-screening tool for all people before some of them need to undergo a thorough clinical checkup. This work presents a novel systematic approach to identify compromised pulmonary systems in smokers from acquired tidal breathing patterns. Tidal breathing patterns are acquired during restful breathing of adult participants. Thereafter, physiological attributes are extracted from the acquired tidal breathing signals. Finally, a unique classification approach of locally weighted learning with ridge regression (LWL-ridge) is implemented, which handles the subjective variations in tidal breathing data without performing feature normalization. The LWL-ridge classifier recognized compromised pulmonary systems in smokers with an average classification accuracy of 86.17% along with a sensitivity of 80% and a specificity of 92%. The implemented approach outperformed other variants of LWL as well as other standard classifiers and generated comparable results when applied on an external cohort. This end-to-end automated system is suitable for pre-screening people routinely for early detection of lung ailments as a preventive measure in an infrastructure-agnostic way.
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Hevroni A, Goldman A, Blank-Brachfeld M, Abu Ahmad W, Ben-Dov L, Springer C. Use of tidal breathing curves for evaluating expiratory airway obstruction in infants. J Asthma 2018; 55:1331-1337. [PMID: 29333884 DOI: 10.1080/02770903.2017.1414234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate tidal breathing (TB) flow-volume and flow-time curves for identification of expiratory airway obstruction in infants. METHODS Pulmonary function tests were analyzed retrospectively in 156 infants aged 3-24 months with persistent or recurrent respiratory complaints. Parameters derived from TB curves were compared to maximal expiratory flow at functional residual capacity ( V˙ maxFRC) measured by rapid thoracoabdominal compression technique. Analyzed parameters were: inspiratory time (tI), expiratory time (tE), tidal volume, peak tidal expiratory flow (PTEF), time to peak tidal expiratory flow (tPTEF), expiratory flow when 50% and 25% of tidal volume remains in the lungs (FEF50, FEF25, respectively), and the ratios tPTEF/tE, tI/tE, FEF50/PTEF, and FEF25/PTEF. Statistical comparisons between flow indices and TB parameters were performed using mean squared error and Pearson's sample correlation coefficient. The study population was also divided into two groups based on severity of expiratory obstruction (above or below z-score for V˙ maxFRC of -2) to generate receiver operating characteristic (ROC) curves and calculate discriminatory values between the groups. RESULTS TB parameters that were best correlated to V˙ maxFRC were: tPTEF/tE, FEF50/PTEF, and FEF25/PTEF, with r = 0.61, 0.67, 0.65, respectively (p < 0.0001 for all). ROC curves for FEF50/PTEF, FEF25/PTEF and tPTEF/tE showed areas under the curve of 0.813, 0.797, and 0.796, respectively. Cutoff value z-scores of -0.35, -0.34, and -0.43 for these three parameters, respectively, showed an 86% negative predictive value for severe airway obstructions. CONCLUSION TB curves can assist in ruling out severe expiratory airway obstruction in infants.
