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Barber AT, Liptzin DR, Gower WA, Hinds DM. Pediatric Pulmonology 2022 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:2719-2724. [PMID: 37493100 DOI: 10.1002/ppul.26603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
The field of rare and diffuse pediatric lung disease continues to evolve and expand rapidly as clinicians and researchers make advancements in the diagnosis and treatment of children's interstitial and diffuse lung disease, non-cystic fibrosis bronchiectasis, and primary ciliary dyskinesia. Papers published on these topics in Pediatric Pulmonology and other journals in 2022 describe newly recognized disorders, elucidate disease mechanisms and courses, explore potential biomarkers, and assess novel treatments. In this review, we will discuss these important advancements and place them in the context of existing literature.
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Affiliation(s)
- Andrew T Barber
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Deborah R Liptzin
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Daniel M Hinds
- Department of Pediatrics, University of Iowa School of Medicine, Iowa City, Iowa, USA
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Nevel RJ, Deutsch GH, Craven D, Deterding R, Fishman MP, Wambach JA, Casey A, Krone K, Liptzin DR, O’Connor MG, Kurland G, Taylor JB, Gower WA, Hagood JS, Conrad C, Tam‐Williams JB, Fiorino EK, Goldfarb S, Sadreameli SC, Nogee LM, Montgomery G, Hamvas A, Laguna TA, Bansal M, Lew C, Santiago M, Popova A, De A, Chan M, Powers MR, Josephson MB, Camburn D, Voss L, Li YLR, Young LR. The US national registry for childhood interstitial and diffuse lung disease: Report of study design and initial enrollment cohort. Pediatr Pulmonol 2023:10.1002/ppul.26568. [PMID: 37401889 PMCID: PMC10764638 DOI: 10.1002/ppul.26568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/27/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Childhood interstitial and diffuse lung disease (chILD) encompasses a broad spectrum of rare disorders. The Children's Interstitial and Diffuse Lung Disease Research Network (chILDRN) established a prospective registry to advance knowledge regarding etiology, phenotype, natural history, and management of these disorders. METHODS This longitudinal, observational, multicenter registry utilizes single-IRB reliance agreements, with participation from 25 chILDRN centers across the U.S. Clinical data are collected and managed using the Research Electronic Data Capture (REDCap) electronic data platform. RESULTS We report the study design and selected elements of the initial Registry enrollment cohort, which includes 683 subjects with a broad range of chILD diagnoses. The most common diagnosis reported was neuroendocrine cell hyperplasia of infancy, with 155 (23%) subjects. Components of underlying disease biology were identified by enrolling sites, with cohorts of interstitial fibrosis, immune dysregulation, and airway disease being most commonly reported. Prominent morbidities affecting enrolled children included home supplemental oxygen use (63%) and failure to thrive (46%). CONCLUSION This Registry is the largest longitudinal chILD cohort in the United States to date, providing a powerful framework for collaborating centers committed to improving the understanding and treatment of these rare disorders.
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Affiliation(s)
- Rebekah J. Nevel
- Department of Child Health, Pediatric Pulmonary Medicine, University of Missouri Children’s Hospital, Columbia, Missouri, USA
| | - Gail H. Deutsch
- Department of Laboratory Medicine and Pathology, Seattle Children’s Hospital, University of Washington Medical Center, Seattle, Washington, USA
| | - Daniel Craven
- Pediatric Pulmonology, Rainbow Babies & Children’s Hospital, Case School of Medicine, Cleveland, Ohio, USA
| | - Robin Deterding
- Section of Pediatric Pulmonology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Martha P. Fishman
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer A. Wambach
- Edward Mallinckrodt Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, Missouri, USA
| | - Alicia Casey
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katie Krone
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah R. Liptzin
- Section of Pediatric Pulmonology, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital of Colorado, Aurora, Colorado, USA
| | - Michael G. O’Connor
- Department of Pediatrics, Division of Pediatric Pulmonology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Geoffrey Kurland
- Department of Pediatrics, Division of Pulmonology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jane B. Taylor
- Department of Pediatrics, Division of Pulmonology, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William A. Gower
- Department of Pediatrics, Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - James S. Hagood
- Department of Pediatrics, Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Carol Conrad
- Pulmonary Medicine, Pediatrics Stanford University School of Medicine, Palo Alto, California, USA
| | - Jade B. Tam‐Williams
- Pulmonary and Sleep Medicine, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Elizabeth K. Fiorino
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Children’s Medical Center, New York, New York, USA
| | - Samuel Goldfarb
- Department of Pediatrics, School of Medicine, Division of Pulmonary and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara C. Sadreameli
- Division of Pediatric Respiratory Sciences, Johns Hopkins University, Bethesda, Maryland, USA
| | - Lawrence M. Nogee
- Division of Pediatric Respiratory Sciences, Johns Hopkins University, Bethesda, Maryland, USA
| | - Gregory Montgomery
- Pediatric Pulmonology, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, USA
| | - Aaron Hamvas
- Pediatrics, Ann and Robert H Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Theresa A. Laguna
- Pediatrics, Ann and Robert H Lurie Children’s Hospital of Chicago Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Manvi Bansal
