bluuebunny/crossref_metadata_2025 huggingface dataset:
Exponential analysis of the lung pressure‐volume curve in newborn mammals
Authors: Saetta Marina , Mortola Jacopo P.
Published: March 2007

The compliance of the lung (per unit of lung weight) is less in newborn mammals than in adults. This could result from a smaller volume of airspaces per unit weight and/or a lower lung distensibility. The isolated role of lung distensibility was evaluated by using a mathematical description of the pressure‐volume (P‐V) curve during lung deflation. Deflation limbs of static P‐V curves in newborns of six species (four experimentally obtained and two taken from the literature) ranging from total lung capacity to the resting volume (Vr) were fitted by a monoexponential function of the type V = B − Ae−KP, where B equals Vmax at infinite P, A equals the difference between Vmax and V at P = O, and K is a constant representing lung distensibility. Unlike in adults, in newborns the monoexponential fitting provided an adequate description of the P‐V curve for only a relatively small range of transpulmonary pressure (from P at Vr to 10–15 cm H2O). The K value of this portion of the curve was similar among species but higher than in adult mammals, averaging 0.240 cm H2O−1. This suggests a similar lung structure in the different species. Since lung distensibility in newborns is larger than in adults, the fact that a unit mass of lung in the newborn is less compliant should be due to the smaller volume of its airspaces.
Alterations of airway smooth muscle cell membrane by sensitization
Authors: Souhrada M. , Souhrada J. F.
Published: March 2007

The sensitization of guinea pigs with ovalbumin and Bacillus pertussis vaccine caused an increase (P < 0.001) in the resting membrane potential (Em) of airway smooth muscle (ASM) cells, from −61.3 ± 0.5 mV (± SE) to −72.7 ± 0.6 mV (± SE). One, two, and three weeks after resensitization of sensitized animals with ovalbumin, Em further increased (P < 0.001) to −76.2 ± 0.2 mV (± SE), −77.4 ± 0.3 mV, and −78.1 ± 0.5 mV, respectively. Similarly, both in vivo and in vitro passive sensitization caused an increase (P < 0.001) in Em of ASM cells to −69.5 ± 0.3 mV and −68.5 ± 0.4 mV, respectively. ASM preparations isolated from rabbits showed a similar increase (P < 0.001) in Em after passive in vitro sensitization with serum from ovalbumin‐sensitized rabbits. An increase in the contribution of the electrogenic Na+‐pump was found to be responsible for the observed changes in Em following both active and passive sensitization. The presence of diphenhydramine (anti‐H1), methysergide, indomethacin, 5,8,11,14‐eicosatetraenoic acid (ETYA), FPL 55712 (a leukotriene receptor blocker), phenoxybenzamine, and disodium cromoglycate (a stabilizing agent) during passive in vitro sensitization failed to prevent an increase in the Em of ASM cells. However, incubation of normal guinea pig and rabbit ASM preparations with heated serum (60°C for 2 hours) from ovalbumin‐sensitized guinea pigs or rabbits partially inhibited (in guinea pigs) or completely abolished (in rabbits) such an increase. From these data, it is concluded that the hyperpolarization of ASM cells, as observed after sensitization, seems to result from direct interaction of serum heatsensitive factors (presumably specific antibodies) and ASM cell membrane rather than from the interaction of ASM cells with specific mediator(s) of anaphylaxis. The results suggest that sensitization directly alters the ASM cell membrane.
Apnea and periodic breathing in normal full‐term infants during the first twelve months
Authors: Kelly Dorothy H. , Stellwagen Lisa M. , Kaitz Ellen , Shannon Daniel C.
Published: March 2007

The pediatric pneumogram is a frequently used tool in the diagnosis and management of apnea during infancy. We analyzed 287 pneumographic recordings from 123 full‐term infants (63 males) obtained during the first 12 months of life to establish normative values for apnea, periodic breathing, and bradycardia. The results of the analysis were compared by sex and age. The number of infants who exhibited periodic breathing decreased significantly over time (78% at 0–2 weeks vs 29% at 39–52 weeks; P < 0.05). However, for those infants who did breathe periodically, the percent of sleep time spent in this breathing pattern did not change with age. No apnea ≥ 15 seconds was recorded in any infant, and apnea density (total apnea ≥ 10 seconds in minutes/100 minutes sleep time) did not change with age or sex. Using our definitions, no bradycardia was identified. Normal full‐term infants occasionally have apnea of 10, 11, or 12 seconds, and, until 6 months of age, the majority will have a small amount of periodic breathing (< 1% of sleep time) during sleep at home.
Cardiorespiratory response to physical conditioning in children with bronchial asthma
Authors: Ramazanoglu Yildirim M. , Kraemer Richard
Published: March 2007

