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Collaco JM, McGrath-Morrow SA. Long-term outcomes of infants with severe BPD. Semin Perinatol 2024; 48:151891. [PMID: 38556385 DOI: 10.1016/j.semperi.2024.151891] [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] [Indexed: 04/02/2024]
Abstract
Preterm birth disrupts the normal sequence of lung development. Additionally, interventions that support gas exchange, including positive pressure ventilation and supplemental oxygen can further exacerbate lung injury, increasing the risk of developing bronchopulmonary dysplasia (BPD) in infants born preterm. Approximately 50,000 preterm infants each year in the United States develop BPD. Heterogeneous lung pathology involving the upper and lower respiratory tract can contribute to the BPD phenotype and can be age-dependent. These phenotypes include alveolar, upper airway, large airways, small airways, and vascular. Each of these phenotypes may improve, resolve, or persist at different ages, throughout childhood. The development of BPD endotypes can be influenced by gestational age and length and type of respiratory support. Although, long-term pulmonary outcomes of infants with severe BPD are variable, the presence of small airway disease is a common phenotype in school age and adolescent children. In this review we examine the more common respiratory endotypes found in infants and children with severe BPD and discuss the long-term prognosis for cardiovascular, neurological, and gastrointestinal morbidities in this patient population.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Sharon A McGrath-Morrow
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States.
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Singla R, Sankar J, Tayal A, Bhadani H, Bagri NK, Kabra S, Lodha R. Long-Term Outcomes of Survivors of COVID-19 with Moderate to Severe Infection and Children with Multisystem Inflammatory Syndrome or MIS-C. Indian J Pediatr 2024:10.1007/s12098-024-05033-0. [PMID: 38244185 DOI: 10.1007/s12098-024-05033-0] [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: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
The study aims to evaluate the long-term outcomes - functional, pulmonary and non-pulmonary (other organs) - in children hospitalized with COVID-19 infection or with Multisystem inflammatory syndrome (MIS-C) after 1-2 y of discharge. All children with moderate or severe COVID-19 or MIS-C were enrolled. Out of 45 enrolled subjects, 19.8% had COVID-19 infection and 82% had MIS-C. Four children (8.9%) had abnormal baseline echocardiography; two each with cardiac dysfunction and coronary dilatation. At baseline, 44% had moderate disability and 24% had mild disability as per Pediatric Cerebral Performance Category (PCPC). On follow-up, only 8.9% (n = 4) had mild and 2.2% (n = 1) had moderate disability as per the PCPC score. One child developed new onset tuberculosis of the bone. None had any pulmonary morbidities. Follow-up echocardiogram was also within normal limits for children with abnormal findings. Further studies in different populations (settings) are required to draw meaningful conclusions about long-term effects of COVID-19 on children.
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Affiliation(s)
- Raman Singla
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Jhuma Sankar
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India.
| | - Anshula Tayal
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Himanshu Bhadani
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Narendra K Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Sushil Kabra
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
| | - Rakesh Lodha
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029, India
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Graf A, Wendler D, Court T, Talhelm J, Carver T, Beck C, Schmeling G. Acute clavicle fixation after blunt chest trauma: effect on pulmonary outcomes and patient disposition. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03368-y. [PMID: 36036820 DOI: 10.1007/s00590-022-03368-y] [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] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Clavicle fractures are common in patients who sustain blunt chest trauma (BCT). Recently, surgical fixation of rib fractures in patients with BCT has been shown to improve pulmonary and clinical outcomes. Therefore, the purpose of this study is to assess the role of early clavicle fixation (ECF) versus non-operative (NO) treatment for midshaft clavicle fractures in this same population. METHODS A retrospective chart review was performed in patients with midshaft clavicle fractures and BCT at a Level I Trauma Center between 2007 and 2017. Patients with pre-existing pulmonary conditions and head injuries necessitating mechanical ventilation were excluded. Demographic data, injury mechanisms, and Thoracic Trauma Severity Scores (TTS) were analyzed. Inpatient pulmonary outcomes were assessed with serial vital capacity (VC) measurements, intubation, mechanical ventilation, and pulmonary complications data. In addition, intensive care unit (ICU) and hospital length of stay (LOS), mortality, discharge location, and incidence of postoperative complications in the ECF group were also measured. RESULTS Thirty-six patients underwent ECF, and 24 underwent NO treatment. The ECF cohort was statistically younger and had a greater incidence of clavicle fracture shortening than the NO group. There was no difference in pulmonary outcomes, ICU or hospital LOS, or mortality between groups. There were no complications associated with ECF. Patients who underwent ECF were more likely to discharge to home. There were no postoperative complications associated with ECF. CONCLUSION ECF of midshaft clavicle fractures does not improve pulmonary outcomes in patients with BCT. However, despite the lack of pulmonary benefit, there appears to be no added risk of harm. Therefore, ECF is a reasonable consideration in this patient population who otherwise meet clavicle fracture operative indications.