- Division of Pediatric Pulmonology/Sleep Medicine, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Cheryl Lew
- Division of Pediatric Pulmonology/Sleep Medicine, Keck School of Medicine, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, California, USA
| | - Maria Santiago
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Steven and Alexandra Cohen Children’s Medical Center, New York, New York, USA
| | - Antonia Popova
- Pediatrics, University of Michigan C. S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Marilynn Chan
- Pediatric Pulmonology, University of California San Francisco Benioff Children’s Hospital, San Francisco, California, USA
| | - Michael R. Powers
- Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - Maureen B. Josephson
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Devaney Camburn
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura Voss
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yun Lisa R. Li
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa R. Young
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Eaves LA, Enggasser AE, Camerota M, Gogcu S, Gower WA, Hartwell H, Jackson WM, Jensen E, Joseph RM, Marsit CJ, Roell K, Santos HP, Shenberger JS, Smeester L, Yanni D, Kuban KCK, O'Shea TM, Fry RC. CpG methylation patterns in placenta and neonatal blood are differentially associated with neonatal inflammation. Pediatr Res 2023; 93:1072-1084. [PMID: 35764815 PMCID: PMC10289042 DOI: 10.1038/s41390-022-02150-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Infants born extremely premature are at increased risk for health complications later in life for which neonatal inflammation may be a contributing biological driver. Placental CpG methylation provides mechanistic information regarding the relationship between prenatal epigenetic programming, prematurity, neonatal inflammation, and later-in-life health. METHODS We contrasted CpG methylation in the placenta and neonatal blood spots in relation to neonatal inflammation in the Extremely Low Gestational Age Newborn (ELGAN) cohort. Neonatal inflammation status was based on the expression of six inflammation-related proteins, assessed as (1) day-one inflammation (DOI) or (2) intermittent or sustained systemic inflammation (ISSI, inflammation on ≥2 days in the first 2 postnatal weeks). Epigenome-wide CpG methylation was assessed in 354 placental samples and 318 neonatal blood samples. RESULTS Placental CpG methylation displayed the strongest association with ISSI (48 CpG sites) but was not associated with DOI. This was in contrast to CpG methylation in blood spots, which was associated with DOI (111 CpG sites) and not with ISSI (one CpG site). CONCLUSIONS Placental CpG methylation was strongly associated with ISSI, a measure of inflammation previously linked to later-in-life cognitive impairment, while day-one neonatal blood methylation was associated with DOI. IMPACT Neonatal inflammation increases the risk of adverse later-life outcomes, especially in infants born extremely preterm. CpG methylation in the placenta and neonatal blood spots were evaluated in relation to neonatal inflammation assessed via circulating proteins as either (i) day-one inflammation (DOI) or (ii) intermittent or sustained systemic inflammation (ISSI, inflammation on ≥2 days in the first 2 weeks). Tissue specificity was observed in epigenetic-inflammatory relationships: placental CpG methylation was associated with ISSI, neonatal blood CpG methylation was associated with DOI. Supporting the placental origins of disease framework, placental epigenetic patterns are associated with a propensity for ISSI in neonates.
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Affiliation(s)
- Lauren A Eaves
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam E Enggasser
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marie Camerota
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - William A Gower
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Hadley Hartwell
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wesley M Jackson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Elizabeth Jensen
- Department of Epidemiology and Prevention, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert M Joseph
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Carmen J Marsit
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Kyle Roell
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hudson P Santos
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Nursing & Health Studies, University of Miami, Miami, FL, USA
| | - Jeffrey S Shenberger
- Division of Neonatology, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lisa Smeester
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana Yanni
- Department of Neonatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Karl C K Kuban
- Division of Pediatric Neurology, Department of Pediatrics, School of Medicine, Boston University Medical Center, Boston, MA, USA
| | - T Michael O'Shea
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Institute for Environmental Health Solutions, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Popler J, Vece TJ, Liptzin DR, Gower WA. Pediatric pulmonology 2021 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:374-381. [PMID: 36426677 DOI: 10.1002/ppul.26227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022]
Abstract
The field of rare and diffuse pediatric lung disease is experiencing rapid progress as diagnostic and therapeutic options continue to expand. In this annual review, we discuss manuscripts published in Pediatric Pulmonology in 2021 in (1) children's interstitial and diffuse lung disease, (2) congenital airway and lung malformations, and (3) noncystic fibrosis bronchiectasis including primary ciliary dyskinesia. These include case reports, descriptive cohorts, trials of therapies, animal model studies, and review articles. The results are put into the context of other literature in the field. Each furthers the field in important ways, while also highlighting the continued need for further studies.
