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van Beveren GJ, de Steenhuijsen Piters WAA, Boeschoten SA, Louman S, Chu ML, Arp K, Fraaij PL, de Hoog M, Buysse C, van Houten MA, Sanders EAM, Merkus PJFM, Boehmer AL, Bogaert D. Nasopharyngeal microbiota in children is associated with severe asthma exacerbations. J Allergy Clin Immunol 2024:S0091-6749(24)00239-2. [PMID: 38467291 DOI: 10.1016/j.jaci.2024.02.020] [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] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 02/08/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The respiratory microbiome has been associated with the etiology and disease course of asthma. OBJECTIVE We sought to assess the nasopharyngeal microbiota in children with a severe asthma exacerbation and their associations with medication, air quality, and viral infection. METHODS A cross-sectional study was performed among children aged 2 to 18 years admitted to the medium care unit (MCU; n = 84) or intensive care unit (ICU; n = 78) with an asthma exacerbation. For case-control analyses, we matched all cases aged 2 to 6 years (n = 87) to controls in a 1:2 ratio. Controls were participants of either a prospective case-control study or a longitudinal birth cohort (n = 182). The nasopharyngeal microbiota was characterized by 16S-rRNA-gene sequencing. RESULTS Cases showed higher Shannon diversity index (ICU and MCU combined; P = .002) and a distinct microbial community composition when compared with controls (permutational multivariate ANOVA R2 = 1.9%; P < .001). We observed significantly higher abundance of Staphylococcus and "oral" taxa, including Neisseria, Veillonella, and Streptococcus spp. and a lower abundance of Dolosigranulum pigrum, Corynebacterium, and Moraxella spp. (MaAsLin2; q < 0.25) in cases versus controls. Furthermore, Neisseria abundance was associated with more severe disease (ICU vs MCU MaAslin2, P = .03; q = 0.30). Neisseria spp. abundance was also related with fine particulate matter exposure, whereas Haemophilus and Streptococcus abundances were related with recent inhaled corticosteroid use. We observed no correlations with viral infection. CONCLUSIONS Our results demonstrate that children admitted with asthma exacerbations harbor a microbiome characterized by overgrowth of Staphylococcus and "oral" microbes and an underrepresentation of beneficial niche-appropriate commensals. Several of these associations may be explained by (environmental or medical) exposures, although cause-consequence relationships remain unclear and require further investigations.
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Affiliation(s)
- Gina J van Beveren
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Paediatrics, Spaarne Hospital, Haarlem, The Netherlands
| | - Wouter A A de Steenhuijsen Piters
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Shelley A Boeschoten
- Department of Neonatal and Paediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sam Louman
- Department of Paediatrics, Spaarne Hospital, Haarlem, The Netherlands
| | - Mei Ling Chu
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kayleigh Arp
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Pieter L Fraaij
- Pediatric Infectious Diseases & Immunology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Viroscience, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Neonatal and Paediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Corinne Buysse
- Department of Neonatal and Paediatric Intensive Care, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Elisabeth A M Sanders
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Peter J F M Merkus
- Division of Respiratory Medicine, Department of Paediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Annemie L Boehmer
- Department of Paediatrics, Spaarne Hospital, Haarlem, The Netherlands; Department of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Debby Bogaert
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands; Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, United Kingdom.
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Vet NJ, de Winter BCM, Koninckx M, Boeschoten SA, Boehmer ALM, Verhallen JT, Plötz FB, Vaessen-Verberne AA, van der Nagel BCH, Knibbe CAJ, Buysse CMP, de Wildt SN, Koch BCP, de Hoog M. Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus. Clin Pharmacokinet 2021; 59:257-264. [PMID: 31432470 PMCID: PMC7007440 DOI: 10.1007/s40262-019-00811-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Intravenous salbutamol is used to treat children with refractory status asthmaticus, however insufficient pharmacokinetic data are available to guide initial and subsequent dosing recommendations for its intravenous use. The pharmacologic activity of salbutamol resides predominantly in the (R)-enantiomer, with little or no activity and even concerns of adverse reactions attributed to the (S)-enantiomer. OBJECTIVE Our aim was to develop a population pharmacokinetic model to characterize the pharmacokinetic profile for intravenous salbutamol in children with status asthmaticus admitted to the pediatric intensive care unit (PICU), and to use this model to study the effect of different dosing schemes with and without a loading dose. METHODS From 19 children (median age 4.9 years [range 9 months-15.3 years], median weight 18 kg [range 7.8-70 kg]) treated with continuous intravenous salbutamol at the PICU, plasma samples for R- and S-salbutamol concentrations (111 samples), as well as asthma scores, were collected prospectively at the same time points. Possible adverse reactions and patients' clinical data (age, sex, weight, drug doses, liver and kidney function) were recorded. With these data, a population pharmacokinetic model was developed using NONMEM 7.2. After validation, the model was used for simulations to evaluate the effect of different dosing regimens with or without a loading dose. RESULTS A two-compartment model with separate clearance for R- and S-salbutamol (16.3 L/h and 8.8 L/h, respectively) best described the data. Weight was found to be a significant covariate for clearance and volume of distribution. No other covariates were identified. Simulations showed that a loading dose can result in higher R-salbutamol concentrations in the early phase after the start of infusion therapy, preventing accumulation of S-salbutamol. CONCLUSIONS The pharmacokinetic model of intravenous R- and S-salbutamol described the data well and showed that a loading dose should be considered in children. This model can be used to evaluate the pharmacokinetic-pharmacodynamic relationship of intravenous salbutamol in children, and, as a next step, the effectiveness and tolerability of intravenous salbutamol in children with severe asthma.