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Affiliation(s)
- Avigdor Hevroni
- a Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center , The Hebrew University , Jerusalem , Israel
| | - Aliza Goldman
- a Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center , The Hebrew University , Jerusalem , Israel
| | - Miriam Blank-Brachfeld
- a Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center , The Hebrew University , Jerusalem , Israel
| | - Wiessam Abu Ahmad
- b Braun School of Public Health and Community Medicine , Hebrew University of Jerusalem, Hadassah Medical Organization , Jerusalem , Israel
| | - Lior Ben-Dov
- a Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center , The Hebrew University , Jerusalem , Israel
| | - Chaim Springer
- a Department of Pediatrics and Pediatric Pulmonology, Hadassah-Hebrew University Medical Center , The Hebrew University , Jerusalem , Israel
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Usemann J, Demann D, Anagnostopoulou P, Korten I, Gorlanova O, Schulzke S, Frey U, Latzin P. Interrupter technique in infancy: Higher airway resistance and lower short-term variability in preterm versus term infants. Pediatr Pulmonol 2017; 52:1355-1362. [PMID: 28771980 DOI: 10.1002/ppul.23771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/28/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND In preschool children, measurement of airway resistance using interrupter technique (Rint) is feasible to assess the degree of bronchial obstruction. Although some studies measured Rint in infancy, values of Rint and its variability in preterm infants are unknown. In this study, Rint and its variability was measured at infancy and compared between healthy term and preterm infants. METHODS High quality Rint measurements in term (n = 50) and preterm (n = 48) infants were obtained at postmenstrual age of 42-50 weeks in two study centers in Switzerland. Intra-measurement variability of Rint in one measurement and inter-measurement variability between two subsequent measurements was assessed by coefficient of variation (CV). RESULTS Mean Rint in term infants was 4.2 ± (SD; 1.9) kPa · s · L-1 and in preterm infants was 5.6 ± (2.8) kPa · s · L-1 . Mean CV in term infants was 29.6 ± (14.9)% and in preterm infants was 20.2 ± (8.4)%. Rint was significantly lower (95%CI -2.31 to -0.38; P = 0.007) and CV significantly higher (95%CI 4.53-14.3; P < 0.001) in term compared to preterm infants. There were no differences in mean Rint and mean CV between the first and the second measurement obtained in a subgroup of term (n = 24, 48%) and preterm (n = 22, 45%) infants. CONCLUSIONS Our results suggest that differences in airway mechanics between term and preterm infants can be assessed with the interrupter technique during early infancy. Before clinical application of Rint measurements in this age group, reasons underlying the variability of measurements should be further investigated.
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Affiliation(s)
- Jakob Usemann
- University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Désirée Demann
- University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Pinelopi Anagnostopoulou
- Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Insa Korten
- University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Sven Schulzke
- University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Urs Frey
- University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Philipp Latzin
- University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Liao SL, Tsai MH, Yao TC, Hua MC, Yeh KW, Chiu CY, Su KW, Huang SY, Kao CC, Lai SH, Huang JL. Caesarean Section is associated with reduced perinatal cytokine response, increased risk of bacterial colonization in the airway, and infantile wheezing. Sci Rep 2017; 7:9053. [PMID: 28831038 PMCID: PMC5567317 DOI: 10.1038/s41598-017-07894-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/29/2017] [Indexed: 11/29/2022] Open
Abstract
The relationship between cesarean section (CS) and allergic disorders such as asthma and wheezing has been inconsistent, and the mechanisms for their connection remained largely unknown. We aimed to investigate whether CS is associated with infantile wheeze and to explore the connection between CS and several risk factors known to correlate with allergy development. Mononuclear cells were isolated from cord blood and assessed for cytokine responses by ELISA. Bacteria from nasopharyngeal specimens were identified with traditional culture methods. Infant lung function tests were performed at 6 and 12 months of age. IgE levels and clinical outcomes were assessed at 12 months. The result showed that children delivered by CS were associated with increased risk of wheezing (aHR 1.63; 95% CI: 1.01–2.62) and decreased compliance of the respiratory system at 12 months (p = 0.045). In addition, CS was associated with reduced TLR1–2- triggered TNF-α and IL-6 responses at birth. By12 months of age, children delivered by CS had significantly less airway bacterial clearance. Our findings suggested that CS was associated with decreased pro-inflammatory cytokine response to TLR1–2 stimulation, followed by higher abundance of bacterial colonization in the airway during late infancy, thus increasing the risk of infantile wheezing.
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Affiliation(s)
- Sui-Ling Liao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Ming-Han Tsai
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Man-Chin Hua
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chih-Yung Chiu
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kuan-Wen Su
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shih-Yin Huang
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chuan-Chi Kao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shen-Hao Lai
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan. .,Division of Pulmonology, Department of Pediatric, Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Taoyuan, Taiwan.