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Affiliation(s)
- Jonathan Popler
- Children's Physician Group-Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Deborah R Liptzin
- School of Public and Community Health, University of Montana, Missoula, Montana, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Nageswaran S, Gower WA, Golden SL, King NMP. Collaborative decision-making: A framework for decision-making about life-sustaining treatments in children with medical complexity. Pediatr Pulmonol 2022; 57:3094-3103. [PMID: 36098220 PMCID: PMC9825978 DOI: 10.1002/ppul.26140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/28/2022] [Accepted: 09/09/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Caregivers of children with medical complexity (CMC) face decisions about life-sustaining treatments (LST) like tracheostomy. We sought to develop a clinically relevant and realistic model for decision-making about tracheostomy placement that might apply to other LST in CMC. DESIGN This qualitative study, conducted between 2013 and 2015, consisted of 41 interviews with 56 caregivers of CMC who had received tracheostomies and 5 focus groups of 33 healthcare providers (HCPs) at a tertiary-care children's hospital in North Carolina. Participants were asked about their perspectives on the tracheostomy decision-making process. Data were transcribed, and coded. Using thematic content analysis, we inductively developed a tracheostomy decision-making framework and process. RESULTS Many factors influenced caregivers' decisions, including children's well-being and caregivers' values, faith, knowledge, experience, emotional state, and social factors; preserving the child's life was the most important. HCPs consider many clinical and nonclinical factors; recommending tracheostomy for children with limited survival, perceived poor functioning and quality of life, and progressive conditions is ethically difficult. The framework of tracheostomy decision-making has inter-related caregiver- and HCP-level factors that influence the process. The framework contains elements not captured in a shared decision-making model, but better fits a collaborative decision-making (CDM) model. The tracheostomy CDM process that emerged from the data has two nonsequential components that HCPs could use: (1) gaining understanding and (2) holding decision-making conversations. CONCLUSIONS CDM could be a useful model for clinicians guiding families about tracheostomy for CMC. The applicability of CDM for decision-making about other LSTs needs further exploration.
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Affiliation(s)
- Savithri Nageswaran
- Department of PediatricsWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - William A. Gower
- Department of PediatricsWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of PediatricsUniversity of North Carolina at Chapel Hill School of MedicineChapel HillNorth CarolinaUSA
| | - Shannon L. Golden
- Qualitative Research ConsultantGoldsmith Research GroupWinston‐SalemNorth CarolinaUSA
| | - Nancy M. P. King
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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Vece TJ, Gower WA, Davis SD, Austin A, McKinzie CJ, Hatch JE, Davis M, Hagood JS. Building a pediatric rare lung disease program: It takes a community of villages. Pediatr Pulmonol 2022; 57:2583-2588. [PMID: 35932221 DOI: 10.1002/ppul.26083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022]
Abstract
Pediatric rare lung disease programs are increasing in number due to an increase in recognition of the diseases, increased clinical and research interest in children's interstitial lung disease, and the expansion of the children's interstitial lung disease research network. Due to this increased interest newly graduated trainees in pediatric pulmonology and other physicians are often starting new programs, which can be daunting. We provide some guidance for new programs based on our experiences.