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Affiliation(s)
- Nienke J Vet
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | | | - Muriel Koninckx
- Pediatric Intensive Care, Middelheim Ziekenhuis, Antwerp, Belgium
| | - Shelley A Boeschoten
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | | | - Jacintha T Verhallen
- Department of Pediatrics, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Frans B Plötz
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | | | | | - Catherijne A J Knibbe
- Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden, The Netherlands
| | - Corinne M P Buysse
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Saskia N de Wildt
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Pediatric Intensive Care Unit, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Boeschoten SA, Dulfer K, Boehmer ALM, Merkus PJFM, van Rosmalen J, de Jongste JC, de Hoog M, Buysse CMP. Quality of life and psychosocial outcomes in children with severe acute asthma and their parents. Pediatr Pulmonol 2020; 55:2883-2892. [PMID: 32816405 PMCID: PMC7589240 DOI: 10.1002/ppul.25034] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/13/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To prospectively evaluate quality of life (QoL) and psychosocial outcomes in children with severe acute asthma (SAA) after pediatric intensive care (PICU) admission compared to children with SAA who were admitted to a general ward (GW). In addition, we assessed post-traumatic stress (PTS) and asthma-related QoL in the parents. METHODS A preplanned follow-up of 3-9 months of our nationwide prospective multicenter study, in which children with SAA admitted to a Dutch PICU (n=110) or GW (n=111) were enrolled between 2016-2018. Asthma-related QoL, PTS symptoms, emotional and behavioral problems, and social impact in children and/or parents were assessed with validated web-based questionnaires. RESULTS We included 100 children after PICU and 103 after GW admission, with a response rate of 50% for the questionnaires. Median time to follow-up was 5 months (range 1-12 months). Time to reach full schooldays after admission was significantly longer in the PICU group (mean of 10 vs 4 days, p=0.001). Parents in the PICU group reported more PTS symptoms (intrusion p=0.01, avoidance p=0.01, arousal p=0.02) compared to the GW group. CONCLUSION No significant differences were found between PICU and GW children on self-reported outcome domains, except for the time to reach full schooldays. PICU parents reported PTS symptoms more often than the GW group. Therefore, monitoring asthma symptoms and psychosocial screening of children and parents after PICU admission should both be part of standard care after SAA. This should identify those who are at risk for developing PTSD, in order to timely provide appropriate interventions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shelley A. Boeschoten
- Intensive Care Unit, Department of Pediatrics and Paediatric SurgeryErasmus Medical Centre—Sophia Children's HospitalRotterdamThe Netherlands
| | - Karolijn Dulfer
- Intensive Care Unit, Department of Pediatrics and Paediatric SurgeryErasmus Medical Centre—Sophia Children's HospitalRotterdamThe Netherlands
| | - Annemie L. M. Boehmer
- Department of PediatricsMaasstad HospitalRotterdamThe Netherlands
- Department of PediatricsSpaarne HospitalHaarlemThe Netherlands
| | - Peter J. F. M. Merkus
- Division of Respiratory Medicine, Department of Pediatrics
Radboudumc Amalia Children's HospitalNijmegenThe Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Johan C. de Jongste
- Department of Pediatrics, Erasmus Medical CenterSophia Children's HospitalRotterdamThe Netherlands
| | - Matthijs de Hoog
- Intensive Care Unit, Department of Pediatrics and Paediatric SurgeryErasmus Medical Centre—Sophia Children's HospitalRotterdamThe Netherlands
| | - Corinne M. P. Buysse
- Intensive Care Unit, Department of Pediatrics and Paediatric SurgeryErasmus Medical Centre—Sophia Children's HospitalRotterdamThe Netherlands
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Boeschoten SA, Boehmer AL, Merkus PJ, van Rosmalen J, de Jongste JC, Fraaij PLA, Molenkamp R, Heisterkamp SG, van Woensel JB, Kapitein B, Haarman EG, Wösten-van Asperen RM, Kneyber MC, Lemson J, Hartman S, van Waardenburg DA, Bunker-Wiersma HE, Brouwer CN, van Ewijk BE, Landstra AM, Verwaal M, Vaessen-Verberne AA, Hammer S, Buysse CM, de Hoog M. Risk factors for intensive care admission in children with severe acute asthma in the Netherlands: a prospective multicentre study. ERJ Open Res 2020; 6:00126-2020. [PMID: 32832524 PMCID: PMC7430140 DOI: 10.1183/23120541.00126-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