The relationship of physical conditioning to changes in static lung volumes (hyperinflation) and airway dynamics (bronchoconstriction) as well as to ventilatory gas exchange, heart rate reserve, breathing reserves, and working capacity at a heart rate of 170/min (WC 170) was evaluated in 23 children (16 girls, 7 boys) between 6 and 15 years of age who had perennial asthma. Lung function tests including incremental cycle ergooxymetry were performed before and after a 15‐week period of regular physical training (RPT). Lung function data obtained after RPT showed a significant improvement (P< 0.05) in both hyperinflation and specific airway conductance, whereas oxygen consumption only increased related to lean body mass and heart rate. However, WC 170 and work tolerance during the endurance phase of the exercise test were significantly increased (P< 0.05 and < 0.01, respectively). In view of the relationship that has recently been found between exercise tolerance and lung mechanics in adults, the decreased hyperinflation and bronchoconstriction observed in our population after RPT is striking. This finding was presumably a consequence of the effect of RPT on breathing technique and chest wall mechanics. Ventilation of the lungs may improve because of mobilization of the costovertebral articulations, inspiratory muscle relaxation, an optimized force‐length relationship of the respiratory muscles, and closer linkage between the diaphragm and intercostal muscles. Therefore, RPT might be an effective addition to standard drug regimens in the management of childhood asthma.
The bronchodilator effect of a fixed‐combination metered aerosol (fenoterol and ipratropium bromide)
Authors: Berdel D. , Kellersmann U.
Published: March 2007

The fixed‐combination metered aerosol IK6 (fenoterol 0.05 mg/puff, ipratropium bromide 0.02 mg/puff‐Berodual, Boehringer‐Ingelheim Ltd., Ridgefield, Conn.) was administered to 12 children (8 boys, 4 girls) aged 3 1/2 to 6 1/12 years who had extrinsic bronchial asthma. Three forms of administration, each with a different site of action, were compared: 1) Two puffs during inspiration. Probable site of action: oral cavity, pharynx, larynx, trachea, and bronchi. 2) Two puffs using an inhalational aid during inspiration. Probable site of action: pharynx, larynx, trachea, and bronchi. 3) Two puffs in the breathing interval after deep inspiration. Probable site of action: oral cavity and pharynx. The resistance of the respiratory system (Rrs) was measured using oscillometry for up to 360 minutes after administration. A significant decrease of the median resistance was found with all three forms of administration. The changes were Form 1–48% of baseline after 120 minutes; Form 2–47.9% of baseline after 60 minutes; Form 3–44.4% of baseline after 30 minutes. The greatest decrease was observed with form 1. The study indicates that significant bronchodilation was achieved in small children using the combination of fenoterol and ipratropium bromide administered by metered aerosol even when inhalation and the release of the puff were not synchronized. A significant bronchodilator effect was also observed in cases of severe bronchial obstruction in which transport of the active ingredients to the lower airways could not be sufficiently guaranteed.
Peripherally inserted central venous catheters for treatment of cystic fibrosis
Authors: Zann Robert L. , Shutack John G. , Schuler Pamela M. , Christie Deborah , Holsclaw Douglas S.
Published: March 2007