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Affiliation(s)
- Timothy J Vece
- Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - William A Gower
- Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ashley Austin
- Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cameron J McKinzie
- School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joseph E Hatch
- Children's Research Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Miriam Davis
- Children's Research Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - James S Hagood
- Pediatric Pulmonology, University of North Carolina, Chapel Hill, North Carolina, USA
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Nageswaran S, Gower WA, King NM, Golden SL. Tracheostomy decision-making for children with medical complexity: What supports and resources do caregivers need? Palliat Support Care 2022:1-7. [PMID: 36000170 PMCID: PMC9950280 DOI: 10.1017/s1478951522001122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Caregivers of children with medical complexity (CMC) face decisions about life-sustaining interventions, such as tracheostomy. Our objective is to describe the support needs of caregivers of CMC and the resources they use surrounding tracheostomy decision-making (TDM) for their children. METHODS This qualitative study, conducted between 2013 and 2015, consisted of semi-structured interviews with 56 caregivers of 41 CMC who had tracheostomies, and 5 focus groups of 33 clinicians at a tertiary care children's hospital. Participants were asked about their perspectives on the TDM process. Qualitative data were transcribed, coded, and organized into themes. RESULTS Caregivers used five domains of resources surrounding TDM: (1) social network including extended family members, friends, and clergy; (2) healthcare providers including physicians and nurses; (3) other parents of children with tracheostomy; (4) tangible materials such as print materials, videos, tracheostomy tubes, mannequins, and simulation labs; and (5) internet including websites, social media, and online health communities. Caregivers used these resources for (1) decision-making, (2) becoming knowledgeable and skillful about child's diagnosis, tracheostomy, and home care, and (3) emotional and spiritual well-being. Caregivers agreed that they received enough support, but there were gaps. Clinicians were knowledgeable about these resources, discussed social network and internet less often than the other domains, and identified gaps in supporting caregivers. SIGNIFICANCE OF RESULTS Caregivers' need for support and use of resources surrounding tracheostomy placement for CMC extended beyond decision-making, and included becoming knowledgeable and getting emotional/spiritual support. Healthcare providers exploring these resources with caregivers could improve the quality of TDM communication.
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Affiliation(s)
- Savithri Nageswaran
- Department of Pediatrics, Wake Forest School of Medicine
- Department of Social Science and Health Policy, Wake Forest University
| | - William A. Gower
- Department of Pediatrics, Wake Forest School of Medicine
- Department of Pediatrics, University of North Carolina School of Medicine (current affiliation)
| | - Nancy M.P. King
- Department of Social Science and Health Policy, Wake Forest University
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McKinzie CJ, Hagood JS, Fiorino EK, Fishman MP, Nevel RJ, Gower WA, Vece TJ. The role of pharmacy services beyond cystic fibrosis: A case for support in childhood interstitial lung disease. Pediatr Pulmonol 2022; 57:1535-1536. [PMID: 35246971 DOI: 10.1002/ppul.25883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Cameron J McKinzie
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - James S Hagood
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth K Fiorino
- Division of Pediatric Pulmonology, Weill Cornell Medicine, New York-Presbyterian Phyllis and David Komansky Children's Hospital, New York, New York, USA
| | - Martha P Fishman
- Division of Pulmonary Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rebekah J Nevel
- Division of Pulmonology, Women's and Children's Hospital, University of Missouri, Columbia, Missouri, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Vece TJ, Popler J, Gower WA. Pediatric pulmonology 2020 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2022; 57:807-813. [PMID: 34964566 DOI: 10.1002/ppul.25807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/08/2022]
Abstract
Pediatric Pulmonology publishes original research, review articles, and case reports on topics related to a wide range of children's respiratory disorders. Here we review some of the most notable manuscripts published in 2020 in this journal on (1) children's interstitial lung disease (chILD), (2) congenital airway and lung anomalies, and (3) primary ciliary dyskinesia and other non-cystic fibrosis bronchiectasis. The articles reviewed are discussed in context with published works from other journals.
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Affiliation(s)
- Timothy J Vece
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jonathan Popler
- Children's Physician Group - Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Bradford L, Ross MK, Minso J, Cernelc-Kohan M, Shayan K, Wong SS, Li X, Rivier L, Jegga AG, Deutsch GH, Vece TJ, Loughlin CE, Gower WA, Hurley C, Furman W, Stokes D, Hagood JS. Interstitial lung disease in children with Rubinstein-Taybi syndrome. Pediatr Pulmonol 2022; 57:264-272. [PMID: 34585851 DOI: 10.1002/ppul.25709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/30/2021] [Accepted: 09/21/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Rubinstein-Taybi syndrome (RSTS) is a rare genetic syndrome caused primarily by a mutation in the CREBBP gene found on chromosome 16. Patients with RSTS are at greater risk for a variety of medical problems, including upper airway obstruction and aspiration. Childhood interstitial lung disease (ILD) thus far has not been definitively linked to RSTS. Here we present three patients with RSTS who developed ILD and discuss possible mechanisms by which a mutation in CREBBP may be involved in the development of ILD. METHODS Routine hematoxylin and eosin staining was performed on lung biopsy tissue for histological analysis. Immunofluorescent staining was performed on lung biopsy tissue for markers of fibrosis, surfactant deficiency and histone acetylation. Cases 1 and 2 had standard clinical microarray analysis. Case 3 had whole exome sequencing. Bioinformatics analyses were performed to identify possible causative genes using ToppGene. RESULTS Computed tomography images in all cases showed consolidated densities overlying ground glass opacities. Lung histopathology revealed accumulation of proteinaceous material within alveolar spaces, evidence of fibrosis, and increased alveolar macrophages. Immunofluorescent staining showed increase in surfactant protein C staining, patchy areas of increased anti-smooth muscle antibody staining, and increased staining for acetylated histone 2 and histone 3 lysine 9. DISCUSSION Clinical characteristics, radiographic imaging, lung histopathology, and immunofluorescent staining results shared by all cases demonstrated findings consistent with ILD. Immunofluorescent staining suggests two possible mechanisms for the development of ILD: abnormal surfactant metabolism and/or persistent activation of myofibroblasts. These two pathways could be related to dysfunctional CREBBP protein.
