ABSTRACT
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
We report a case of congenital lobar emphysema diagnosed antenatally in an infant of 32 weeks' gestation. Histology and serology confirmed infection with cytomegalovirus (CMV). CMV pneumonitis leading to inflammation and obstruction in the bronchial tree may have resulted in the development of congenital lobar emphysema.
Subject(s)
Cytomegalovirus Infections/congenital , Pulmonary Emphysema/congenital , Adult , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnostic imaging , Female , Humans , Infant, Newborn , Male , Pregnancy , Pulmonary Emphysema/complications , Pulmonary Emphysema/diagnostic imaging , Radiography , UltrasonographyABSTRACT
UNLABELLED: Clinical parameters, available on day 4, were collected for 204 ventilated neonates < 32 weeks gestation. Logistic regression was used to identify factors significantly and independently associated with chronic neonatal lung disease (CNLD) at 36 weeks postconception, which developed in 29% of neonates. At 36 weeks birth weight, peak inspiratory ventilator pressure and requirement for assisted ventilation on day 4 were such factors. The logistic regression equation for this association was applied to each infant resulting in a value between 0 and 1. By knowing which neonates developed CNLD, the discriminatory ability in this value was assessed. A receiver-operator characteristic curve for this value had an area under the curve of 0.97 (SE 0.03) in a unrelated population. A logistic equation value > 0.4 had a sensitivity of 90% and a specificity of 88% in predicting CNLD at 36 weeks. CONCLUSION: Use of logistic regression to identify factors independently associated with chronic drug disease at 36 weeks postconception, allowed accurate prediction of this disorder. This would allow reduction in size of randomised trials of early intervention in chronic lung disease.
Subject(s)
Infant, Premature , Lung Diseases/therapy , Respiration, Artificial , Chronic Disease , Gestational Age , Humans , Infant, Newborn , Logistic Models , Lung Diseases/etiology , Predictive Value of Tests , Pulmonary Surfactants/therapeutic use , Steroids/therapeutic use , Treatment OutcomeABSTRACT
There are good theoretical reasons for earlier intervention in neonates likely to develop chronic neonatal lung disease (CNLD). Very low birthweight (VLBW) neonates who receive artificial ventilation are at high risk of CNLD. A test was therefore developed to predict CNLD based on clinical and radiological information readily available at 7 days of age in VLBW neonates. Logistic regression analysis was used to identify those factors significantly and independently associated with CNLD. For each neonate it was possible to insert the value of the independent factors into the equation, providing a probability value between 0 and 1. By selecting different cut off values between 0 and 1, and knowing which neonates had developed CNLD, it was possible to assess the use of varying probability values as a predictive test for CNLD. The variation in these two parameters was graphically represented by a receiver operator characteristic (ROC) curve. The area under the ROC curve was used to represent the discriminatory capacity of the test over its full range of values. The maximum area under an ROC curve is unity. The area under the ROC curve was similar in a model with and without radiographic information (0.926 and 0.913 respectively) and was 0.937 in neonates from another hospital.