Patients who have cystic fibrosis (CF) are frequently hospitalized for long‐term intravenous(IV) treatment. We evaluated clinical effectiveness of the Drum‐Cartridge Catheter (Abbott Laboratories) for such patients. The catheter is placed peripherally under local anesthesia via an antecubital vein into the superiorvena cava or right atrium. Patients who were more than 10 years of age and who were hospitalized for IV antibiotic therapy and/or IV hyperalimentation were studied. All but 2 patients had CF. Using an aseptic technique the catheters were inserted into the basilic or cephalic vein. Chest radiographs were used to confirm the final location of the catheter. Catheters were used to administer IV antibiotics, hyperalimentation, and lipids. There were 38 catheterizations in 23 patients; several patients had repeated insertions at later admissions. The success rate of insertion was 86% with 31 of the 38 insertions initially located either in the superior vena cava or right atrium. Mean duration of catherization was 15.4 days (range 5–49 days). No major complications such as sepsis, catheter or clot embolism, pneumothorax, vascular perforation, or hemorrhage occurred in the patients who had CF. Complications that required catheter removal were thrombophlebitis (1 patient), clot occlusion (1 patient), displacement of catheter into the axillary vein (1 patient), and cracked catheter hub (1 patient). This study shows that the Drum‐Cartridge Catheter can be used easily for IV therapy of patients who have CF for a long duration, repeatedly, and with no major complications.
The accuracy of esophageal pressure measurements in convalescent and sick intubated infants
Authors: Heaf D. P. , Turner H. , Stocks J. , Helms P.
Published: March 2007

Assessment of the esophageal pressure technique for measuring dynamic lung compliance (Cdyn) showed that accurate results were obtained in only 5 of 15 studies of sick intubated infants, whereas they were obtained in 6 of 6 studies of convalescent nonintubated infants. In sick infants, inaccuracy was due to large variations in esophageal pressure change (APes) at different esophageal depths and difficulties validating Pes using the occlusion test. Methods of assessing lung stiffness that depend on the measurement of esophageal pressure are unreliable and should not be used in sick intubated infants.
The functional response of infants with persistent wheezing to nebulized beclomethasone dipropionate
Authors: Maayan C. , Itzhaki T. , Bar‐Yishay E. , Gross S. , Tal A. , Godfrey S.
Published: March 2007

Lung function was measured in nine infants, ages 15‐36 weeks, who had persistent wheezing, apparently following acute bronchiolitis, before and after 2 weeks of treatment with either inhaled nebulized beclomethasone dipropionate (BDP) or placebo in a randomized, double blind, crossover trial. The effect of nebulized albuterol (Salbutamol) was measured before and after the steroid treatment. Thoracic gas volume (TGV) and specific airway conductance (SGaw) were determined using a whole body plethysmograph, and forced expiratory flow at resting lung volume (VmaxFRC) was determined with a thoracoabdominal compression jacket. All infants had marked airways obstruction before treatment with mean ± SE VmaxFRC of 24 ± 4% predicted and SGaw of 37 ± 5% predicted. Two weeks of placebo treatment had no significant effect on lung function, but after 2 weeks of BDP inhalation there was a significant rise in SGaw to 61 ± 7% (P < 0.005). VmaxFRC increased to 42 ± 13% but the difference did not reach significance. Respiratory rate and clinical score for retractions and wheezing also fell significantly with BDP therapy (P < 0.01 and P < 0.001 respectively). Albuterol had no effect on lung function either before or during steroid therapy. Steroids may have a role in the management of persistent wheezing following bronchiolitis.
Bronchial sensitivity to inhaled histamine in healthy, nonatopic children
Authors: Riedel Frank , Hardt Horst von der
Published: March 2007

Bronchial reactivity was determined in 38 healthy children by histamine inhalation challenge using forced expiratory and body plethysmographic methods. The histamine concentrations which produced a 20% decrease in forced expiratory volume in 1 second (PC20, FEv1), were comparable to the concentrations producing a 60% fall in specific airway conductance (PC60,SGaw). There was a significant difference in bronchial reactivity between the healthy children and a group of 29 asthmatic children (P < 0.001), although there was some overlap. Bronchial reactivity in healthy children was found to be much higher than expected from surveys of adults. External influences or intrinsically increased bronchial reactivity in childhood are discussed as possible explanations.
Cardiorespiratory status in long‐term survivors of prematurity, with and without hyaline membrane disease
Authors: Maclusky I. B. , Stringer D. , Zarfen J. , Smallhorn J. , Levison H.
Published: March 2007

