ABSTRACT
CONTEXT: Increasing numbers of very low birth weight (VLBW) infants are surviving into adulthood because of improvements in neonatal intensive care. Adverse events in early life can have long-term effects through reprogramming of metabolic systems. OBJECTIVE: To determine whether young adult VLBW survivors have abnormalities of skeletal development or endocrine function. DESIGN: Cross-sectional, observational, case-control study. PARTICIPANTS: Thirty-seven VLBW subjects and 27 healthy controls at peak bone mass (mean age 23). MEASUREMENTS: Differences between cases and controls in body size, body composition, bone mass and bone geometry [assessed by dual-energy X-ray absorptiometry (DXA), hip structure analysis and peripheral quantitative computed tomography (pQCT)], bone turnover [urine N-terminal telopeptide of type I collagen (NTX), serum C-terminal telopeptide of type I collagen (CTX)], aminoterminal propeptide of type I procollagen (PINP) and bone alkaline phosphatase), hormones (sex steroids, IGF-1, PTH and 25-OH vitamin D) and insulin sensitivity (HOMA-IR and oral glucose tolerance testing). RESULTS: VLBW subjects had lower bone density at the lumbar spine (5.7%) and femoral neck (8.6%), which persisted after correction for bone size by the estimation of volumetric density (bone mineral apparent density). Urine NTX was higher in VLBW subjects than in controls, but there were no significant differences in other bone turnover markers. VLBW survivors had lower insulin sensitivity (mean INS-30 controls = 57.0, VLBW subjects = 94.3, P < 0.01), but there were no differences in whole body fat mass or truncal fat mass between VLBW subjects and controls. CONCLUSIONS: Young adult VLBW survivors have reduced bone density for their bone size and reduced insulin sensitivity, which may have significant implications for their risk of fracture and diabetes in later life.
Subject(s)
Bone Density/physiology , Infant, Very Low Birth Weight/blood , Infant, Very Low Birth Weight/metabolism , Insulin Resistance/physiology , Absorptiometry, Photon , Adult , Case-Control Studies , Collagen Type I/blood , Cross-Sectional Studies , Female , Glucose Tolerance Test , Hip Joint/diagnostic imaging , Hip Joint/metabolism , Humans , Infant, Newborn , Male , Peptides/blood , Young AdultABSTRACT
BACKGROUND: With the introduction of a standardised ordering system in February 2006, the opportunity arose to collect data on children requiring home oxygen in England and Wales. The authors' aim was to determine the incidence and patterns of home oxygen prescribing. METHODS: A paediatric home oxygen clinical network and the Children's Home Oxygen Record Database were established. During a 3-year period (February 2006 to January 2009), prescribers were requested to submit copies of the Home Oxygen Order Forms. In addition, anonymised point prevalence data on all patients currently receiving home oxygen in June 2007 were obtained from the four provider companies. RESULTS: Children's Home Oxygen Record Database--Forms were analysed for 888 children <16 years (58% boys) with a median age of 4.1 months; 656 (74%) were <1 year. 541 (68%) had a diagnosis of chronic neonatal lung disease; 53 (7%), neurodisability; and 49 (6%), cardiac disease. Order forms were often incomplete, and prescribing practice was variable. Provider's cross-sectional survey--There were 3338 children <16 years, representing 4% of all patients on home oxygen. Median age was 3.1 years with a peak at 6 months. The prevalence for paediatric home oxygen use in England and Wales was 0.33 per 1000, with a peak of 1.08 per 1000 for those <1 year. Marked regional variation was noted. CONCLUSIONS: This is the first national dataset available for children prescribed home oxygen in England and Wales. The study emphasises the need for a coordinated approach to home oxygen prescribing and justifies the recent publication of evidence-based guidelines.