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Affiliation(s)
- Alexander Graf
- Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave, P.O. Box 26099, Milwaukee, WI, 53226-0099, USA.
| | | | - Tannor Court
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Jacob Talhelm
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas Carver
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Gregory Schmeling
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Redding GJ. 55th Harrington Lecture: The respiratory impact of EOS and its therapies: where are we and where do we go from here? Spine Deform 2021; 9:629-633. [PMID: 33822321 DOI: 10.1007/s43390-021-00344-0] [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: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
The following lecture was delivered at the Scoliosis Research Society annual meeting in 2020. It addresses our current knowledge about the respiratory impact of Early Onset Scoliosis, the limitations in the data that have been published, and the opportunity for further clinical research in the field.
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Affiliation(s)
- Gregory J Redding
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
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Sheehan S, Baer G, Romine M, Hudson L, Lim R, Papadopoulos E, Campbell M, Daniel G, McCune S. Advancing Therapeutic Development for Pulmonary Morbidities Associated with Preterm Birth. Ther Innov Regul Sci 2020; 54:1312-1318. [PMID: 33258093 DOI: 10.1007/s43441-020-00153-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 02/13/2020] [Accepted: 04/10/2020] [Indexed: 01/25/2023]
Abstract
Chronic pulmonary and respiratory conditions associated with preterm birth are incompletely characterized, complicating long-term treatment and development of more effective therapies. Stakeholders face challenges in the development of validated, clinically meaningful endpoints that adequately measure morbidities and predict or represent health outcomes for preterm neonates. We propose in this paper a research agenda, informed by the input of experts from a 2018 workshop we convened on this topic, to advance endpoint and treatment development. We discuss the necessity of further evaluation of existing endpoints and the improved characterization of disease endotypes. We also discuss key steps to the development of optimized short- and long-term endpoints that can be linked to meaningful health outcomes. Finally, we discuss the importance of limiting variability in data collection and the application of new clinical trial endpoints as well as the critical nature of multi-stakeholder collaboration to advancing therapeutic development for this vulnerable patient population.
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Affiliation(s)
- Sarah Sheehan
- Duke-Margolis Center for Health Policy, Washington, DC, USA.
- Duke-Margolis Center for Health Policy, 1201 Pennsylvania Ave. NW Suite 500, Washington, DC, 20004, USA.
