Pediatric pulmonology
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Pediatric pulmonology · Nov 2015
Airway obstruction, upper airway artifact and response to bronchodilator in asthmatic and healthy children.
The forced oscillation technique (FOT) may be affected by the upper airway artifact in children with airway obstruction. The aim was to test the impact of the artifact on FOT ability to diagnose asthma in children as recommended by current guidelines. ⋯ In asthmatic children, the upper airway artifact significantly impacts FOT measurements. The diagnostic value may be improved by minimization of the shunt, such as the computation of Δ%Ars.
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Pediatric pulmonology · Nov 2015
Comparison of HFNC, bubble CPAP and SiPAP on aerosol delivery in neonates: An in-vitro study.
Aerosol drug delivery via high flow nasal cannula (HFNC), bubble continuous positive airway pressure (CPAP), and synchronized inspiratory positive airway pressure (SiPAP) has not been quantified in spontaneously breathing premature infants. ⋯ Aerosol can be delivered via all three devices used in this study. Device selection and nebulizer position impacted aerosol delivery in this simulated model of a spontaneously breathing preterm infant.
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Pediatric pulmonology · Nov 2015
RSV: Immunoprophylaxis and non-invasive respiratory support in ex-preterms: A northern UK perspective.
Recent guidance has suggested that immunoprophylaxis with monoclonal antibody against respiratory syncytial virus (RSV) should be extended to ex-preterm infants who are moderate-to-late-preterm and discharged home during the RSV season. Noninvasive respiratory support (NIV) for infants with bronchiolitis is becoming widespread with little supporting evidence for efficacy over nonpressure support methods. We used multicentre prospective audit and service evaluation to evaluate whether extension of current practice in line with the guidance would provide a clinical or cost benefit, and whether NIV provides any benefits in the ex-preterm population. ⋯ NIV use has been widely adopted (9% of 'bronchiolitic' admissions) in our region but the data do not support it as a useful adjunct for ex-preterms with RSV positive illness requiring respiratory support: it does not appear to reduce the need for subsequent formal ventilation. Our study does not support a case for change to more widespread, protocol driven immunisation for RSV. Further research is needed in a randomised, controlled setting to examine the use of NIV in bronchiolitis in a wider context.
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Pediatric pulmonology · Oct 2015
ReviewPersonalized medicine for cystic fibrosis: establishing human model systems.
With over 1,500 identifiable mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that result in distinct functional and phenotypical abnormalities, it is virtually impossible to perform randomized clinical trials to identify the best therapeutics for all patients. Therefore, a personalized medicine approach is essential. ⋯ We propose that a concerted two-pronged approach is necessary for patient-specific cystic fibrosis research to continue to prosper and realize its potential: (1) more effective culture and differentiation conditions for growing primary human airway and nasal epithelial cells and (2) the development of collective protocols for efficiently differentiating disease- and patient-specific induced pluripotent stem cells (iPSC) into pure populations of adult epithelial cells. Ultimately, we need a personalized human model system for cystic fibrosis with the capacity for uncomplicated bankability, widespread availability, and universal applicability for patient-specific disease modeling, novel pharmacotherapy investigation and screening, and readily executable genetic modification.
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Pediatric pulmonology · Oct 2015
Reference ranges for shape indices of the flow-volume loop of healthy children.
The concavity of the descending limb of the maximum expiratory flow-volume loop (MEFVL) is the earliest change associated with airflow obstruction in small airways (ATS/ERS Task Force). The shape of the MEFVL changes with age but there are no reference values for shape indices for preschool and school children. ⋯ This study provides standard reference equations for indices of mid-expiratory flows in children and we suggest using the FEF50 /PEF index.