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Affiliation(s)
- Lauren Bradford
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mindy K Ross
- Division of Pediatric Pulmonology, University of California-Los Angeles, Los Angeles, California, USA
| | - Jagila Minso
- Division of Pediatric Critical Care, Sanford Health, Fargo, North Dakota, USA
| | - Mateja Cernelc-Kohan
- Department of Pediatrics, UC-San Diego Pediatric Respiratory Medicine, La Jolla, California, USA.,Division of Pediatric Respiratory Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Katayoon Shayan
- Division of Pediatric Respiratory Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Simon S Wong
- Department of Pediatrics, UC-San Diego Pediatric Respiratory Medicine, La Jolla, California, USA
| | - Xiaoping Li
- Department of Pediatrics, UC-San Diego Pediatric Respiratory Medicine, La Jolla, California, USA
| | - Lauraine Rivier
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anil G Jegga
- Department of Pediatrics, Division of Biomedical Informatics, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, Division of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gail H Deutsch
- Department of Pathology and Laboratory Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Gower
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Caitlin Hurley
- Critical Care Medicine Division, Departments of Pediatric Medicine and Bone Marrow Transplant, St. Jude Children's Hospital, Memphis, Tennessee, USA.,Department of Oncology, Division of Solid Tumor, St. Jude Children's Hospital, Memphis, Tennessee, USA
| | - Wayne Furman
- Critical Care Medicine Division, Departments of Pediatric Medicine and Bone Marrow Transplant, St. Jude Children's Hospital, Memphis, Tennessee, USA.,Department of Oncology, Division of Solid Tumor, St. Jude Children's Hospital, Memphis, Tennessee, USA
| | - Dennis Stokes
- Department of Pediatrics, Division of Pediatric Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Hagood
- Division of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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11
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Stratakis N, Garcia E, Chandran A, Hsu T, Alshawabkeh A, Aris IM, Aschner JL, Breton C, Burbank A, Camargo CA, Carroll KN, Chen Z, Claud EC, Dabelea D, Dunlop AL, Elliott AJ, Ferrara A, Ganiban JM, Gern JE, Gold DR, Gower WA, Hertz-Picciotto I, Karagas MR, Karr CJ, Lester B, Leve LD, Litonjua AA, Ludena Y, McEvoy CT, Miller RL, Mueller NT, O’Connor TG, Oken E, O’Shea TM, Perera F, Stanford JB, Rivera-Spoljaric K, Rundle A, Trasande L, Wright RJ, Zhang Y, Zhu Y, Berhane K, Gilliland F, Chatzi L. The Role of Childhood Asthma in Obesity Development: A Nationwide US Multicohort Study. Epidemiology 2022; 33:131-140. [PMID: 34561347 PMCID: PMC8633057 DOI: 10.1097/ede.0000000000001421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
RATIONALE Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. OBJECTIVES To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. METHODS We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). MEASUREMENTS AND MAIN RESULTS We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). CONCLUSIONS This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.