Rationale Severe acute asthma (SAA) can be fatal, but is often preventable. We previously observed in a retrospective cohort study, a three-fold increase in SAA paediatric intensive care (PICU) admissions between 2003 and 2013 in the Netherlands, with a significant increase during those years of numbers of children without treatment of inhaled corticosteroids (ICS). Objectives To determine whether steroid-naïve children are at higher risk of PICU admission among those hospitalised for SAA. Furthermore, we included the secondary risk factors tobacco smoke exposure, allergic sensitisation, previous admissions and viral infections. Methods A prospective, nationwide multicentre study of children with SAA (2–18 years) admitted to all Dutch PICUs and four general wards between 2016 and 2018. Potential risk factors for PICU admission were assessed using logistic regression analyses. Measurements and main results 110 PICU and 111 general ward patients were included. The proportion of steroid-naïve children did not differ significantly between PICU and ward patients. PICU children were significantly older and more exposed to tobacco smoke, with symptoms >1 week prior to admission. Viral susceptibility was not a significant risk factor for PICU admission. Conclusions Children with SAA admitted to a PICU were comparable to those admitted to a general ward with respect to ICS treatment prior to admission. Preventable risk factors for PICU admission were >7 days of symptoms without adjustment of therapy and exposure to tobacco smoke. Physicians who treat children with asthma must be aware of these risk factors. Preventable risk factors for PICU admission among those with severe acute asthma are >7 days of symptoms without adjustment of therapy and environmental exposure to tobacco smoke, underlining the importance of smoking cessation of caregivershttps://bit.ly/3ezPzxT
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Affiliation(s)
- Shelley A Boeschoten
- Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annemie L Boehmer
- Dept of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands.,Dept of Paediatrics, Spaarne Hospital, Haarlem, The Netherlands
| | - Peter J Merkus
- Division of Respiratory Medicine, Dept of Paediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Joost van Rosmalen
- Dept of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan C de Jongste
- Dept of Paediatric Pulmonology and Allergology, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pieter L A Fraaij
- Dept of Paediatrics, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands.,ViroScience, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | - Sabien G Heisterkamp
- Paediatric Intensive Care Unit, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Job B van Woensel
- Paediatric Intensive Care Unit, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Berber Kapitein
- Paediatric Intensive Care Unit, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Eric G Haarman
- Dept of Paediatrics, Amsterdam University Medical Centers - Emma's Children's Hospital, Amsterdam, The Netherlands
| | - Roelie M Wösten-van Asperen
- Paediatric Intensive Care Unit, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin C Kneyber
- Paediatric Intensive Care Unit, Beatrix Children's Hospital/University Medical Center Groningen, Groningen, The Netherlands
| | - Joris Lemson
- Paediatric Intensive Care Unit, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Stan Hartman
- Paediatric Intensive Care Unit, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Dick A van Waardenburg
- Paediatric Intensive Care Unit, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Carole N Brouwer
- Paediatric Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart E van Ewijk
- Dept of Paediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | | | - Mariel Verwaal
- Dept of Paediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Sanne Hammer
- Dept of Paediatrics, Amphia Hospital, Breda, The Netherlands
| | - Corinne M Buysse
- Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Intensive Care and Dept of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Zijlstra EE, van Hellemond JJ, Moes AD, de Boer C, Boeschoten SA, van Blijswijk CEM, van der Vuurst de Vries RM, Bailey PAB, Kampondeni S, van Lieshout L, Smits SL, Katchanov J, Mkandawire NM, Rothe C. Nontraumatic Myelopathy in Malawi: A Prospective Study in an Area with High HIV Prevalence. Am J Trop Med Hyg 2020; 102:451-457. [PMID: 31837130 DOI: 10.4269/ajtmh.19-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Nontraumatic myelopathy causes severe morbidity and is not uncommon in Africa. Clinically, patients often present with paraplegia, and extrinsic cord compression and transverse myelitis are most common causes. Data on exact pathogenesis are scanty because of limitations in diagnostic methods. In Queen Elizabeth Central Hospital, Blantyre, Malawi, we recorded consecutive patients presenting with nontraumatic paraplegia for maximally 6 months between January and July 2010 and from March to December 2011. The diagnostic workup included imaging and examining blood, stool, urine, sputum, and cerebrospinal fluid (CSF) samples for infection. After discharge, additional diagnostic tests, including screening for virus infections, borreliosis, syphilis, and schistosomiasis, were carried out in the Netherlands. The clinical diagnosis was, thus, revised in retrospect with a more accurate final differential diagnosis. Of 58 patients included, the mean age was 41 years (range, 12-83 years) and the median time between onset and presentation was 18 days (range, 0-121 days), and of 55 patients tested, 23 (42%) were HIV positive. Spinal tuberculosis (n = 24, 41%), tumors (n = 16, 28%), and transverse myelitis (n = 6, 10%) were most common; in six cases (10%), no diagnosis could be made. The additional tests yielded evidence for CSF infection with Schistosoma, Treponema pallidum, Epstein-Barr virus (EBV), HHV-6, HIV, as well as a novel cyclovirus. The diagnosis of the cause of paraplegia is complex and requires access to an magnetic resonance imaging (MRI) scan and other diagnostic (molecular) tools to demonstrate infection. The major challenge is to confirm the role of detected pathogens in the pathophysiology and to design an effective and affordable diagnostic approach.
