Pediatric pulmonology
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Pediatric pulmonology · Jul 2008
Comparative StudyImproved pulmonary and growth outcomes in cystic fibrosis by newborn screening.
Newborn screening for cystic fibrosis (CF) is effective in improving long-term growth outcomes. However, there is conflicting evidence that early diagnosis maintains normal pulmonary function. Our goal was to determine if newborn screening results in improved longitudinal growth and maintenance of normal pulmonary function. ⋯ In this CF cohort, individuals diagnosed by newborn screening have improved growth and preservation of normal pulmonary function without increased risk of Pseudomonas aeruginosa colonization.
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Pediatric pulmonology · Jul 2008
A drop in gas temperature in the external part of the endotracheal tube is problematic during neonatal respiratory support.
During neonatal respiratory support, maintaining optimal humidity minimizes the risk of airway occlusion and chronic lung disease. With neonatal respiratory support using a heated humidifier,condensation following decreases in temperature within the unheated part of the inspiratory circuit represents a serious problem, due to the resulting drop in absolute humidity. Several reports describing the temperature/humidity gradient in the unheated inspiratory limb have excluded the endotracheal tube (ETT). ⋯ By measuring temperature/dew point at various sites along the inspiratory circuit, including inside the ETT, we evaluated the effects of temperature change in the ETT using an in vitro model of a micropremie on mechanical respirator care in an incubator. We confirmed significant moisture loss (absolute humidity loss; 7.5-10.1 mg/L) with decreasing gas temperature in the ETT external to the body, with subsequent drying of the gas (relative humidity drop, 10.7-22.3%) as temperature increased in the ETT inside the body. The present results suggest that temperature decreases in the ETT represent an important issue in the respiratory care of very premature infants.
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Pediatric pulmonology · Jun 2008
ReviewChronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis.
The role of persistent and recurrent bacterial infection of the conducting airways (endobronchial infection) in the causation of chronic respiratory symptoms, particularly chronic wet cough, has received very little attention over recent decades other than in the context of cystic fibrosis (CF). This is probably related (at least in part) to the (a) reduction in non-CF bronchiectasis in affluent countries and, (b) intense focus on asthma. In addition failure to characterize endobronchial infections has led to under-recognition and lack of research. ⋯ Also misdiagnosis of asthma is common and the diagnostic process is further complicated by the fact that the co-existence of asthma is not uncommon. The principles of managing PBB, CSLD and bronchiectasis are the same. Further work is required to improve recognition, diagnosis and management of these causes of chronic wet cough in children.
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Pediatric pulmonology · May 2008
Predictors of mucoid Pseudomonas colonization in cystic fibrosis patients.
Chronic mucoid Pseudomonas aeruginosa within the airway in cystic fibrosis (CF) patients can determine prognosis. Understanding the risk factors of mucoid P. aeruginosa acquisition may change how we deliver care. This study aims to evaluate whether presence of risk factors reported to predict disease severity including gender, CFTR genotype, bacterial organisms in airway cultures, and serum levels of vitamins A and E, albumin, C-reactive protein, alpha 1-antitrypsin, and immunoglobulins increased the risk of mucoid P. aeruginosa acquisition. ⋯ Female gender, number of DF508 alleles, decreased lung function, and lack of S. aureus on recent sputum culture are important risk factors for early detection of mucoid P. aeruginosa.
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Pediatric pulmonology · May 2008
Pulse rate and pulse rate variability decrease after adenotonsillectomy for obstructive sleep apnea.
Data suggest that obstructive sleep apnea syndrome (OSA) results in sympathetic stimulation, brady/tachycardia and cardiac stress. Heart rate variability, but not baseline heart rate, is known to be elevated in pediatric OSA. Our patients with moderate to severe OSA (McGill Oximetry Scores of 3 or 4) have been re-evaluated with pulse oximetry after adenotonsillectomy (T&A). We hypothesized that pulse rate (PR) and pulse rate variability (PRV) would decrease after treatment of OSA with T&A. ⋯ Nocturnal pulse oximetry complements clinical history to document improvement and/or resolution of moderate to severe OSA in children. Resolution of tachycardia and diminished PRV after T&A illustrate the stress that recurrent airway obstruction during sleep places on the cardiovascular system. Further work will be required to determine if PR and PRV as measured by pulse oximetry would be useful in the diagnosis and follow-up of OSA in children.