ABSTRACT
OBJECTIVE: Patients with cystic fibrosis are more susceptible than members of the general population to lung infections. Infections with Pseudomonas aeruginosa require particular attention, because they may accelerate the deterioration of lung function if not adequately treated. This study assessed the eradication rate of P. aeruginosa primoinfections, with a protocol of inhaled tobramycin and oral ciprofloxacin over a 3 months' period. RESULTS: Retrospective single-center study from June 1st, 2007 to December 31st, 2015. Inclusion of 28 pediatric patients (11 females, 17 males), with a total of 49 primoinfections. Overall success rate of 67.3%, which is similar or even inferior to figures published in the literature.
Subject(s)
Anti-Bacterial Agents/pharmacology , Ciprofloxacin/pharmacology , Clinical Protocols , Cystic Fibrosis , Outcome and Process Assessment, Health Care , Pseudomonas Infections/drug therapy , Pseudomonas aeruginosa/drug effects , Tobramycin/pharmacology , Anti-Bacterial Agents/administration & dosage , Child , Ciprofloxacin/administration & dosage , Cystic Fibrosis/complications , Female , Humans , Male , Pseudomonas Infections/etiology , Retrospective Studies , Time Factors , Tobramycin/administration & dosageABSTRACT
Major improvements in perinatal care have led to increased survival after premature birth and have allowed the survival of very young and immature newborns. Bronchopulmonary dysplasia is a serious complication of prematurity and has become a developmental lung disorder, hardly preventable due to its multiple causes. The treatment serves to maintain a normal growth, reduce the respiratory workload, and prevent further complications, by trying not to interfer with postnatal lung development. Bronchopulmonary dysplasia may be associated with bronchial hyperreactivity and an obstructive bronchial pattern that may lead to frequent hospital admissions for reactive airway disease in the small child, and contribute to the persistence of chronic lung disease mainly as a new chronic obstructive pulmonary disease phenotype in adulthood.
Subject(s)
Bronchial Hyperreactivity/therapy , Bronchopulmonary Dysplasia/therapy , Lung Diseases/etiology , Adult , Bronchial Hyperreactivity/etiology , Bronchial Hyperreactivity/physiopathology , Bronchopulmonary Dysplasia/etiology , Bronchopulmonary Dysplasia/physiopathology , Child , Chronic Disease , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Infant, Premature , Lung Diseases/epidemiology , Lung Diseases/physiopathology , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/etiology , Pulmonary Disease, Chronic Obstructive/physiopathologyABSTRACT
The combination of nebulized epinephrine and high dose dexamethasone, or nebulized hypertonic saline, are promising new therapeutic strategies for viral bronchiolitis in the young infant. However, further research is needed before a general recommendation can be given.
Subject(s)
Bronchiolitis, Viral/drug therapy , Bronchodilator Agents/therapeutic use , Dexamethasone/therapeutic use , Epinephrine/therapeutic use , Glucocorticoids/therapeutic use , Humans , Infant , Infant, Newborn , Saline Solution, Hypertonic/therapeutic useABSTRACT
BACKGROUND: Cytological composition of bronchoalveolar lavage (BAL) fluid in pediatric bone marrow transplant (BMT) recipients with pulmonary complications has not been comprehensively described and BAL specific markers of pulmonary GVHD are lacking. The aim of this retrospective study was to assess the role of BAL in the diagnosis of pulmonary GVHD by comparing BAL cytological findings between pediatric allogenic BMT patients with pulmonary complications and oncology children receiving chemotherapy alone. METHODS: Retrospective analysis of BAL specimens for cytology, total and differential cell counts and presence of infections. RESULTS: Seventeen BMT and 13 chemotherapy BAL were analyzed. BAL total cell count was increased but similar between groups (96.9 x 10(4) vs. 98.2 x 10(4), P = NS). BAL cellular composition differed considerably between groups with a significantly higher number of lymphocytes (18% vs. 6.25%, P = 0.03) and a significantly lower number of neutrophils (25.9% vs. 58%, P = 0.02) in BMT BAL specimens. Atypical epithelial cells were significantly more frequent (75% vs. 30.8%, P = 0.027), and significantly more severe (P = 0.01) in BMT patients. The presence and severity of atypia was not associated with infection or pneumotoxic drug exposure (P = NS). CONCLUSION: BAL cytology differs significantly between BMT and chemotherapy patients. The presence BAL lymphocytosis and severe epithelial cell atypia concomitantly to respiratory symptoms and GVHD in other organs may suggest the diagnosis of pulmonary GHVD. Prospective studies assessing the reliability of this finding combined with markers such as epithelial cell apoptosis and increased cytokines are needed.
Subject(s)
Bone Marrow Transplantation/adverse effects , Bronchoalveolar Lavage Fluid/cytology , Graft vs Host Disease/pathology , Lung/pathology , Adolescent , Biomarkers , Child , Epithelial Cells/pathology , Female , Humans , Lymphocytosis , Male , Retrospective StudiesABSTRACT
Sleep related breathing disorders (SDB) in children has a major negative impact on their neurocognitive development and should be identified and treated early as to decrease morbidity. Children do not usually present daytime fatigue and sleepiness like adults, but rather show abnormal behavior patterns and learning disabilities. The presence of sustained nightime snoring is a good screening toll for SDB. Polysomnography is the gold standard for diagnosis even though nightime oxymetry, with its high positive predictive value, can also be used. The most frequent SDB in childhood is sleep obstructive apnea syndrome (SOAS), which generally requires surgical treatment with adenotonsillectomy. Long term evolution of pediatric SOAS still has to be defined, as the role of other diagnostic tools such as outpatient polygraphy.