| | - Jing-Long Huang
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
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Lai SH, Liao SL, Yao TC, Tsai MH, Hua MC, Chiu CY, Yeh KW, Huang JL. Raised-Volume Forced Expiratory Flow-Volume Curve in Healthy Taiwanese Infants. Sci Rep 2017; 7:6314. [PMID: 28740164 PMCID: PMC5524959 DOI: 10.1038/s41598-017-06815-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/19/2017] [Indexed: 01/15/2023] Open
Abstract
The raised-volume rapid thoracoabdominal compression (RVRTC) manoeuvre has been applied to obtain full forced expiratory flow-volume curves in infants. No reference data are available for Asian populations. This study was conducted to establish predictive reference equations for Taiwanese infants. Full-term infants without any chronic disease or major anomaly were enrolled from this cohort study. Full forced expiratory flow-volume curves were acquired using RVRTC manoeuvres through Jaeger's system. Tidal breath analysis, passive respiratory mechanics, and tidal forced expiratory flow-volume curves were performed and collected at the same measurement. Multiple linear analyses were used to model the variables. We performed 117 tests of RVRTC flow-volume curves in 97 infants. The results revealed that all parameters, except for FEV0.5 /FVC, correlated highly and positively with body length. These parameters correlated significantly with other parameters of passive respiratory mechanics and tidal forced expiratory flow-volume curves. This is the first study to establish equipment-specific reference data of full forced expiration using RVRTC manoeuvres in Asian infants. The results revealed that parameters of RVRTC manoeuvres are moderately related to other parameters of infant lung function. These race-specific reference data can be used to more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan. .,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan.
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Prinable J, Jones P, Thamrin C, McEwan A. A novel hardware implementation for detecting respiration rate using photoplethysmography. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:726-729. [PMID: 29059975 DOI: 10.1109/embc.2017.8036927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Asthma is a serious public health problem. Continuous monitoring of breathing may offer an alternative way to assess disease status. In this paper we present a novel hardware implementation for the capture and storage of a photoplethysmography (PPG) signal. The LED duty cycle was altered to determine the effect on respiratory rate accuracy. The oximeter was mounted to the left index finger of ten healthy volunteers. The breathing rate derived from the oximeter was validated against a nasal airflow sensor. The duty cycle of a pulse oximeter was changed between 5%, 10% and 25% at a sample rate of 500 Hz. A PPG signal and reference signal was captured for each duty cycle. The PPG signals were post processed in Matlab to derive a respiration rate using an existing Matlab toolbox. At a 25% duty cycle the RMSE was <;2 breaths per minute for the top performing algorithm. The RMSE increased to over 5 breaths per minute when the duty cycle was reduced to 5%. The power consumed by the hardware for a 5%, 10% and 25% duty cycle was 5.4 mW, 7.8 mW, and 15 mW respectively. For clinical assessment of respiratory rate, a RSME of <;2 breaths per minute is recommended. Further work is required to determine utility in asthma management. However for non-clinical applications such as fitness tracking, lower accuracy may be sufficient to allow a reduced duty cycle setting.
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Jiang G, Li A, Wang L, Qian L, Cao Y, Huang J, Wan C, Zhang X. Reference data for BabyBody-plethysmographic measurements in Chinese neonates and infants. Respirology 2017. [PMID: 28621890 DOI: 10.1111/resp.13104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gaoli Jiang
- Department of Respirology; Children's Hospital of Fudan University; Shanghai China
| | - Albert Li
- Department of Peadiatrics, Faculty of Medicine; The Chinese University of Hong Kong; Hong Kong China
| | - Libo Wang
- Department of Respirology; Children's Hospital of Fudan University; Shanghai China
| | - Liling Qian
- Department of Respirology; Children's Hospital of Fudan University; Shanghai China
| | - Yun Cao
- Department of Neonatology; Children's Hospital of Fudan University; Shanghai China
| | - Jianfeng Huang
- Department of Respirology; Children's Hospital of Fudan University; Shanghai China
| | - Chengzhou Wan
- Department of Pulmonary Function Laboratory; Children's Hospital of Fudan University; Shanghai China
| | - Xiaobo Zhang
- Department of Respirology; Children's Hospital of Fudan University; Shanghai China
