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The article presents current data on the prevalence of vitamin D deficiency and criteria for its deficiency in children in different countries. Vitamin D is recognized as one of the most important vitamins involved in many biochemical processes in the body. Its active metabolites play a key role in calcium absorption, bone mineralization and promote phosphate and magnesium metabolism. At the same time, in addition to affecting mineral metabolism, there is a wide range of conditions in which vitamin D also plays a preventive role. Vitamin D has been shown to play a vital role in innate immunity maintenance and is important in prevention of several diseases, including infections, autoimmune diseases, certain forms of cancer, type 1 and 2 diabetes, and cardiovascular diseases. Vitamin D is of particular importance for newborns and young children. This vitamin is involved in important physiological regulatory processes such as bone metabolism, lung development, maturation of the immune system and differentiation of the nervous system. Vitamin D deficiency increases risks of neonatal sepsis, necrotizing enterocolitis, respiratory distress syndrome, and bronchopulmonary dysplasia. Adequate intake of vitamin D and calcium during childhood can reduce the risk of osteoporosis and other diseases associated with vitamin D deficiency in adults. Recently, vitamin D deficiency has shown to be a potential risk factor for COVID-19 propensity. It has been established that to date most scientific pediatric societies have recognized the need to prevent vitamin D deficiency in healthy children of all ages, but data on the dosage of vitamin D in its prophylactic use differ. Most scientific societies recommend an average of 400-600 IU per day of vitamin D for prophylactic purposes. The analysis of published data shows the need to follow a strategy based on an individual approach, taking into account physiological characteristics, individual requirements and lifestyle.Copyright © 2021 University of Tartu Press. All rights reserved.
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Respiratory syncytial virus (RSV) infection remains a major public health problem, especially in younger children and the elderly. But several monoclonal antibodies, antivirals and vaccines, either recently launched or in development, offer new hope for RSV prevention and treatment.Copyright © 2023 Wiley Interface Ltd.
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Advances in neonatal medicine have progressively increased the survival of premature infants. Increased survival has however come at the cost of increased number of infants with prematurity-related complications. This is represented by high rates of respiratory distress syndrome, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), sepsis, periventricular leukomalacia (PVL), intraventricular haemorrhage (IVH), cerebral palsy, hypoxic ischaemic encephalopathy (HIE) and visual and hearing problems in survivors. In addition to prolonged hospital stay after birth, readmission to hospital in the first year of life is common if chronic lung disease exists. Around 3% of newborns have a congenital physical anomaly with 60% of congenital anomalies affecting the brain or heart and around 1% having multiple anomalies. Individual congenital conditions requiring surgical intervention in the neonatal period are rare. Neonates have a higher perioperative mortality risk largely due to the degree of prior illness, the complexity of their surgeries, and infant physiology. The maintenance of oxygenation and perfusion in the perioperative phase is critical as both affect cerebral perfusion and neurocognitive outcome but the triggers for intervention and the thresholds of physiological parameters during neonatal anaesthesia are not well described. After even minor surgical procedures, ex-premature infants are at higher risk for postoperative complications than infants born at term.Copyright © 2022
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The proceedings contain 85 papers. The topics discussed include: T2-high asthma across all ages - comparative analysis in children and adults from the ALLIANCE cohort;targeting IL-6 to prevent vascular and bronchial remodeling in an experimental model of bronchopulmonary dysplasia;diagnostic testing in people with primary ciliary dyskinesia around the world: where do we stand?;effects of elexacaftor/tezacaftor/ivacaftor in children with cystic fibrosis: a comprehensive assessment using spirometry, lung-clearance-index, functional and structural lung MRI;cough phenotypes in children: findings from the Swiss Pediatric Airway Cohort;pleuropneumonia caused byNocardia cyriacigeorgica in a 14-year-old girl with PCD;in severe juvenile-onset recurrent respiratory papillomatosis of a 10-year-old, systemic bevacizumab is highly effective and well tolerated;and impact of COVID-19 related alterations in circulating respiratory viruses on children and adult patients with recurrent wheeze and asthma.
