Flexible bronchoscopy in 76 children: Indications, yield, and complications

PURPOSE: This study was performed to investigate the indications, yield, and complications of flexible bronchoscopy for respiratory disease in children compared to earlier domestic studies and to examine if any differences existed in comparison to international studies. METHODS: The medical records of 100 cases of flexible bronchoscopy that were performed in 76 patients at the Department of Pediatrics of The Catholic University of Korea, Seoul St. Mary's Hospital from June 16, 2010 to August 6, 2013 were reviewed. RESULTS: A total of 76 patients (50 males and 26 females) were included in the study. The most common indication of flexible bronchoscopy was persistent pneumonia or pneumonia in immunocompromised patients (53 cases). The object of flexible bronchoscopy was accomplished in 65 of 100 cases, and, the treatment was changed in 24 of 65 cases. The most common abnormal finding was tracheomalacia that was found in 18 cases. In 67 cases where bronchoalveolar lavage was performed, bacteria were identified in 47 cases, fungi in 9 cases, and viruses in 22 cases. Complications occurred in 8 cases. CONCLUSION: Compared to earlier domestic studies, there was no significant change in diagnostic approaches and therapeutic improvement. However, this study showed that flexible bronchoscopy appears to be safe in patients with hemato-oncologic disease. Compared to international studies, the occurrence of complications due to flexible bronchoscopy was relatively low.

Readmission risk factors for children admitted to pediatric intensive care unit with respiratory tract disease

PURPOSE: Children admitted to pediatric intensive care unit (PICU) with respiratory tract disease, often have a tendency to be readmitted to PICU with disease progression. We studied the risk factors for readmission to PICU, with respiratory disease progression. METHODS: Among 286 children admitted to Seoul St. Mary's Hospital PICU from April 2009 to March 2012, 129 children admitted with respiratory tract disease were enrolled. We grouped the children readmitted to PICU with respiratory tract disease progression within 2 weeks (readmission group), and the others (control group). We compared basic and respiratory tract disease characteristics at initial PICU admission between them, by retrospective chart review. RESULTS: Among 129 children, 8 were included in the readmission group, and 121 in the control group. Mortality and underlying disease incidence were higher in the readmission group (P=0.003 and P=0.033, respectively). The readmission group showed higher parenchymal lung disease incidence, and lower initial saturation by pulse oxymeter (SpO2)/fraction of inspiratory oxygen (FiO2), despite underlying disease influence (P=0.035 and P=0.041, respectively). Logistic regression on the underlying disease and respiratory variables showed no single factor with a significantly independent influence on readmission, but parenchymal lung disease had more independent influence. CONCLUSION: For PICU readmission with respiratory tract disease progression, parenchymal lung disease and lower initial SpO2/FiO2 can be a risk factor despite underlying disease influence. Underlying disease and each respiratory characteristic were not significantly independent risk factors, suggesting a correlation of factors. But, parenchymal lung disease can be a more independent risk factor.

Comparison of respiratory disease by human metapneumovirus and respiratory syncytial virus in children

PURPOSE: Human metapneumovirus (hMPV) is known to result in clinical manifestation similar to respiratory syncytial virus (RSV) in children. But some recent studies showed different features. This study compared the clinical manifestation of respiratory disease between hMPV and RSV. METHODS: A total of 801 children who admitted to Seoul St. Mary's Hospital for respiratory infection from January to June, 2012 were enrolled. Respiratory viral polymerase chain reaction (PCR) using nasopharyngeal swab was performed in all children. We grouped hMPV positive children and RSV positive children and compared clinical features between them by retrospective chart review. RESULTS: Among 801 children, 365 showed one virus PCR positive with 44 showing hMPV and 41 showing RSV. Respiratory diseases were upper respiratory infection, acute bronchitis, acute bronchiolitis and pneumonia. The peak season was March and April for hMPV and February and March for RSV. Fever incidence, fever duration and neutrophil percent of complete blood cell count were higher in hMPV group than RSV group (P<0.05). The mean age of hMPV group was higher than RSV group (P<0.05). But in acute bronchiolitis children, there was no mean age difference between two group. Acute bronchiolitis incidence declined with increased age for both group (P<0.05). The hMPV group showed relatively lower bronchiolitis and higher pneumonia incidence than RSV group, suggesting relation with age. CONCLUSION: Respiratory infection by hMPV developed at late winter and spring, slightly later than RSV and at older age. The lower incidence of acute bronchiolitis for hMPV infection than RSV is maybe due to older age than RSV.

