Add-on treatment with nebulized hypertonic saline in a child with plastic bronchitis after the Glenn procedure.

Plastic bronchitis (PB), although a rare cause of airway obstruction, has mortality rates up to 50% in children after Fontan-type cardiac surgery. We present the case of an 18-month-old female patient with PB following pneumonia. At 6 months of age, the patient underwent the Glenn procedure due to functionally univentricular heart. Fiberoptic bronchoscopy revealed complete blockage of the left bronchus by mucoid casts. Pharmacotherapy consisted of glucocorticosteroids, azithromycin, and enalapril maleate. The child also received nebulized 3% NaCl solution, which proved to be beneficial. In children submitted to Fontan-type procedures, physicians must be alert for PB, which can be triggered by respiratory tract infection.

Add-on treatment with nebulized hypertonic saline in a child with plastic bronchitis after the Glenn procedure / Tratamento adjuvante com nebulização de salina hipertônica em uma criança com bronquite plástica após a operação de Glenn

Plastic bronchitis (PB), although a rare cause of airway obstruction, has mortality rates up to 50% in children after Fontan-type cardiac surgery. We present the case of an 18-month-old female patient with PB following pneumonia. At 6 months of age, the patient underwent the Glenn procedure due to functionally univentricular heart. Fiberoptic bronchoscopy revealed complete blockage of the left bronchus by mucoid casts. Pharmacotherapy consisted of glucocorticosteroids, azithromycin, and enalapril maleate. The child also received nebulized 3% NaCl solution, which proved to be beneficial. In children submitted to Fontan-type procedures, physicians must be alert for PB, which can be triggered by respiratory tract infection.

A bronquite plástica (BP), embora uma causa rara de obstrução de vias aéreas, apresenta taxas de mortalidade de até 50% em crianças submetidas a cirurgia cardíaca do tipo Fontan. Apresentamos o caso de uma menina de 18 meses de idade com BP secundária a pneumonia. Aos 6 meses de idade, a paciente havia sido submetida à operação de Glenn devido a coração funcionalmente univentricular. A fibrobroncoscopia revelou obstrução completa do bronco esquerdo por moldes mucoides. A farmacoterapia consistiu em glicocorticosteroides, azitromicina e maleate de enalapril. Adicionalmente, a criança recebeu nebulização de solução de NaCl a 3%, que provou ser benéfica. Em crianças submetidas a operações do tipo Fontan, devemos nos manter alerta quanto à BP, que pode ser desencadeada por infecção do trato respiratório.

Exhaled eicosanoid profiles in children with atopic asthma and healthy controls.

RATIONALE: Chronic endobronchial inflammation is a hallmark of pediatric asthma and involves the arachidonic acid pathway. Its non-volatile metabolites can be quantified in the exhaled breath condensate (EBC), and single substances have been studied as non-invasive biomarkers for the diagnosis and monitoring of children with asthma. The aim of this study was to compare the content and profile of a wider range of eicosanoids in the EBC between patients and a control group. MATERIALS AND METHODS: EBC was sampled from 33 children (aged 12.4 ± 3.1 years) with stable atopic asthma (26 on inhaled steroid treatment) and 25 healthy controls (11.8 ± 3.2 years). Validated high performance liquid chromatography coupled with a tandem mass spectrometry platform (HPLC-MS2 ) was used to measure 13 different compounds. In addition, exhaled nitric oxide levels (FeNO) were measured and bronchial hyperresponsiveness (BHR) was assessed by an exercise challenge test in all subjects. An analytical approach was used for multivariate regression modeling of disease status using the most relevant variables. RESULTS: The levels of PGEM (P < 0.001), PGD2 (P < 0.001), 6keto-PGF1α (P = 0.03), LTC4 (P < 0.001), trans-LTC4 (P = 0.04), and 5HETE (P = 0.02) were significantly higher in asthmatics compared to healthy children, while 11-dehydro TXB2 was significantly less abundant (P = 0.02). The eicosanoids asthma classification ratio (EACR) was computed as the logistic regression function using four variables: PGEM, PGD2, LTC4, and 5HETE. This composite parameter discriminated asthmatic from healthy children better than FEV1, FeNO, or BHR. CONCLUSION: Complementary measurements of PGEM, PGD2, LTC4, and 5HETE in small-volume EBC samples are feasible by HPLC-MS2 and showed a specific profile in our study population. EACR should be evaluated further in the context of diagnosing and monitoring childhood asthma.