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SESSION TITLE: Biological Markers in Patients with COVID-19 Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Pandemic SARS-CoV-2 infection (COVID-19), like other respiratory viruses, caused a massive incidence of acute respiratory distress syndrome (ARDS). Prior literature showed that influenza infection results in a significant increase in the level of circulating High Mobility Group Box 1 (HMGB1) in infected mice, cotton rats, and in humans;and a small molecule inhibitor of HMGB1 blocked lung pathology and lethality in influenza-infected mice and cotton rats. Moreover, HMGB1 has also been shown to be elevated in the serum of patients with ARDS and is an indicator of increased mortality. Gastrin Releasing Peptide (GRP) has been implicated in bronchopulmonary dysplasia, chronic obstructive pulmonary disease, chronic bronchitis, emphysema, and fibrosis. In addition to HMGB1, GRP represents a novel DAMP that, when targeted therapeutically in influenza-infected mice, is highly protective. The interaction between GRP and HMGB1 is currently under study. We examined if these DAMPS are associated with poor clinical outcomes in patients with COVID-19 ARDS. METHODS: Deidentified patient plasma and serum samples were obtained from discarded, clinical blood samples from 100 patients with COVID-19 admitted to UMMC's intensive care unit (ICU). Demographic and clinical data were collected from the patient’s electronic medical record. HMGB1 and GRP ELISA kits were used to analyze their concentrations in patients’ sera at Day 1 of admission to ICU. Cox proportional hazards models were used to examine the relationship between risk factors and severity of hypoxemia (P/F ratio), need for mechanical ventilation, and need for mechanical circulatory support (VV-ECMO). RESULTS: The average age of study participants was 59.1 years of which 59.2% were men and 57.1% were African American. The mean BMI was 34.3 kg/m2. The prevalence of hypertension, hyperlipidemia, diabetes, pulmonary and cardiovascular disease was 57.1%, 26.5%, 42.9%, 32.7%, and 42.9%, respectively. We found that GRP concentration was associated with worsening hypoxemia (mild 31.9, mod. 42.7, severe 79.0 ng/ml;p=0.014), requirement for mechanical ventilation (No 40.1, Yes 61.5 ng/ml;p=0.063), and need for VV-ECMO (No 48.6, Yes 93.1 ng/ml;p=0.026). HMGB1 concentration was associated with worsening hypoxemia (mild 24.4, mod. 55.1, severe 40.9 ng/ml;p=0.021) but did not correlate with other outcomes. CONCLUSIONS: GRP and HMGB1 have been previously implicated in the pathogenesis of viral infections, such as influenza, and ARDS in animal models and human. Our results suggest that these DAMPs maybe associated with severity of disease in critically ill patients with COVID-19 infection. CLINICAL IMPLICATIONS: Future studies should elucidate the specific cellular and biochemical pathways implicated in pathogenesis of ARDS, identify whether HMGB1 and GRP could be potential biomarkers for severe illness outcomes, and test novel anti-HMGB1 and GRP therapeutics in ARDS. DISCLOSURES: No relevant relationships by Fahid Alghanim no disclosure on file for Jeffrey Hasday;Consultant relationship with Guidepoint Please note: $1-$1000 by Carl Shanholtz, value=Consulting fee stock holder relationship with Teva Pharmaceuticals Please note: $1001 - $5000 by Carl Shanholtz, value=stock iinvestor relationship with illumina Please note: $1001 - $5000 by Carl Shanholtz, value=options No relevant relationships by Kari Ann Shirey No relevant relationships by Mohan Tulapurkar No relevant relationships by Stefanie Vogel
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Rationale: Hypoxia altitude simulation tests (HASTs) simulate changes in physiology that occur during commercial air flight (FiO2 16% in cabin pressurized to 8,000 ft) and help identify patients who may need additional respiratory support during flight. There is a paucity of literature regarding pediatric HAST studies. The purpose of this study is to identify patient characteristics, indications, and results of HAST studies at a pediatric tertiary care referral center. Methods: This IRB-exempt, retrospective chart review examined HAST studies over 5 years (2017-2021) at Nemours Children's Hospital (Wilmington, Delaware, USA). HAST studies were performed by respiratory therapists, supervised by pulmonologists, in the PFT laboratory. Standard protocol for the studies was performed including administration of 16% oxygen while monitoring SpO2 and heart rate for 10 minutes and administration of supplemental oxygen as indicated. Patient information collected included: demographic and anthropometric data, primary indication for HAST, baseline respiratory support, co-morbidities, reported prior difficulty with air travel, and results. Descriptive statistics were calculated. Results: 22 studies were ordered, and 12 were completed. Characteristics of patients who completed testing (N=12) are as follows: Mean age 77.0 (range 1.4-216) months, mean weight 21.7 kg, 58% male, 75% white, 8.3% with baseline tracheostomy/ventilatordependence, and 16.7% with baseline supplemental oxygen dependence. 