Evaluation of changes in random blood glucose and body mass index during and after completion of chemotherapy in children with acute lymphoblastic leukemia / 소아과

PURPOSE: Improved survival of patients with childhood acute lymphoblastic leukemia (ALL) has drawn attention to the potential for late consequences of previous treatments among survivors, including metabolic syndrome. In this study, we evaluated changes in 3 parameters, namely, random blood glucose, body mass index (BMI), and Z score for BMI (Z-BMI), in children with ALL during chemotherapy and after completion of treatment. METHODS: Patients newly diagnosed with ALL from January, 2005 to December, 2008 at Saint Mary's Hospital, The Catholic University of Korea, who completed treatment with chemotherapy only were included (n=107). Random glucose, BMI, and Z-BMI were recorded at 5 intervals: at diagnosis, before maintenance treatment, at completion of maintenance treatment, and 6 and 12 months after completion of maintenance treatment. Similar analyses were conducted on 2 subcohorts based on ALL risk groups. RESULTS: For random glucose, a paired comparison showed significantly lower levels at 12 months post-treatment compared to those at initial diagnosis (P<0.001) and before maintenance (P<0.001). The Z-BMI score was significantly higher before maintenance than at diagnosis (P<0.001), but decreased significantly at the end of treatment (P<0.001) and remained low at 6 months (P<0.001) and 12 months (P<0.001) post-treatment. Similar results were obtained upon analysis of risk group-based subcohorts. CONCLUSION: For a cohort of ALL patients treated without allogeneic transplantation or cranial irradiation, decrease in random glucose and Z-BMI after completion of chemotherapy does not indicate future glucose intolerance or obesity.

Pseudomonas Meningitis in a Child with Acute Lymphoblastic Leukemia during Induction Chemotherapy / 임상소아혈액종양

Pseudomonas species have been a cause of important infection associated with significant morbidity and mortality in immunocompromised patients. Pseudomonas meningitis is very rare, although bacteremia with Pseudomonas is common amongst cancer patients. We encountered a case of Pseudomonas meningitis in a child with acute lymphoblastic leukemia during induction chemotherapy. Pseudomonas meningitis may spread from skin and mucosal infection during the leukopenic nadir period. Ancillary manifestations associated with main signs, such as fever, may prompt us to consider Pseudomonas infection in hospitalized immunocompromised patients due to increased bacterial colonization.

Pseudomonas Meningitis in a Child with Acute Lymphoblastic Leukemia during Induction Chemotherapy / 임상소아혈액종양

Pseudomonas species have been a cause of important infection associated with significant morbidity and mortality in immunocompromised patients. Pseudomonas meningitis is very rare, although bacteremia with Pseudomonas is common amongst cancer patients. We encountered a case of Pseudomonas meningitis in a child with acute lymphoblastic leukemia during induction chemotherapy. Pseudomonas meningitis may spread from skin and mucosal infection during the leukopenic nadir period. Ancillary manifestations associated with main signs, such as fever, may prompt us to consider Pseudomonas infection in hospitalized immunocompromised patients due to increased bacterial colonization.

Neostigmine for the treatment of acute colonic pseudo-obstruction (ACPO) in pediatric hematologic malignancies

BACKGROUND: Acute colonic pseudo-obstruction (ACPO) refers to dilatation of the colon and decreased bowel motility without evidence of mechanical obstruction. Neostigmine, an acetylcholinesterase inhibitor, has been used in patients in whom supportive therapy failed to resolve ACPO. Here, we report the results of administering neostigmine to treat ACPO in children with hematologic malignancies. METHODS: Between September 2005 and December 2009, 10 patients (8 male and 2 female) were diagnosed with ACPO at the Department of Pediatrics, Catholic University of Korea. Diagnosis of ACPO was based on typical clinical features as well as colonic dilatation found on abdominal CT imaging. Neostigmine was administered subcutaneously at a dosage of 0.01 mg/kg/dose (maximum 0.5 mg) twice daily for a maximum of 5 total doses. ACPO was determined to be responsive to neostigmine if the patient showed both stool passage and improvement of clinical symptoms. RESULTS: The study group included 8 acute lymphoblastic leukemia patients, 1 patient with malignant lymphoma, and 1 patient with juvenile myelomonocytic leukemia. The median age at ACPO diagnosis was 8.5 years (range, 3-14). Overall, 8 patients (80%) showed therapeutic response to neostigmine at a median of 29 hours after the initial administration (range, 1-70). Two patients (20%) showed side effects of grade 2 or above, but none complained of cardiovascular symptoms that required treatment. CONCLUSION: In this study, ACPO was diagnosed most often in late-childhood ALL patients. Subcutaneous neostigmine can be used to effectively treat ACPO diagnosed in children with hematologic malignancies without major cardiovascular complications.