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Stafler P, Weinreb S, Mussaffi H, Mei-Zahav M, Prais D, Steuer G, Bar-On O, Hoshen M, Blau H. Feasibility of multiple breath washout measurements in infants with bronchiolitis: A pilot study. Pediatr Pulmonol 2017; 52:763-770. [PMID: 28221737 DOI: 10.1002/ppul.23674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lung clearance index (LCI) reflects ventilation inhomogeneity and is raised in obstructive airway disease. Feasibility of multiple breath washout (MBW) measurement during acute lung disease in infants is unknown. As a further measure of disease, exhaled nitric oxide (eNO) may paradoxically decrease in acute bronchiolitis. We hypothesized that MBW measurements were attainable in infants with bronchiolitis and that LCI was raised and eNO reduced, compared to normal controls. METHODS Infants with acute bronchiolitis were tested with sulfur hexafluoride (SF6 ) MBW during hospitalization and compared to controls. Tidal breathing and eNO parameters were obtained. Measurements were performed during natural sleep. RESULTS Twenty-nine infants with bronchiolitis aged 3.7 ± 2.3 months (mean ± SD) and 23 controls aged 4.2 ± 2.5 months (P = 0.07) were evaluated. Fifteen of 29 (52%) infants with bronchiolitis and 19/23 (83%) controls achieved ≥2 valid MBW measurements. Reasons for test failure included waking up during facemask application and an irregular respiratory pattern. LCI was 8.4 ± 0.8 in the study group and 7.3 ± 0.7 in controls (P < 0.001). ENO was 2.3 ± 2.7 ppb in the study group and 7.9 ± 6.9 ppb in controls (P = 0.004). CONCLUSION MBW measurements during natural sleep are feasible but technically challenging in infants with acute bronchiolitis. LCI is raised compared to healthy controls. Larger trials, possibly using sedation protocols and shortened washout periods, are required to corroborate these findings. LCI can potentially serve as an objective indicator of severity and could be considered as a biomarker for future interventional trials.
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Affiliation(s)
- Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sigal Weinreb
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Huda Mussaffi
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Steuer
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Ophir Bar-On
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | - Hannah Blau
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gray D, Willemse L, Visagie A, Czövek D, Nduru P, Vanker A, Stein DJ, Koen N, Sly PD, Hantos Z, Hall GL, Zar HJ. Determinants of early-life lung function in African infants. Thorax 2017; 72:445-450. [PMID: 27856821 PMCID: PMC5520243 DOI: 10.1136/thoraxjnl-2015-207401] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Low lung function in early life is associated with later respiratory illness. There is limited data on lung function in African infants despite a high prevalence of respiratory disease. AIM To assess the determinants of early lung function in African infants. METHOD Infants enrolled in a South African birth cohort, the Drakenstein child health study, had lung function measured at 6-10 weeks of age. Measurements, made with the infant breathing via a facemask during natural sleep, included tidal breathing, sulfur hexafluoride multiple breath washout and the forced oscillation technique. Information on antenatal and early postnatal exposures was collected using questionnaires and urine cotinine. Household benzene exposure was measured antenatally. RESULTS Successful tests were obtained in 645/675 (95%) infants, median (IQR) age of 51 (46-58) days. Infant size, age and male gender were associated with larger tidal volume. Infants whose mothers smoked had lower tidal volumes (-1.6 mL (95% CI -3.0 to -0.1), p=0.04) and higher lung clearance index (0.1 turnovers (95% CI 0.01 to 0.3), p=0.03) compared with infants unexposed to tobacco smoke. Infants exposed to alcohol in utero or household benzene had lower time to peak tidal expiratory flow over total expiratory time ratios, 10% (95% CI -15.4% to -3.7%), p=0.002) and 3.0% (95% CI -5.2% to -0.7%, p=0.01) lower respectively compared with unexposed infants. HIV-exposed infants had higher tidal volumes (1.7 mL (95% CI 0.06 to 3.3) p=0.04) compared with infants whose mothers were HIV negative. CONCLUSION We identified several factors including infant size, sex, maternal smoking, maternal alcohol, maternal HIV and household benzene associated with altered early lung function, many of which are factors amenable to public health interventions. Long-term study of lung function and respiratory disease in these children is a priority to develop strategies to strengthen child health.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dorottya Czövek
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Polite Nduru
- Division of Epidemiology and Biostatistics, Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorder, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorder, University of Cape Town, Cape Town, South Africa
| | - Peter D Sly
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Zoltán Hantos
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Graham L Hall