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Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tingju Hsu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
| | - Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley NJ and the Albert Einstein College of Medicine, Bronx, NY
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Allison Burbank
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kecia N. Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Zhanghua Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika C. Claud
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, IL
| | - Dana Dabelea
- University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing and Department of Family & Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Jody M. Ganiban
- Department of Psychology The George Washington University, Washington, DC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Diane R Gold
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William A. Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Catherine J. Karr
- Department of Pediatrics & Environmental and Occupational Health Sciences, University of Washington, WA
| | - Barry Lester
- Department of Psychiatry and Human Behavior and Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI
| | - Leslie D. Leve
- Department of Education, University of Oregon, Eugene, OR
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Yunin Ludena
- University of California, Davis, School of Medicine, CA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience and Obstetrics and Gynecology, University of Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Katherine Rivera-Spoljaric
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of PediatricsSt. Louis Children’s Hospital, Washington University School of Medicine St. Louis, MO
| | - Andrew Rundle
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine and Population Health, New York University School of Medicine, NY
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Lida Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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12
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Shanthikumar S, Gower WA, Abts M, Liptzin DR, Fiorino EK, Stone A, Srinivasan S, Vece TJ, Akil N, Cole T, Cooke KR, Goldfarb SB. Pulmonary surveillance in pediatric hematopoietic stem cell transplant: A multinational multidisciplinary survey. Cancer Rep (Hoboken) 2021; 5:e1501. [PMID: 34319008 PMCID: PMC9124519 DOI: 10.1002/cnr2.1501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/16/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
Background Hematopoietic Stem Cell Transplant (HSCT) is an established treatment for malignant and non‐malignant conditions and pulmonary disease is a leading cause of late term morbidity and mortality. Accurate and early detection of pulmonary complications is a critical step in improving long term outcomes. Existing guidelines for surveillance of pulmonary complications post‐HSCT contain conflicting recommendations. Aim To determine the breadth of current practice in monitoring for pulmonary complications of pediatric HSCT. Methods An institutional review board approved, online, anonymous multiple‐choice survey was distributed to HSCT and pulmonary physicians from the United States of America and Australasia using the REDcap platform. The survey was developed by members of the American Thoracic Society Working Group on Complications of Childhood Cancer, and was designed to assess patient management and service design. Results A total of 40 (34.8%) responses were received. The majority (62.5%) were pulmonologists, and 82.5% were from the United States of America. In all, 67.5% reported having a protocol for monitoring pulmonary complications and 50.0% reported adhering “well” or “very well” to protocols. Pulmonary function tests (PFTs) most commonly involved spirometry and diffusion capacity for carbon monoxide. The frequency of PFTs varied depending on time post‐HSCT and presence of complications. In all, 55.0% reported a set threshold for a clinically significant change in PFT. Conclusions These results illustrate current variation in surveillance for pulmonary complications of pediatric HSCT. The results of this survey will inform development of future guidelines for monitoring of pulmonary complications after pediatric HSCT.
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Affiliation(s)
- Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - William A Gower
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Matthew Abts
- Seattle Children's Hospital, Seattle, Washington, USA.,Pediatric Pulmonary and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Deborah R Liptzin
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elizabeth K Fiorino
- Division of Pulmonology, Allergy, and Immunology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA
| | - Anne Stone
- Division of Pulmonology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Saumini Srinivasan
- Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nour Akil
- Division of Pulmonology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Theresa Cole
- Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kenneth R Cooke
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samuel B Goldfarb
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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13
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Gower WA, Vece TJ. Pediatric pulmonology 2019 year in review: rare and diffuse lung disease. Pediatr Pulmonol 2021; 56:1324-1331. [PMID: 33559960 DOI: 10.1002/ppul.25297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/31/2020] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
Pediatric Pulmonology publishes original research, review articles, and case reports on topics related to a wide range of children's respiratory disorders. Here we review manuscripts published in 2019 in this journal and others on (1) anatomic lung, airway, and vascular malformations, (2) children's interstitial lung disease, and (3) primary ciliary dyskinesia and non-cystic fibrosis bronchiectasis.
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Affiliation(s)
- William A Gower
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology, Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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14
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Gower WA, Golden SL, King NMP, Nageswaran S. Decision-Making About Tracheostomy for Children With Medical Complexity: Caregiver and Health Care Provider Perspectives. Acad Pediatr 2020; 20:1094-1100. [PMID: 32540425 DOI: 10.1016/j.acap.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Caregivers of children with medical complexity (CMC) face decisions about tracheostomy. The objectives of this paper are to identify facilitators and barriers to tracheostomy decision-making (TDM) process for CMC. METHODS Using phenomenology as its methodologic orientation, this qualitative study conducted in North Carolina between 2013 and 2015 consists of semistructured interviews with 56 caregivers of 41 CMC who received tracheostomies, and 5 focus groups of 33 health care providers (HCP) at a tertiary care children's hospital involved in TDM for CMC. Participants were asked to share their experiences and perspectives on the TDM process. Qualitative data were transcribed, coded, and organized into themes as is consistent with thematic content analysis. RESULTS Five themes were identified. 1) Caregivers perceived decision about tracheostomy for their children was theirs to make. 2) Strategies that increased caregivers' active participation in the TDM process facilitated the TDM process. 3) Caregiver emotional stress and lack of understanding about tracheostomy were barriers. 4) Good HCP communication during the TDM process was valued; poor communication was a barrier. 5) Collaboration among HCP-facilitated TDM, especially when nurses were involved, whereas fragmentation in care was a barrier. CONCLUSIONS Caregivers take a primary role in the TDM process. Many caregiver and HCP-level facilitators and barriers for TDM exist. Augmenting the facilitators and reducing the barriers identified in this study could improve the TDM process for CMC.
