[A pilot trial on the treatment of gastroesophageal reflux-related cough in infants].

OBJECTIVE: Diagnosing asthma in infancy is largely made on the basis of the symptoms of cough and wheezing. A similar presentation can be seen in neurologically normal infants with excessive gastroesophageal reflux (GER). There are no randomized placebo controlled studies in infants using proton pump inhibitors (PPI) alone or in addition to prokinetic agents. The primary objective was to confirm the presence of excessive GER in a population of infants that also had respiratory symptoms suggestive of asthma. Second, in a randomized placebo-controlled fashion, we determined whether treatment of GER with bethanacol and omeprazole could improve these respiratory symptoms. METHODS: Infants (n=22) with a history of chronic cough and wheeze were enrolled, if they had evidence of GER by history and an abnormal pH probe or gastric emptying scan. Infants were randomly allocated to four treatment groups: placebo/placebo (PP), omeprazole plus bethanacol (OB), omeprazole/placebo (OP), bethanacol/placebo (BP). Evaluations by clinic questionnaire and exam, home diary, and pH probe data were done before, after study-medication and after open label of OB. RESULTS: Nineteen children were studied. PP did not affect GER or respiratory symptoms, and did not decrease GER measured by pH probe. In contrast, OB decreased GER as measured by pH probe indices and parental assessment. In association, OB significantly decreased daytime coughing and improved respiratory scores. No adverse effects were reported. CONCLUSIONS: In infants with a clinical presentation suggestive of chronic GER-related cough, the use of omeprazole and bethanacol appears to be viable therapeutic option.

A pilot trial on the treatment of gastroesophageal reflux-related cough in infants.

BACKGROUND: Diagnosing asthma in infancy is largely made on the basis of the symptoms of cough and wheeze. A similar presentation can be seen in neurologically normal infants with excessive gastroesophageal reflux (GER). There are no randomized placebo controlled studies in infants using proton pump inhibitors (PPI) alone or in addition to prokinetic agents. OBJECTIVES: The primary objective was to confirm the presence of excessive GER in a population of infants that also had respiratory symptoms suggestive of asthma. Second, in a randomized placebo-controlled fashion, we determined whether treatment of GER with bethanacol and omeprazole could improve these respiratory symptoms. METHODS: Infants (n=22) with a history of chronic cough and wheeze were enrolled, if they had evidence of GER by history and an abnormal pH probe or gastric emptying scan. Infants were randomly allocated to four treatment groups: placebo/placebo (PP), omeprazole plus bethanacol (OB), omeprazole/placebo (OP), bethanacol/placebo (BP). Evaluations by clinic questionnaire and exam, home diary, and pH probe data were done before, after study-medication and after open label of OB. RESULTS: Nineteen children were studied. PP did not affect GER or respiratory symptoms, and did not decrease GER measured by pH probe. In contrast, OB decreased GER as measured by pH probe indices and parental assessment. In association, OB significantly decreased daytime coughing and improved respiratory scores. No adverse effects were reported. CONCLUSIONS: In infants with a clinical presentation suggestive of chronic GER-related cough, the use of omeprazole and bethanacol appears to be viable therapeutic option.

Vitamin D receptor polymorphisms and the risk of acute lower respiratory tract infection in early childhood.

To investigate associations of 2 vitamin D receptor (VDR) gene polymorphisms and acute lower respiratory tract infection (ALRI), we compared 56 young children hospitalized with ALRI and 64 children without a history of ALRI. The FokI ff genotype was associated with an adjusted relative odds of ALRI that was approximately 7 times that of FokI FF. A weaker association with the TaqI polymorphism was also found. These data provide preliminary evidence of associations of VDR polymorphisms with the risk of ALRI (predominantly viral bronchiolitis) in young children, consistent with a potential role of vitamin D in the immune response to respiratory tract infection.

Are national vitamin D guidelines sufficient to maintain adequate blood levels in children?

BACKGROUND: Vitamin D insufficiency (defined as 25-hydroxyvitamin D [25(OH)D] concentrations <40 nmol/L) may be associated with subclinical adverse effects on bone mineralization. The current vitamin D status of children and adolescents in Canada has not been described. The purpose of this study was to describe the association between 25(OH)D serum concentration and dietary vitamin D intake, and other potential determinants of vitamin D status, among a sample of children and adolescents aged 2-16 years presenting to a pediatric emergency department in Edmonton, Alberta (latitude 52 degrees N) at the end of winter. METHODS: In early April 2003, 90 patients between the ages of 2 and 16 years who presented to the pediatric emergency department in Edmonton volunteered to participate. All participants and/or parents or guardians completed questionnaires regarding potential risk factors for vitamin D insufficiency, detailed dietary assessments, and anthropometric measurements. Serum 25(OH)D concentrations were measured in 68 of 90 participants. RESULTS: The mean serum 25(OH)D concentration was 47.2 nmol/L (95% CI 43.8-50.8 nmol/L). 34% of participants had vitamin D insufficiency (<40 nmol/L) and 6% were deficient (<25 nmol/L). Boys and girls aged 9-16 years had a prevalence of insufficiency of 69% and 35% respectively, while boys and girls 2-8 years old had a prevalence of insufficiency of 22% and 8% respectively. Dietary vitamin D intake per kilogram body weight was the most important independent determinant of 25(OH)D concentration (r = 0.446, p<0.001). Vitamin D intake, age and male sex best predicted insufficiency. No subject was insufficient if they had an intake >0.45 mcg/kg/day. INTERPRETATION: Vitamin D insufficiency may be common among children and adolescents at the beginning of spring. The risk may be highest among older children because vitamin D intake does not adequately rise in proportion with increases in body mass. Further studies are needed to assess whether Canadian dietary vitamin D recommendations should be changed.