Forty‐eight children, born at less than 33 weeks' gestation and without bronchopulmonary dysplasia (BPD) or Wilson‐Mikity syndrome (WM) were studied at a mean age of 9.1 years, to identify the incidence and possible factors contributing to the development of long‐term abnormalities in pulmonary function. As neonates, 30 children had hyaline membrane disease (HMD) of whom 21 required ventilation. Eighteen did not have HMD, of whom 9 required ventilation for nonrespiratory reasons. All patients had grown normally. Four of the 48 (8.3%) had clinical asthma, 5 had persisting chest x‐ray abnormalities (10.6% of 47 chest x‐rays performed), each having been ventilated for HMD. There was a close association between duration of ventilation, oxygen administration, and subsequent abnormal chest x‐ray. Electrocardiogram and M‐mode echocardiograms were normal in all but 2 patients. Only 3 patients had significant restrictive lung disease, 3 had evidence of significant airways obstruction, and 13 (27.7%) had signs of air trapping. Methacholine challenge was positive in 30 of 46 patients (65.2%). The incidence of a positive methacholine challenge did not correlate with history of HMD, duration of ventilation, or high oxygen administration. There is an increased incidence of airway hyperreactivity in survivors of prematurity, not associated with any identified therapeutic maneuver during the neonatal period.
Trapped gas and airflow limitation in children with cystic fibrosis and asthma
Authors: Desmond Katharine J. , Coates Allan L. , Martin James G. , Beaudry Pierre H.
Published: March 2007

Trapped gas (TG) has been shown to be present in cystic fibrosis (CF) and asthma, but its relationship with airflow limitation (AL) has not been explored. TG was defined as the difference between the functional residual capacity measured by body plethysmography [FRC(BP)] and that measured by helium dilution [FRC(He)] expressed as a percentage of total lung capacity (TLC). We studied 21 children with CF and 15 with asthma who had a similar degree of AL and hyperinflation, however the children with CF had greater amounts of TG compared with asthma [15% ± 2 (mean ± 1SE) vs 8 ± 2, P < 0.05]. Mixing efficiency (ME), an index of the distribution of ventilation, was found to be lower in the CF children than in those with asthma (34 ± 4 vs 54 ± 4). In CF, TG correlated with forced expiratory flow between 25 and 75% of vital capacity (FEF25‐75), ME, RV/TLC, and maximal expiratory flow rates at 25 and 50% of vital capacity (V̇max25 and 50, respectively; r = −0.66, −0.61, 0.72, −0.71, −0.74). ME also correlated with the above measures. In asthma, TG did not correlate with the FEF25‐75, ME, RV/TLC, V̇max25, or V̇max50. Furthermore, TG was frequently found in patients with asthma with moderate AL while it was often absent in patients with severe AL. For both CF and asthma, neither the severity of AL nor the magnitude of the TG could be predicted from the increase in V̇max 50 with helium (ΔV̇50). In CF, TG and ME correlated, thus allowing for an assessment of the validity of FRC(He) in determining hyperinflation. In asthma, the presence or absence of TG could not be anticipated from tests of ME or AL, and hence the validity of FRC(He) in determining hyperinflation could not be anticipated.
Magnetic resonance imaging of inflammatory lung disorders: Preliminary studies in children
Authors: Cohen Mervyn D. , Cory David A. , Smith John A. , Eigen Howard , Scott Peter H. , Tepper Robert , Scales Richard L.
Published: March 2007

Magnetic resonance (MR) scans were performed on 14 children with a variety of inflammatory disorders of the lungs. MR successfully identified disease in all of the children and accurately localized the disease within the lung fields. In patients with pneumonia and luns abscesses the acute inflammation was associated with a marked increase in signal intensity on T2 when compared with T1 weighted images. One patient with an inflammatory pseudotumor demonstrated a smaller increase in signal intensity on T2 weighted images than was seen in acute pneumonia. Abscess cavities were well identified along with the wall thickness. In patients with diffuse lung disease (diffuse histoplasmosis, miliary tuberculosis, Letterer‐Siwe disease, and allergic alveolitis), each disease appeared different on the MR images. These preliminary studies indicate that magnetic resonance imaging is effective for identifying pulmonary disease in children and may improve the radiologist's ability to differentiate pulmonary disorders.
A comparison of proximal and distal high‐frequency jet ventilation in an experimental animal model
Authors: Bandy Kenneth R , Nicks Joanne J. , Donn Steven M. , Naglie Ronald A.
Published: March 2007