Subject(s)
Home Care Services/statistics & numerical data , Oxygen Inhalation Therapy/statistics & numerical data , Adolescent , Age Distribution , Child , Child, Preschool , England/epidemiology , Epidemiologic Methods , Female , Home Care Services/organization & administration , Humans , Infant , Infant, Newborn , Lung Diseases/epidemiology , Lung Diseases/therapy , Male , Wales/epidemiologyABSTRACT
During 2008, ENT-UK received a number of professional enquiries from colleagues about the management of children with upper airway obstruction and uncomplicated obstructive sleep apnoea (OSA). These children with sleep-related breathing disorders (SRBDs) are usually referred to paediatricians and ENT surgeons. In some district general hospitals, (DGHs) where paediatric intensive care (PICU) facilities to ventilate children were not available, paediatrician and anaesthetist colleagues were expressing concern about children with a clinical diagnosis of OSA having routine tonsillectomy, with or without adenoidectomy. As BAPO President, I was asked by the ENT-UK President, Professor Richard Ramsden, to investigate the issues and rapidly develop a working consensus statement to support safe but local treatment of these children. The Royal Colleges of Anaesthetists and Paediatrics and Child Health and the Association of Paediatric Anaesthetists nominated expert members from both secondary and tertiary care to contribute and develop a consensus statement based on the limited evidence base available. Our terms of reference were to produce a statement that was brief, with a limited number of references, to inform decision-making at the present time. With patient safety as the first priority, the working party wished to support practice that facilitated referral to a tertiary centre of those children who could be expected, on clinical assessment alone, potentially to require PICU facilities. In contrast, the majority of children who could be safely managed in a secondary care setting should be managed closer to home in a DGH. BAPO, ENT-UK, APA, RCS-CSF and RCoA have endorsed the consensus statement; the RCPCH has no mechanism for endorsing consensus statements, but the RCPCH Clinical Effectiveness Committee reviewed the statement, concluding it was a 'concise, accurate and helpful document'. The consensus statement is an interim working tool, based on level-five evidence. It is intended as the starting point to catalyze further development towards a fully structured, evidence-based guideline; to this end, feedback and comment are welcomed. This and the constructive feedback from APA and RCPCH will be incorporated into a future guideline proposal.
Subject(s)
Adenoidectomy/adverse effects , Consensus , Sleep Apnea Syndromes/surgery , Tonsillectomy/adverse effects , Child, Preschool , Humans , Infant , Patient Selection , Practice Guidelines as Topic , Referral and Consultation , Risk Factors , Societies, Medical , United KingdomSubject(s)
Home Care Services, Hospital-Based/organization & administration , Oxygen Inhalation Therapy/methods , Anemia, Sickle Cell/therapy , Child , Child, Preschool , Cystic Fibrosis/therapy , Evidence-Based Medicine/methods , Heart Defects, Congenital/therapy , Humans , Hypertension, Pulmonary/therapy , Infant , Infant, Newborn , Lung Diseases/therapy , Needs Assessment , Oxygen/blood , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/instrumentation , Partial Pressure , Patient Discharge , Sleep Apnea, Obstructive/therapySubject(s)
Adenoidectomy/methods , Adenoidectomy/statistics & numerical data , Consensus , Cooperative Behavior , Interdisciplinary Communication , Sleep Apnea Syndromes/epidemiology , Tonsillectomy/methods , Tonsillectomy/statistics & numerical data , Anesthesiology , Humans , Infant , Obesity , Pediatrics , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control , United KingdomABSTRACT
The use of interrupter resistance (R(int)) is a feasible method of measuring bronchodilator responsiveness and bronchial hyperresponsiveness in preschool children. It has been suggested that analysis of recorded oscillations of the mouth pressure may provide additional indices of changes in airway mechanics. The aim of our study was to determine whether amplitude or damping properties of oscillations were more sensitive than R(int) in describing changes during bronchoconstriction. Data from 44 children (24 boys) who completed tripling dose methacholine (Mch) challenge were analysed. The median (range) age of children was 4.9 (3.1-6.1 years). In addition to baseline and maximal R(int) after Mch [mean (SD) were 0.92 (0.19) and 1.44 (0.35) kPa l(-1) s, respectively], obtained from a commercial device we analysed the following parameters: difference between the first maximum and minimum (A(MxMn)), maximum instantaneous amplitude (A(inst)), amplitudes of fitted mathematical model and the dominant frequency, sum of frequency component amplitudes, two damping factors and frequency. All amplitude parameters changed significantly after Mch. For comparison of the decrease in amplitudes and increase in R(int) we additionally used reciprocals of amplitudes. Using the sensitivity index (SI) i.e. the change after intervention divided by the baseline SD, 1/A(inst) and 1/A(MxMn) were the most sensitive indices to describe the change (with median SI of 6.29 and 6.28, respectively). R(int) had a median SI of 5.13. Frequency and damping factors were less sensitive, with median SI values <1. These findings suggest that oscillation amplitude analysis implemented in the software of commercial devices could have further applications in assessing respiratory mechanics.