[Bronchopulmonary dysplasia -- early and long-term pulmonary sequelae]. / Dysplazja oskrzelowo-plucna -- wczesne i odlegle nastepstwa w zakresie ukladu oddechowego.

Improvement in perinatal care have resulted in significantly increased survival of premature infants. Discontinuation of correct intrauterine lung development and a necessity of oxygen-therapy and/or mechanical ventilation become a reason of bronchopulmonary dysplasia (BPD). In the first period of life the main complaint of these patients is oxygen dependence. Moreover the risk of serious infections of lower respiratory tract (particularly RSV) increases. This becomes the reason of readmission of about 50% prematures with diagnosed BPD in the first year of life. The main problem of these patients is airway obstruction, which very often doesn't respond to brochodilatators. The probable reason of these disturbances is imperfect development of respiratory system and remodelling of respiratory tract. Reduction in lung function (reduced FEV(1), PEF, FVC) persists until adolescence. Acceleration of the decrease in FEV(1)/FVC ratio may suggest that these patients are a risk group of COPD development. The assessment of lung radiography at the age of 11 years of former prematures with diagnosed BPD reveals the presence of persistent emphysematic changes (86% of these children had one or more bubbles). Abnormalities in chest high resolution CT occur in the majority of these patients (in 81.3% of the 10-years-olds group and in 92.5% of 18-year-olds group). Further prospective long-term study of prematures is essential for the establishment of remote prognosis and treatment standards.

[Risk factors of retinopathy of prematurity in newborns treated in neonatal intensive care unit of University Children's Hospital Collegium Medicum Jagiellonian University]. / Czynniki ryzyka rozwoju retinopatii wczesniaków u pacjentów Oddzialu Patologii i Intensywnej Terapii Noworodka Uniwersyteckiego Szpitala Dzieciecego Collegium Medium Uniwersytetu Jagiellonskiego.

BACKGROUND: A persistent progress in perinatal care and a large increase in infants' survival rate have been observed recently. As a result, the number of neonates requiring ophthalmologic examinations due to retinopathy of prematurity (ROP) increased as well. METHOD: A retrospective survey including 206 neonates with mean birth weight 1342 g and mean gestational age 30 weeks. MATERIAL: Three groups: 1) without ROP--165 infants (80.1%); 2) with ROP not requiring treatment--13 infants (6.3%); 3) with prethreshold and threshold ROP requiring cryotherapy--28 infants (13.6%) were analysed. RESULTS: Threshold ROP was not observed in infants with gestational age > 32 weeks and/or birth weight > 1500 g. Cryotherapy was applied between the 6th and 18th weeks of life (Mo: 12). The procedure was applied at postmenstrual age between the 34th and 45th weeks of life (Mo: 38). The correlation of ROP with the following factors was observed: length of mechanical ventilation (Me in the studied groups: 6; 22; 33 days respectively; p < 0.01), length of oxygen therapy (Me: 27; 58; 70 days; p < 0.01), number of blood transfusions in first month of life (Me: 2; 4; 4; p < 0.01), minimum pO2 (average: 37.2; 30.2; 29.2 mmHg p < 0.01), pO2 oscillation (measured as SD) (Me: 10.25; 13.2; 15.4 mmHg p < 0.016) and maximal pCO2 (average: 52.5; 56.8; 66.5 p < 0.01) between the 2nd and 4th weeks of life. CONCLUSION: Monitoring of pO2 and pCO2 in infants in the 1st month of life reduce the risk of ROP development. Infants born before the 32nd week of gestational age belong to high risk group and require very systematic ophthalmologic examination. The current prophylactic examination schedule for ROP for more mature infants may be changed.