High‐frequency jet ventilation using either a proximal or a distal endotracheal injection site through a triple‐lumen endotracheal tube was studied in 10 adult cats. The comparative effects on pulmonary gas exchange, tracheal pressure, heart rate, and blood pressure were examined for each injection site at both high (8–12 pounds per square inch [PSI] and low (5–8 PSI) jet‐driving pressures in normal and lung‐injured cats. Lung injury was created by modification of a surfactant washout technique previously demonstrated in rabbits. Alveolar ventilation (Paco2) was found to be significantly better with distal than with proximal jet injection under all experimental conditions. At high jet‐driving pressures, peak inspiratory pressure was higher in both normal (p = 0.03) and lung‐injured cats (p = 0.002) with distal high‐frequency jet ventilation. In addition, lung‐injured animals were observed to have higher distal mean airway pressures at high jet‐driving pressures (p < 0.01). No differences in oxygenation were found in any circumstances. The results of this animal study suggest that distal high‐frequency jet ventilation may be more effective in those situations in which improvement in alveolar ventilation is the major goal and that during proximal high‐frequency jet ventilation airway pressures should be monitored as far distally as possible.
Aerosolized metaproterenol compared to subcutaneous epinephrine in the emergency treatment of acute childhood asthma
Authors: Ruddy Richard M. , Kolski Gerald , Scarpa Nina , Wilmott Robert
Published: March 2007

In a double‐blind, randomized trial, we compared the effects of aerosolized metaproterenol to subcutaneous epinephrine in 35 episodes of acute asthma in children between 6 and 19 years of age. Patients were randomized to two parallel groups and then received both a placebo medication and an active medication to a maximum of three treatments. Repeated treatments were given to 15 patients on metaproterenol and 12 patients on epinephrine. Initial improvement in PEFR and FEV, were statistically significant and comparable in both groups. Patients receiving a second metaproterenol treatment had more improvement in respiratory rate and clinical score compared with those in the epinephrine group. There were fewer treatment failures in the metaproterenol group. Follow‐up at 24 to 48 hours showed significant treatment failure differences between the two groups (metaproterenol = 0, epinephrine = 5; p < 0.05). Side effects were similar in both groups; in all instances they were mild, and their frequency did not increase in patients receiving repeated doses of medications. In conclusion, aerosolized metaproterenol was well tolerated in acute childhood asthma in repeated doses, and it appeared to be associated with prolonged bronchodilation and improved outcome.
Breast feeding and maternal smoking as predictors of wheezing in children age 6 to 10 years
Authors: McConnochie Kenneth M. , Roghmann Klaus J.
Published: March 2007

The possibility that controllable environmental factors such as passive smoking and non‐breast feeding contribute substantially to wheezing has implications for prevention. Effects of passive smoking and non‐breast feeding on wheezing in children aged 6 to 10 years were explored in a historical cohort study of 223 children. Family history of respiratory allergy or asthma, male sex, maternal smoking, and non‐breast feeding were significantly associated (p < 0.05) with wheezing in bivariate analysis. In multivariate loglinear analyses, predictors of wheezing included non‐breast feeding (p = 0.05, odds ration = 2.1), male sex (p< 0.03, odds ratio = 3.1), and family history of respiratory allergy (p < 0.03, odds ratio = 2.6). In a second model, predictors included an interaction of maternal smoking and family history (p < 0.005, odds ratio = 4.6) in addition to male sex and family history of respiratory allergy. In further exploration based on tabular analysis, maternal smoking appeared to increase wheezing among children in whom the family history of respiratory allergy was positive (p < 0.001). Among children in whom the family history of respiratory allergy was negative, non‐breast feeding appeared to increase wheezing (p = 0.01). Promotion of breast feeding and reduction of maternal smoking might reduce childhood wheezing.
Effect of a beta‐agonist nebulization on lung function in neonates with increased pulmonary resistance
Authors: Rio Maria Gomez‐Del , Gerhardt Tilo , Hehre Dorothy , Feller Rosalyn , Bancalari Eduardo
Published: March 2007

Pulmonary resistance is elevated early in preterm infants who later develop chronic lung disease. This early increase in pulmonary resistance may play a role in the development of severe bronchopulmonary dysplasia (BPD)