Subject(s)
Airway Resistance , Bronchial Provocation Tests , Bronchoconstriction , Bronchoconstrictor Agents , Lung/physiopathology , Methacholine Chloride , Respiratory Mechanics , Bronchial Provocation Tests/instrumentation , Child , Child, Preschool , Feasibility Studies , Female , Humans , Male , Models, Biological , Mouth/physiopathology , Oscillometry , Predictive Value of Tests , Pressure , Pulmonary Alveoli/physiopathology , Sensitivity and Specificity , Software , Time FactorsSubject(s)
Cough/therapy , Acute Disease , Anti-Asthmatic Agents/therapeutic use , Asthma/complications , Asthma/drug therapy , Bronchitis/complications , Bronchitis/therapy , Child , Chronic Disease , Common Cold/complications , Common Cold/therapy , Cough/etiology , Humans , Rhinitis/complications , Rhinitis/therapy , Sinusitis/complications , Sinusitis/therapyABSTRACT
The aim of our study was to evaluate the utility of interrupter resistance (R(int)), transcutaneous oximetry and auscultation as outcome measures for a recently suggested tripling-dose methacholine (Mch) challenge in pre-school children. We studied 57 children aged 3-6 years. R(int) was measured at baseline and after each Mch dose. Oxygen saturation (SaO(2)) and transcutaneous oxygen pressure (tcpO(2)) were monitored during the challenge. Mch concentrations of 0.22, 0.66, 2.0, 6.0 and 18.0 mg/ml were nebulised during tidal breathing. The challenge was terminated if there was wheeze, SaO(2) below 91% or persistent cough; this final Mch dose was considered as PCW. Nine healthy children, 17 with cough and 25 with wheeze performed the study up to the point of PCW or all five Mch inhalations. If a change of 20% of predicted R(int) or termination by wheeze, desaturation or cough is taken as a completed test, then 39 out of 51 children (78%) had adequate R(int) measurements on each occasions from start to completion. The success rate for tcpO(2) measurements was similar: 38 out of 51 (76%) had complete tcpO(2) data until a 15% fall of tcpO(2) or clinical endpoint was reached. Using the above-mentioned cut-off levels significant change in R(int) or tcpO(2) preceded PCW in most of the cases. Both R(int) and tcpO(2) measurements may allow detection of bronchial hyper-responsiveness at lower Mch doses and also provide a less subjective measure, but will not be feasible in all children.
Subject(s)
Asthma/diagnosis , Bronchoconstrictor Agents , Methacholine Chloride , Airway Resistance , Auscultation , Bronchial Hyperreactivity/diagnosis , Bronchial Provocation Tests , Child , Child, Preschool , Cough/etiology , Female , Humans , Male , Oximetry , Oxygen/blood , Predictive Value of Tests , Respiratory SoundsABSTRACT
BACKGROUND: Lung disease in preterm infants is often complicated with lung edema. OBJECTIVES: The aim of this review is to assess the risks and benefits of aerosolized diuretic administration in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess effects on short term outcome (changes in need for oxygen or ventilatory support) and effects on long-term outcome. Secondary objectives are to assess changes in pulmonary mechanics and potential complications of therapy. SEARCH STRATEGY: We used the standard search method of the Cochrane Neonatal Review Group. We used the following keywords: {
Subject(s)
Diuretics/administration & dosage , Furosemide/administration & dosage , Infant, Premature, Diseases/drug therapy , Lung Diseases/drug therapy , Aerosols , Chronic Disease , Humans , Infant, Newborn , Infant, Premature , Randomized Controlled Trials as Topic , RiskABSTRACT
BACKGROUND: The relationship between asthma severity and atopy is complex. Many studies have failed to show significant relationships between clinical severity or lung function and markers of atopic sensitisation. AIM: To determine whether increasing asthma severity is related to atopic sensitisation in a population of children with asthma. METHODS: A total of 400 children (7-18 years) with asthma were recruited as part of a multicentre study of the genetics of asthma. Detailed phenotypic data were collected on all participants. Associations between measures of asthma severity and atopic sensitisation were sought using multilevel models allowing variation at the individual and family level. RESULTS: Children recruited to the study had a range of asthma severities, with just over a third having mild persistent asthma. The logarithm of total serum IgE was associated with increased asthma severity score, decreased FEV1, increased airways obstruction, risk of hospital admission, and inhaled steroid use. Increasing skin prick test reactivity to a panel of seven aeroallergens was associated with increased risk of hospital admission, use of an inhaled steroid, and airways obstruction. The results remained highly significant after corrections for age, gender, and birth order. CONCLUSIONS: In children with asthma, increasing atopy is associated with increasing asthma severity. However, the relationships between asthma severity and skin prick tests, and asthma severity and total serum IgE values, appear subtly different.