25% reported history of difficulty with air flight. The most common primary indications included chronic lung disease of prematurity (41.7%), followed by restrictive lung disease (50%), followed by sickle cell disease (8.3%). Of the 12 patients who completed testing, 4 had abnormal results. Of those, the mean age was 45.6 months, mean weight 12.6 kg, 75% were male, and 50% on supplemental oxygen at baseline. The most common indications were chronic lung disease of prematurity (50%) followed by restrictive lung disease (50%). The most common co-morbidity was asthma (75%). See Table 1. Compared to patients who had normal results, patients with abnormal testing had a greater change in SpO2 (10.8 vs 4.9%) with lower mean SpO2 nadir of 87% compared to 93.6%. Discussion: The most common indications for HAST studies in this pediatric study include chronic lung disease of prematurity, restrictive lung disease, and sickle cell disease. Many studies were not completed, likely due to decrease in air travel during the Covid-19 pandemic. Patients with abnormal results were younger and more likely to have baseline oxygen requirements. Further research is needed to better understand which pediatric patients are at risk for cardiorespiratory compromise during flight or at altitude.
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Background It is not known whether children born very preterm have an increased risk of severe symptoms following SARS-CoV-2 infection and whether a history of bronchopulmonary dysplasia (BPD) relates to more severe sympto-matology. We aimed to describe the prevalence of SARS-CoV-2 infection and the severity of symptoms in a sample of children with and without BPD born at a gestational age below 32 weeks, between 2006 and 2019 in the Zurich area, in comparison to their siblings born at term (≥ 37 weeks). Methods Parents were invited to complete an online survey for their preterm child as well as for a term sibling of similar age, between May 2021 and January 2022. The survey included questions about SARS-CoV-2 confirmed infec-tion, symptoms and treatment. Results The survey was completed for 654 preterm children (270 with prior BPD) and for 189 term children aged 2 to 15 years. 28 (7%) preterm children without BPD, 15 (6%) preterm children with BPD and 22 (12%) term chil-dren were infected by SARS-CoV-2. Out of the infected, the proportion of children with respiratory symptoms (cough, sore throat, shortness of breath) was higher in premature children with BPD (67%), than in preterm children without BPD (25%) and slightly higher than in those born at term (59%). In all groups, the majority of children had only mild symptoms. No child had to be hospitalised and only one preterm child with BPD required oxygen. Conclusion Very preterm children with BPD may be more likely to experience respir-atory symptoms following SARS-CoV-2 infection. However, similar to chil-dren born at term, most very preterm children with and without BPD de-veloped mild symptoms only.
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The proceedings contain 122 papers. The topics discussed include: educational impact of targeted neonatal echocardiography (TNE) on neonatal-perinatal medicine (NPM) subspecialty residents;extremely low gestational age neonates and resuscitation: perspectives of Canadian neonatologists;neurodevelopmental outcomes of extremely preterm infants with late-onset bacterial sepsis according to type of bacteria;efficacy of pharmacologic therapy for patent ductus arteriosus closure in preterm newborns according to their gestational age-specific Z-score for birth weight;food insecurity during COVID-19 in a Canadian academic pediatric hospital;the burden of bronchopulmonary dysplasia and pulmonary vascular disease in premature infants;high spontaneous ductal closure even at the extreme of prematurity;exploring the impact of COVID-19 on families of children with developmental disabilities: a community-based formative study;a qualitative study of factors that helped prepare athletes for special Olympics sport programs;and impact of catheter choice on procedural success of minimally invasive surfactant therapy.