- Telethon Kids Institute, Australia Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Qi YY, Jiang GL, Wang LB, Wan CZ, Zhang XB, Qian LL. Lung Function in Wheezing Infants after Acute Lower Respiratory Tract Infection and Its Association with Respiratory Outcome. Chin Med J (Engl) 2017; 130:4-10. [PMID: 28051016 PMCID: PMC5221110 DOI: 10.4103/0366-6999.196577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Wheezing is common in early childhood and remains an important health concern. The aim of this study was to assess the lung function of wheezing infants and to investigate the relationship between lung function and respiratory outcome. Methods: Infants <2 years of age with acute lower respiratory tract infection (ALRTI) who had undergone lung function tests were included in the study. They were assigned to wheeze or no wheeze group based on physical examination. Infants without any respiratory diseases were enrolled as controls. Lung function was measured during the acute phase and 3 months after ALRTI. One-year follow-up for infants with ALRTI was achieved. Results: A total of 252 infants with ALRTI who had acceptable data regarding tidal breathing were included in the final analysis. Compared with the control and the no wheeze groups, infants in the wheeze group had significantly decreased time to peak tidal expiratory flow as a percentage of total expiratory time (TPTEF/TE) (20.1 ± 6.4% vs. 34.4 ± 6.2% and 26.4 ± 8.3%, respectively, P < 0.0001) and significantly increased peak tidal expiratory flow (PTEF) (90.7 ± 26.3 ml/s vs. 79.3 ± 18.4 ml/s and 86.1 ± 28.0 ml/s, respectively, P < 0.01), sReff and Reff. The infants in the wheeze group still had lower TPTEF/TE and volume to peak tidal expiratory flow as a percentage of total expiratory volume (VPTEF/VE) than the no wheeze infants 3 months after the ALRTI. Moreover, there was a significant inverse relationship between TPTEF/TE, VPTEF/VE, and the recurrence of wheezing and pneumonia. Conclusions: Impaired lung function was present in wheezing infants with ALRTI and the deficits persisted. In addition, the lower level of TPTEF/TE and VPTEF/VE was a risk factor for poor respiratory outcome.
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Affiliation(s)
- Yuan-Yuan Qi
- Department of Respiration, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Gao-Li Jiang
- Department of Respiration, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Li-Bo Wang
- Department of Respiration, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Cheng-Zhou Wan
- Department of Respiration, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xiao-Bo Zhang
- Department of Respiration, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Li-Ling Qian
- Department of Respiration, Children's Hospital of Fudan University, Shanghai 201102, China
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Lai SH, Liao SL, Tsai MH, Hua MC, Chiu CY, Yeh KW, Yao TC, Huang JL. Low cord-serum 25-hydroxyvitamin D levels are associated with poor lung function performance and increased respiratory infection in infancy. PLoS One 2017; 12:e0173268. [PMID: 28267792 PMCID: PMC5340372 DOI: 10.1371/journal.pone.0173268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 02/17/2017] [Indexed: 11/20/2022] Open
Abstract
Background Perinatal vitamin D deficiency is associated with a higher risk of wheezing in childhood. However, the relationship between vitamin D levels and lung function in infancy has not been investigated. The aim of this study was to investigate the impact of perinatal vitamin D levels on respiratory function and disease outcome in infancy. Materials and methods Full-term infants without any chronic diseases or major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children cohort study. Maternal and cord blood were collected for determining the 25(OH)D level. Questionnaires were recorded at birth and 6 months of age. Infant lung function, including tidal breathing analysis, respiratory mechanics, and forced tidal expiration, was tested at 6 months of age. Results A total of 122 mother—infant pairs were enrolled in this study, and 71 infants underwent lung function testing at 6 months of age. 25(OH)D levels in maternal and cord serum were highly correlated (r2 = 0.457, p < 0.0001). Infants with lower cord serum 25(OH)D levels (< 13.7 ng/ml) had higher resistance of respiratory system (p < 0.01) and a higher risk of a respiratory tract infection before the age of 6 months (p < 0.01). Conclusion Although a high correlation was found between maternal and cord vitamin D levels, the effect on respiratory outcome was different. Our study is the first to show that low cord 25(OH)D levels significantly relationship with poorer lung function performance and higher likelihood of a respiratory tract infection before 6 months of age.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- * E-mail: (TCY); (JLH)
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) Cohort Study Group, Keelung, Taiwan
- * E-mail: (TCY); (JLH)