Subject(s)
Asthma/immunology , Hypersensitivity/complications , Adolescent , Airway Obstruction , Asthma/blood , Asthma/physiopathology , Bronchodilator Agents/therapeutic use , Child , Chronic Disease , Female , Forced Expiratory Volume , Hospitalization , Humans , Hypersensitivity/blood , Hypersensitivity/physiopathology , Immunoglobulin E/blood , Lung/physiopathology , Male , Risk Assessment , Risk Factors , Skin TestsSubject(s)
Immunoglobulins, Intravenous/therapeutic use , Sepsis/therapy , Staphylococcal Infections/therapy , Adolescent , Bacterial Toxins , Community-Acquired Infections/therapy , Exotoxins , Humans , Leukocidins , Male , Methicillin Resistance , Staphylococcus aureus/drug effects , Staphylococcus aureus/metabolismABSTRACT
The aim of our study was to assess the feasibility and safety of a recently suggested tripling-dose methacholine (Mch) challenge in preschool children. Fifty-seven children aged 3-6 years were studied. Mch challenge was carried out using a tidal breathing method, with concentrations of 0.22, 0.66, 2.0, 6.0, and 18.0 mg/ml, at 5-min intervals, given by a Pari Turbo Boy compressor and Pari LC Plus nebulizer, for 1 min only. Oxygen saturation (SaO(2)) was monitored during the challenge. The challenge was terminated if there was wheeze, SaO(2) below 91%, or persistent cough. This final Mch dose was considered the provocative concentration inducing audible wheeze (PCW). Nine healthy children, 17 with cough and 25 with wheeze, completed the study. Mean output from nebulizers (SD) in these 51 children was 0.30 (0.05) ml/min. Geometric means for PCW in these groups were 2.88, 2.58, and 1.28 mg/ml Mch, respectively. The wheezing children were significantly more hyperresponsive than the coughing children (P < 0.05). A tripling-dose Mch protocol is safe and practicable in children over 3 years of age. A further reduction in nebulized dose may be needed for a more discriminatory test.
Subject(s)
Asthma/diagnosis , Bronchoconstriction/drug effects , Bronchoconstrictor Agents , Methacholine Chloride , Administration, Inhalation , Asthma/physiopathology , Bronchial Hyperreactivity/diagnosis , Bronchial Hyperreactivity/physiopathology , Bronchoconstrictor Agents/administration & dosage , Child , Child, Preschool , Dose-Response Relationship, Drug , Feasibility Studies , Humans , Methacholine Chloride/administration & dosage , Nebulizers and Vaporizers , Oxygen Consumption/drug effectsABSTRACT
RATIONALE: Previous data have suggested that glutathione-S-transferase (GST) genotypes are important in determining the rate of lung function growth in childhood. This effect was most marked in Caucasian children with asthma. OBJECTIVES: We investigated the association of lung function with GSTM1, GSTP1 and GSTT1 genotypes in Caucasian families with asthma. METHODS: Four hundred and eighteen children and 316 parents from 224 Caucasian families were recruited via a child with asthma, the proband. Associations between lung function and GST genotype were determined using multilevel models. RESULTS: There were no observed associations between lung function and GST genotype in parents. However, in the children, the GSTP1 val(105)/val(105) and GSTM1 null genotypes were associated with significantly higher forced expiratory volume in 1 s (FEV(1)) and FVC values as percentage of predicted. This effect was not statistically significant in the probands but was marked in their siblings in whom GSTP1 val(105)/val(105) was associated with 9.4% higher FEV(1) and 10.7% higher FVC (P=0.005 and 0.001, respectively). The GSTM1 null genotype was associated with a 6.7% higher FEV(1) and 4.1% higher FVC (P=0.003 and 0.063, respectively). These effects remained significant after correcting for the confounders of individual atopic status, tobacco smoke exposure and familial aggregation of lung function values. CONCLUSIONS: GSTM1 and GSTP1 genotypes are important determinants of lung function in childhood. The smaller differences seen in probands are predicted by a simple model in which more rapid decline in lung function is seen in these individuals.
Subject(s)
Asthma/enzymology , Glutathione Transferase/genetics , Isoenzymes/genetics , Lung/enzymology , Adolescent , Adult , Asthma/genetics , Asthma/physiopathology , Child , England , Female , Forced Expiratory Volume , Genotype , Homozygote , Humans , Linear Models , Lung/physiopathology , Male , Middle Aged , Parents , Siblings , Vital Capacity , White PeopleABSTRACT
Families with asthmatic children were recruited to take part in a multi-centre collaborative study into the genetics of asthma. Detailed phenotypic information was collected on all family members including: lung function, anthropomorphic measurements, response to methacholine challenge, skin prick testing, serum IgE measurements and a detailed nurse-administered questionnaire. Families were eligible for entry into the study if they had two children with a doctor-diagnosis of asthma. Bennett/Twin nebulisers were supplied to each centre from a single source and these were calibrated to determine gravimetric nebuliser output prior to use. Asthmatic probands from each centre had similar degrees of asthma severity and atopy. There was no significant difference in the sex ratios or ages of the probands or numbers of parents with a history of smoking in the families recruited at each centre. However, there was a significant difference in the number of children with airway hyperresponsiveness, with 90% of the North Staffordshire group but only 60% of the Sheffield group having a PC20 of <8 mg/ml for methacholine. This difference highlights the difficulty of using families from different centres in genetic and epidemiological studies.