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Affiliation(s)
| | - Jaap J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arthur D Moes
- Division of Nephrology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christa de Boer
- Infectious Disease Control, Municipal Health Service Zuid-Holland Zuid, Dordrecht, The Netherlands
| | - Shelley A Boeschoten
- Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia L Smits
- Viroclinics Biosciences BV, Rotterdam Science Tower, Rotterdam, The Netherlands
| | - Juri Katchanov
- Department of Hematology and Oncology, LMU University of Munich, Munich, Germany.,Department of Medicine, College of Medicine, Blantyre, Malawi
| | | | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Medicine, College of Medicine, Blantyre, Malawi
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Boeschoten SA, Buysse CMP, Merkus PJFM, van Wijngaarden JMC, Heisterkamp SGJ, de Jongste JC, van Rosmalen J, Cochius-den Otter SCM, Boehmer ALM, de Hoog M. Children with severe acute asthma admitted to Dutch PICUs: A changing landscape. Pediatr Pulmonol 2018; 53:857-865. [PMID: 29635844 PMCID: PMC6032863 DOI: 10.1002/ppul.24009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 03/14/2018] [Indexed: 12/23/2022]
Abstract
UNLABELLED The number of children requiring pediatric intensive care unit (PICU) admission for severe acute asthma (SAA) around the world has increased. OBJECTIVES We investigated whether this trend in SAA PICU admissions is present in the Netherlands. METHODS A multicenter retrospective cohort study across all tertiary care PICUs in the Netherlands. Inclusion criteria were children (2-18 years) hospitalized for SAA between 2003 and 2013. Data included demographic data, asthma diagnosis, treatment, and mortality. RESULTS In the 11-year study period 590 children (660 admissions) were admitted to a PICU with a threefold increase in the number of admissions per year over time. The severity of SAA seemed unchanged, based on the first blood gas, length of stay and mortality rate (0.6%). More children received highflow nasal cannula (P < 0.001) and fewer children needed invasive ventilation (P < 0.001). In 58% of the patients the maximal intravenous (IV) salbutamol infusion rate during PICU admission was 1 mcg/kg/min. However, the number of patients treated with IV salbutamol in the referring hospitals increased significantly over time (P = 0.005). The proportion of steroid-naïve patients increased from 35% to 54% (P = 0.004), with a significant increase in both age groups (2-4 years [P = 0.026] and 5-17 years [P = 0.036]). CONCLUSIONS The number of children requiring PICU admission for SAA in the Netherlands has increased. We speculate that this threefold increase is explained by an increasing number of steroid-naïve children, in conjunction with a lowered threshold for PICU admission, possibly caused by earlier use of salbutamol IV in the referring hospitals.
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Affiliation(s)
- Shelley A Boeschoten
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Corinne M P Buysse
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Peter J F M Merkus
- Department of Pediatrics, Division of Respiratory Medicine, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jacob M C van Wijngaarden
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Sabien G J Heisterkamp
- Department of Pediatric Intensive Care, Academic Medical Centre, Emma's Children Hospital, Amsterdam, The Netherlands
| | - Johan C de Jongste
- Department of Pediatrics, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Suzan C M Cochius-den Otter
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
| | | | - Matthijs de Hoog
- Department of Pediatric Intensive Care, Erasmus Medical Centre, Sophia's Children Hospital, Rotterdam, The Netherlands
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