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Poncin W, Singer F, Aubriot AS, Lebecque P. Agreement between multiple-breath nitrogen washout systems in children and adults. J Cyst Fibros 2016; 16:258-266. [PMID: 27919570 DOI: 10.1016/j.jcf.2016.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 10/19/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Comparability of multiple breath washout (MBW) systems has been little explored. We assessed agreement in lung clearance index (LCI) from two similar, commercial nitrogen MBW setups in patients with Cystic Fibrosis (CF) and controls. METHODS The EasyOne Pro (NDD) and Exhalyzer D (EM) were randomly applied in 85 adults (34 with CF) and 97 children (47 with CF and normal forced expiratory volume in one second). We assessed differences between setups in LCI, lung volumes and breathing pattern and diagnostic performance for detecting abnormal lung function. RESULTS Compared to NDD, EM measured higher LCI, functional residual capacity and cumulative expired volume while respiratory rate was lower. Mean difference (limits of agreement) in LCI was 1.30 (-2.34 to 4.94). In CF, prevalence of abnormal LCI was greater in children and similar in adults using EM compared to NDD. CONCLUSIONS Agreement of MBW outcomes between setups is poor and explained by nitrogen measurement techniques and breathing pattern.
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Affiliation(s)
- William Poncin
- Cystic Fibrosis Unit, Cliniques Universitaires St Luc, Université de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Florian Singer
- Division of Pediatric Pulmonology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Anne-Sophie Aubriot
- Cystic Fibrosis Unit, Cliniques Universitaires St Luc, Université de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Patrick Lebecque
- Cystic Fibrosis Unit, Cliniques Universitaires St Luc, Université de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
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Bentsen MHL, Eriksen M, Olsen MS, Markestad T, Halvorsen T. Electromagnetic inductance plethysmography is well suited to measure tidal breathing in infants. ERJ Open Res 2016; 2:00062-2016. [PMID: 28053968 PMCID: PMC5152798 DOI: 10.1183/23120541.00062-2016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/31/2016] [Indexed: 11/10/2022] Open
Abstract
Reliable, accurate and noninvasive methods for measuring lung function in infants are desirable. Electromagnetic inductance plethysmography has been used to perform infant spirometry and VoluSense Pediatrics (VSP) (VoluSense, Bergen, Norway) represents an updated version of this technique. We aimed to examine its accuracy compared to a validated system measuring airflow via a facemask using an ultrasonic flowmeter. We tested 30 infants with postmenstrual ages between 36 to 43 weeks and weights from 2.3 to 4.8 kg, applying both methods simultaneously and applying VSP alone. Agreement between the methods was calculated using Bland–Altman analyses and we also estimated the effect of applying the mask. Mean differences for all breathing parameters were within ±5.5% and limits of agreement between the two methods were acceptable, except perhaps for peak tidal expiratory flow (PTEF). Application of the facemask significantly increased tidal volume, minute ventilation, PTEF, the ratio of inspiratory to expiratory time and the ratio of expiratory flow at 50% of expired volume to PTEF. VSP accurately measured tidal breathing parameters and seems well suited for tidal breathing measurements in infants under treatment with equipment that precludes the use of a facemask. Accuracy of VoluSense Pediatricshttp://ow.ly/BIFS304sheG
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Affiliation(s)
- Mariann H L Bentsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway; Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| | | | - Merete S Olsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Trond Markestad
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway; Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Dept of Pediatrics, Haukeland University Hospital, Bergen, Norway; Dept of Clinical Science, Faculty of Medicine and Odontology, University of Bergen, Bergen, Norway
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An Official American Thoracic Society/European Respiratory Society Workshop Report: Evaluation of Respiratory Mechanics and Function in the Pediatric and Neonatal Intensive Care Units. Ann Am Thorac Soc 2016; 13:S1-11. [PMID: 26848609 DOI: 10.1513/annalsats.201511-730st] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU. It outlines for each test how readily it is performed at the bedside and how it may impact patient management as well as indicating future areas of potential research collaboration. From expert panel discussions and literature reviews, we conclude that many of the techniques can aid in optimizing respiratory support in the PICU and NICU, quantifying the effect of therapeutic interventions, and guiding ventilator weaning and extubation. Most techniques now have commercially available equipment for the PICU and NICU, and many can generate continuous data points to help with ventilator weaning and other interventions. Technical and validation studies in the PICU and NICU are published for the majority of techniques; some have been used as outcome measures in clinical trials, but few have been assessed specifically for their ability to improve clinical outcomes. Although they show considerable promise, these techniques still require further study in the PICU and NICU together with increased availability of commercial equipment before wider incorporation into daily clinical practice.