| | - Gerri Baer
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Morgan Romine
- Duke-Margolis Center for Health Policy, Washington, DC, USA
| | | | - Robert Lim
- U.S. Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Gregory Daniel
- Duke-Margolis Center for Health Policy, Washington, DC, USA
| | - Susan McCune
- U.S. Food and Drug Administration, Silver Spring, MD, USA
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Soto M, Bang SI, McCombs J, Rodgers KE. Renin Angiotensin system-modifying therapies are associated with improved pulmonary health. Clin Diabetes Endocrinol 2017; 3:6. [PMID: 28702260 PMCID: PMC5488416 DOI: 10.1186/s40842-017-0044-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023] Open
Abstract
Background Pulmonary diseases are often complicated and have diverse etiologies. One common factor is the lack of therapeutics available for these diseases. The goal of this study was to investigate the impact of Renin-Angiotensin System (RAS)-modifying medications on incidence and time to pulmonary complications. Methods A retrospective analysis was conducted using claims data from a US commercial insurance company (2007–2013). The study consisted of patients with an emerging hypertension (HTN) diagnosis. Cox analysis was used to look at the effect of angiotensin converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in this population. The events included pneumonia and influenza (infectious), Chronic obstructive pulmonary disease (COPD) and allied conditions (inflammatory), and other diseases (structural). Results A total of 215,225 patients were followed in the study. These fell into three groups depending on the first prescribed anti-hypertension medication; ACE-Is (47.21%), ARBs (11.40%) and calcium channel blockers (CCBs)/Diuretics-Control (41.39%). The use of ACE-I as first treatment significantly reduced the incidence of infectious (Hazard Ratio (HR) 0.886, 95% Confidence Interval (95% CI) 0.859–0.886), inflammatory (HR 0.924, 95% CI 0.906–0.942) and structural outcomes (HR 0.865, 95% CI 0.847–0.885); it also increased the time (delayed) to diagnosis with prolonged treatment. Primary ARB use only significantly lowered the incidence of structural outcomes (HR 0.900, 95% CI 0.868–0.933); prolonged treatment did reduce incidence of all three diagnosis groups and significantly delayed disease onset. Conclusions There is an association between the use of ACE-Is and ARBs and a delay in the progression of pulmonary complications in vulnerable populations. Research into the RAS may identify future therapies for patients with potential chronic pulmonary conditions.
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Affiliation(s)
- Maira Soto
- Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, 1985 Zonal Ave.,PSC 530, Los Angeles, CA 90033 USA
| | - Soo I Bang
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD 212B, Los Angeles, CA 90089 USA
| | - Jeff McCombs
- Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, VPD 212B, Los Angeles, CA 90089 USA
| | - Kathleen E Rodgers
- Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, 1985 Zonal Ave.,PSC 530, Los Angeles, CA 90033 USA
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Glotzbecker MP, Gold M, Miller P, Akbarnia BA, Johnston C, Sanchez Perez Grueso F, Shah SA, Emans J. Distraction-Based Treatment Maintains Predicted Thoracic Dimensions in Early-Onset Scoliosis. Spine Deform 2014; 2:203-207. [PMID: 27927419 DOI: 10.1016/j.jspd.2014.03.001] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/07/2014] [Indexed: 11/15/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. SUMMARY OF BACKGROUND DATA Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. METHODS Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (pelvic inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on pelvic inlet width, and expressed as a percentile of predicted measure. RESULTS Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of .78 to a postoperative percentile of .88 (p < .001); at long-term follow-up, it was .85. Absolute thoracic height increased at all 3 time points: 141.6, 159.79, and 203.45 mm, respectively Mean chest width was similar preoperatively (170 mm) and immediately postoperatively (166.5 mm) but increased at latest follow-up (206.9 mm). Chest width percentile was similar at all 3 times (.93, .90, and .91). CONCLUSIONS Distraction-based treatment increases absolute thoracic height over time. There is significant improvement in the thoracic height percentile normalized after initial surgery, which was maintained over time. Measuring expected gains as a percentile normalized for pelvic width may be a more relevant outcome measure compared with measuring only absolute values.
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Affiliation(s)
- Michael P Glotzbecker
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
| | - Meryl Gold
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Patrica Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
| | - Behrooz A Akbarnia
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr #300, La Jolla, San Diego, CA 92037, USA
| | - Charles Johnston
- Orthopedics, Texas Scottish Rite Hospital for Children, 2222 Welborn St. Dallas, TX 75219, USA
| | | | - Suken A Shah
- Department of Orthopaedics, Nemours/Alfred I DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899, USA
| | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
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