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Affiliation(s)
- William A Gower
- Department of Pediatrics, Wake Forest School of Medicine (WA Gower and S Nageswaran), Winston-Salem, NC; Department of Pediatrics, University of North Carolina School of Medicine (WA Gower), Chapel Hill, NC
| | - Shannon L Golden
- Department of Social Science and Health Policy, Wake Forest University (SL Golden, NMP King, and S Nageswaran), Winston-Salem, NC
| | - Nancy M P King
- Department of Social Science and Health Policy, Wake Forest University (SL Golden, NMP King, and S Nageswaran), Winston-Salem, NC
| | - Savithri Nageswaran
- Department of Pediatrics, Wake Forest School of Medicine (WA Gower and S Nageswaran), Winston-Salem, NC; Department of Social Science and Health Policy, Wake Forest University (SL Golden, NMP King, and S Nageswaran), Winston-Salem, NC.
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15
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Gower WA, Hagood JS. To Bx, or not to Bx, that is the question. Pediatr Pulmonol 2020; 55:1303-1304. [PMID: 32364314 DOI: 10.1002/ppul.24797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022]
Affiliation(s)
- William A Gower
- Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - James S Hagood
- Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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16
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Gower WA, Birnkrant DJ, Black JB, Noah TL. Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing. Pediatr Pulmonol 2019; 54:1655-1662. [PMID: 31402599 DOI: 10.1002/ppul.24461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 12/31/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports, and review articles on topics related to a wide range of children's respiratory disorders. In this article, we highlight the past year's publications in the topic areas of rare lung diseases, respiratory complications of neuromuscular disorders, and diagnostic testing, as well as selected literature in these areas from other journals.
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Affiliation(s)
- William A Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane B Black
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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17
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Gower WA, Birnkrant DJ, Black JB, Nicolai T, Noah TL. Pediatric pulmonology year in review 2017: Part 1. Pediatr Pulmonol 2018; 53:1582-1586. [PMID: 29790678 DOI: 10.1002/ppul.24036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/13/2018] [Indexed: 11/10/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports and review articles on topics related to a wide range of children's respiratory disorders. In this article (Part 1 of a series), we summarize the past year's publications in our major topic areas, as well as selected literature in these areas from other journals. In Part 1, we review selected articles on diagnostic testing/endoscopy, respiratory complications of neuromuscular disorders, and rare lung diseases.
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Affiliation(s)
- William A Gower
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - David J Birnkrant
- MetroHealth Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane B Black
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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18
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Perdue AD, Cottrell LA, Lilly CL, Gower WA, Ely BA, Foringer B, Wright ML, Neal WA. Pediatric metabolic outcome comparisons based on a spectrum of obesity and asthmatic symptoms. J Asthma 2018; 56:388-394. [PMID: 29676936 DOI: 10.1080/02770903.2018.1463377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
RATIONALE Asthma and obesity are 2 of the most prevalent public health issues for children in the U.S. Trajectories of both have roughly paralleled one another over the past several decades causing many to explore their connection to one another and to other associated health issues such as diabetes and dyslipidemia. Earlier models have commonly designated obesity as the central hub of these associations; however, more recent models have argued connections between pediatric asthma and other obesity-related metabolic conditions regardless of children's obesity risk. OBJECTIVES To examine the relationships between asthma, obesity, and abnormal metabolic indices. METHODS We conducted a cross-sectional study of 179 children ages 7 to 12 years recruited from a rural, Appalachian region. Our model controlled for children's smoke exposure, body mass index percentile, and gender to examine the association between children's asthma (based on pulmonary function tests, medical history, medications, and parent report of severity), lipids (fasting lipid profile), and measures of altered glucose metabolism (glycosylated hemoglobin and homeostatic model assessment 2-insulin resistance). RESULTS Our findings revealed a statistically significant model for low density lipids, high density lipids, log triglyceride, and homeostatic model assessment 2-insulin resistance; however, Asthma had a significant effect for the mean triglycerides. We also found an asthma-obesity interaction effect on children's glycosylated hemoglobin with asthmatic obese children revealing significantly higher glycosylated hemoglobin values than non-asthmatic obese children. CONCLUSIONS Our findings support a connection between asthma and children's glycosylated hemoglobin values; however, this association remains entwined with obesity factors.