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Usemann J, Fuchs O, Anagnostopoulou P, Korten I, Gorlanova O, Röösli M, Latzin P, Frey U. Predictive value of exhaled nitric oxide in healthy infants for asthma at school age. Eur Respir J 2016; 48:925-8. [PMID: 27390276 DOI: 10.1183/13993003.00439-2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/12/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Jakob Usemann
- University Children's Hospital Basel (UKBB), Basel, Switzerland Division of Respiratory Medicine, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oliver Fuchs
- University Children's Hospital Basel (UKBB), Basel, Switzerland Division of Respiratory Medicine, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Pinelopi Anagnostopoulou
- Division of Respiratory Medicine, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Insa Korten
- University Children's Hospital Basel (UKBB), Basel, Switzerland Division of Respiratory Medicine, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute Basel, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Philipp Latzin
- University Children's Hospital Basel (UKBB), Basel, Switzerland Division of Respiratory Medicine, Dept of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Frey
- University Children's Hospital Basel (UKBB), Basel, Switzerland
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Usemann J, Frey U, Mack I, Schmidt A, Gorlanova O, Röösli M, Hartl D, Latzin P. CHI3L1 polymorphisms, cord blood YKL-40 levels and later asthma development. BMC Pulm Med 2016; 16:81. [PMID: 27193312 PMCID: PMC4870763 DOI: 10.1186/s12890-016-0239-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single nucleotide polymorphisms (SNPs) in chitinase 3-like 1 (CHI3L1), the gene encoding YKL-40, and increased serum YKL-40 levels are associated with severe forms of asthma. It has never been addressed whether SNPs in CHI3L1 and cord blood YKL-40 levels could already serve as potential biomarkers for milder forms of asthma. We assessed in an unselected population whether SNPs in CHI3L1 and cord blood YKL-40 levels at birth are associated with respiratory symptoms, lung function changes, asthma, and atopy. METHODS In a prospective birth cohort of healthy term-born neonates (n = 260), we studied CHI3L1 polymorphisms, and measured cord blood YKL-40 levels by ELISA in (n = 170) infants. Lung function was performed at 5 weeks and 6 years. Respiratory health during the first year of life was assessed weekly by telephone interviews. Diagnosis of asthma and allergic sensitisation was assessed at 6 years (n = 142). RESULTS The SNP rs10399805 was significantly associated with asthma at 6 years. The odds ratio for asthma was 4.5 (95 % CI 1.59-12.94) per T-allele. This finding was unchanged when adjusting for cord blood YKL-40 levels. There was no significant association for cord blood YKL-40 levels and asthma. SNPs in CHI3L1 and cord blood YKL-40 were not associated with lung function measurements at 5 weeks and 6 years, respiratory symptoms in the first year, and allergic sensitisation at 6 years. CONCLUSION Genetic variation in CHI3L1 might be related to the development of milder forms of asthma. Larger studies are warranted to establish the role of YKL-40 in that pathway.
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Affiliation(s)
- Jakob Usemann
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Urs Frey
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.
| | - Ines Mack
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland
| | - Anne Schmidt
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
| | - Olga Gorlanova
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute Basel, Basel, 4051, Switzerland.,University of Basel, Basel, 4003, Switzerland
| | - Dominik Hartl
- Children's Hospital, University of Tuebingen, Tuebingen, 72076, Germany
| | - Philipp Latzin
- University of Basel Children's Hospital, University of Basel, Basel, 4056, Switzerland.,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland
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