Subject(s)
Asthma/genetics , Bronchial Hyperreactivity/genetics , Asthma/epidemiology , Asthma/physiopathology , Bronchial Hyperreactivity/epidemiology , Bronchial Hyperreactivity/physiopathology , Child , England/epidemiology , Female , Forced Expiratory Volume/physiology , Humans , Male , Pedigree , Phenotype , Residence Characteristics , Vital Capacity/physiologyABSTRACT
A review of the specific requirements of home oxygen therapy in children which attempts to offer guidance to clinicians and service providers.
Subject(s)
Home Care Services/organization & administration , Lung Diseases/therapy , Oxygen Inhalation Therapy/methods , Ambulatory Care/methods , Child , Decision Making , Follow-Up Studies , Humans , Long-Term Care , Oxygen Inhalation Therapy/instrumentationABSTRACT
This article deals with the discharge planning and continuing care of babies with chronic lung disease of the newborn (CLD), especially those with a continuing oxygen requirement, with some reference to longer term outcome. The pattern of CLD has changed since early descriptions, and the most useful definition for persisting morbidity in a baby with lung disease is a continuing oxygen requirement beyond 36 weeks post-menstrual age. Long-term oxygen therapy to maintain oxygen saturation at a mean of 95% or more and prevent levels below 90% is the cornerstone of management, and with adequate oxygen therapy the excess mortality previously reported in CLD can largely be avoided. Care must be given to the method of assessing oxygen saturation: overnight monitoring using appropriate recording devices is recommended. Exposure to respiratory viruses should be minimized where possible. Metabolic requirements are increased, but if efforts are made to maintain adequate energy input the long-term outlook for catch-up growth in height is good. Respiratory morbidity is increased in early life, but this improves in later childhood, along with lung function and exercise tolerance. Although respiratory symptoms should be treated as they arise, there is no evidence for long-term benefit from any pharmacological intervention in CLD.
Subject(s)
Aftercare/standards , Hypoxia/prevention & control , Infant Care , Lung Diseases/therapy , Patient Discharge/standards , Chronic Disease , Humans , Infant Care/methods , Infant, Newborn , Intensive Care Units, Neonatal/standards , Lung Diseases/etiology , Parents/education , Patient Care Team , Respiratory Distress Syndrome, Newborn/complications , Risk AssessmentABSTRACT
The electrical resistivity of lung tissue can be related to the structure and composition of the tissue and also to the air content. Electrical impedance tomographic measurements have been used on 155 normal children over the first three years of life and 25 pre-term infants, to determine the absolute resistivity of lung tissue as a function of frequency. The results show consistent changes with increasing age in both lung tissue resistivity (5.8 ohm m at birth to 20.9 ohm m at 3 years of age) and in the changes of resistivity with frequency (Cole parameter ratio R/S=0.41 at birth and 0.84 at 3 years of age). Comparison with a lung model showed that the measurements are consistent with maturational changes in the number and size of alveoli, the extracapillary blood volume and the size of the extracapillary vessels. However, the results show that the process of maturation is not complete at the age of three years.
Subject(s)
Aging/physiology , Infant, Newborn/physiology , Lung/physiology , Adult , Child, Preschool , Electric Impedance , Follow-Up Studies , Humans , Infant , Infant, Premature/physiology , TomographyABSTRACT
The electrical resistivity of lung tissue can be related to the structure and composition of the tissue and also to the air content. Conditions such as pulmonary oedema and emphysema have been shown to change lung resistivity. However, direct access to the lungs to enable resistivity to be measured is very difficult. We have developed a new method of using electrical impedance tomographic (EIT) measurements on a group of 142 normal neonates to determine the absolute resistivity of lung tissue. The methodology involves comparing the measured EIT data with that from a finite difference model of the thorax in which lung tissue resistivity can be changed. A mean value of 5.7 +/- 1.7 omega(m) was found over the frequency range 4 kHz to 813 kHz. This value is lower than that usually given for adult lung tissue but consistent with the literature on the composition of the neonatal lung and with structural modelling.