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Affiliation(s)
- Ashley D Perdue
- a Institute for Community and Rural Health , Morgantown , WV , USA
| | - Lesley A Cottrell
- b Department of Pediatrics , West Virginia University School of Medicine , Morgantown , WV , USA
| | - Christa L Lilly
- c Department of Biostatistics , West Virginia University School of Public Health , Morgantown , WV , USA
| | - William A Gower
- d Department of Pediatrics , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Brian A Ely
- b Department of Pediatrics , West Virginia University School of Medicine , Morgantown , WV , USA
| | - Brad Foringer
- e Division of Respiratory Therapy , West Virginia Hospital Association , Morgantown , WV , USA
| | - Melvin L Wright
- b Department of Pediatrics , West Virginia University School of Medicine , Morgantown , WV , USA
| | - William A Neal
- b Department of Pediatrics , West Virginia University School of Medicine , Morgantown , WV , USA
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Birnkrant DJ, Black JB, Tapia IE, Nicolai T, Gower WA, Noah TL. Pediatric Pulmonology year in review 2016: Part 1. Pediatr Pulmonol 2017; 52:1226-1233. [PMID: 28440921 DOI: 10.1002/ppul.23720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 11/07/2022]
Abstract
Pediatric Pulmonology continues to publish research and clinical topics related to the entire range of children's respiratory disorders. As we have done annually in recent years, we here summarize the past year's publications in our major topic areas, as well as selected literature in these areas from other core journals relevant to our discipline. This review (Part 1) covers selected articles on sleep, diagnostic testing/endoscopy, respiratory complications of neuromuscular disorders, and rare lung diseases.
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Affiliation(s)
- David J Birnkrant
- Metro Health Medical Center, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane B Black
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ignacio E Tapia
- Sleep Center, Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - William A Gower
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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20
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Cristiano LM, Hiestand BC, Gower WA, Gilbert KC, Caldwell JW, Fernandez AR, Winslow JE. Prehospital Administration of Epinephrine in Pediatric Anaphylaxis – a Statewide Perspective. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Neuroendocrine cell hyperplasia of infancy (NEHI) is a recently described children's interstitial lung disease (chILD) disorder of unknown etiology. It manifests clinically with tachypnea, retractions, hypoxemia, and crackles. The characteristic radiographic appearance consists of pulmonary hyperexpansion and ground-glass densities on high-resolution computed tomography (HRCT). Lung histology shows hyperplasia of bombesin-immunopositive neuroendocrine cells within distal bronchioles and alveolar ducts without other identifiable lung pathology or developmental anomaly. METHODS We describe four families with multiple siblings diagnosed with NEHI. Cases were identified at three pediatric centers. Inclusion criteria included clinical findings consistent with NEHI, lung biopsy confirmation in the index case, and a diagnostic HRCT or biopsy in other siblings. RESULTS Each family had a proband diagnosed with NEHI based upon pathologic review, and at least one additional sibling diagnosed either by pathologic review or HRCT. All patients presented between 2 and 15 months of age. Both male and female children were affected. The majority of the patients underwent both HRCT and lung biopsy. There were no deaths among affected children. No environmental exposures or other potential etiologies were identified as a cause of presenting symptoms. CONCLUSIONS The familial occurrence of NEHI suggests the possibility of a genetic etiology for this disorder and highlights the importance of taking a complete family medical history for infants presenting with a suggestive clinical picture. Identification of familial NEHI patients allows for the opportunity to further our understanding of this disorder, its natural history, the phenotypic spectrum, and potential genetic causes.
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Affiliation(s)
- J Popler
- Department of Pediatrics, University of Colorado Denver, Aurora, CO 80045, USA
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22
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Gower WA, Collaco JM, Ellis CL, Halbower AC, Mogayzel PJ. A previously healthy adolescent with evolving infiltrates and progressive respiratory distress. Thorax 2009; 64:290, 364. [PMID: 19329730 DOI: 10.1136/thx.2008.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- W A Gower
- Eudowood Division of Pediatric Respiratory Sciences, The Johns Hopkins Medical Institutions, 200 North Wolfe Street, Rubenstein Building 3075, Baltimore, MD 21287-2533, USA.
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Gower WA, McGrath-Morrow SA, Macdonald KD, Fishman EK. Tracheal bronchus in a 6-month-old infant identified by CT with three-dimensional airway reconstruction. BMJ Case Rep 2009; 2009:bcr2006071100. [PMID: 21687095 DOI: 10.1136/bcr.2006.071100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- W A Gower
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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24
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Gower WA, McGrath-Morrow SA, MacDonald KD, Fishman EK. Tracheal bronchus in a 6-month-old infant identified by CT with three-dimensional airway reconstruction. Thorax 2008; 63:93-4. [DOI: 10.1136/thx.2006.071100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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