A β‐2‐agonist (isoetharine HCI) was used as an aerosol in 13 preterm infants with elevated pulmonary resistance. Their birthweight ranged from 880 to 1630 g, their gestational age from 27 to 34 weeks, and their post natal age from 3 to 18 days. All infants had required mechanical ventilation for respiratory distress syndrome and therefore were at risk to develop BPD. Pulmonary mechanics were measured before and 30 minutes after aerosol treatment, determining inspiratory and expiratory flow with a pneumotachometer and esophageal pressure through a water‐filled feeding tube. The treatment was well tolerated with no significant changes in blood pressure, heart rate, or respiratory rate. Pulmonary resistance decreased significantly from 130 ± 35 cm H2O/L/sec to 89 ± 24 cm H2O/L/sec after the treatment. Dynamic lung compliance increased in 11 of the 13 infants. It is concluded that β‐2‐agonist nebulization is effective in reducing the early increase in pulmonary resistance that occurs in preterm infants who are at risk of developing BPD. This effect may be due to relaxation of bronchial smooth muscle, to improved mucociliary transport, and to a reduction in peribronchial edema.
A Study of spirometry in children from Mexico City
Authors: Namihira Delia , Fernandez Federico , Strope Gerald L. , Helms Ronald W. , Pekow Penny , Bojalil Bonfiglio Munoz
Published: March 2007

A study was conducted in two elementary schools in Mexico City to determine values for pulmonary function tests in school‐aged residents of Mexico City. The schools were located in Xalostoc, a highly industrialized area of Mexico City, and San Lorenzo, a suburban area of the city. Although data regarding atmospheric pollution were not available, there is an acknowledged higher level of macroenvironmental air pollution in Xalostoc. Pulmonary function tests were performed on 468 children in San Lorenzo and 405 children in Xalostoc. No differences between residents of the two communities for acute or chronic respiratory conditions were detected by questionnaire. The pulmonary function data demonstrate that boys have larger forced vital capacities (FVC) and forced expiratory flows over the middle half of the FVC (FEF25‐75) than girls. Slopes of regression lines for FVC but not for FEF25‐75 are greater in boys and girls from Xalostoc than in boys and girls from San Lorenzo. This suggests that young children from Xalostoc may experience ill effects of air pollution but develop catch‐up growth later. There were no important community or gender effects on slopes of regression lines for height and weight on age. In general, the regression lines for FVC and FEF25‐75 were below regression lines reported for children of Mexican ancestry living at sea level.
Longitudinal study of lung mechanics in normal infants
Authors: Masters I. B. , Seidenberg J. , Hudson I. , Phelan P. D. , Olinsky A.
Published: March 2007

Lung mechanics and partial forced expiratory flows were measured serially in seven normal infants during the first year of life. Lung mechanics were measured by the end inspiratory occlusion technique and partial forced expiratory flows by the rapid chest compression method. Thoracic gas volume, compliance, and partial forced expiratory flows measured at functional residual capacity progressively increased with age and correlated with height cubed. Respiratory system resistance progressively fell whereas volume‐corrected flows remained fairly constant over the study period. These findings provide longitudinal lung function data and support the concept of isotropic lung growth. Pediatr Pulmonol 1987; 3; 3–7.
Bronchodilating activity of oral clenbuterol in asthmatic children after single administration of different dosages
Authors: Boner A. L. , Bennati D. , Castellani C. , Sette L. , Schiassi M.
Published: March 2007

The dose‐response activity of clenbuterol, a new long‐acting β2‐agonist, was evaluated in 12 children aged 5 to 11 years with moderate to severe asthma. The study was a double‐blind cross‐over comparison of three oral dose levels: 0.5, 1.0, and 1.5 μg/kg and placebo all in the form of syrup. Pulmonary function, heart rate, blood pressure, and tremor were evaluated at 30, 60, 90, and 120 min, then hourly for 8 hr, following the ingestion of the drug. The bronchodilating effect of clenbuterol, evaluated as percentage changes in expiratory flow rates was significantly different from placebo. The overall fall‐off in the effect of 1.0 μg/kg and 1.5 μg/kg doses after 8 hr was small. The results of the 1.0 μg/kg dose often overlapped those of the 1.5 μg/kg dose, suggesting that a single 1.0 μg/kg dose of clenbuterol is most advisable in children, assuring the most favorable risk/benefit ratio. Even the highest dose of clenbuterol caused only a marginal increase in tremor, not statistically different from that induced by placebo. Pediatr Pulmonol 1987; 3; 34–37.
Lung function and bronchial responsiveness in children who had infantile bronchiolitis
Authors: Duiverman E. J. , Neijens H. J. , van Strik R. , Affourtit M. J. , Kerrebijn K. F.
Published: March 2007

A number of studies have shown that children who had infantile bronchiolitis are at increased risk of recurrent episodes of wheezing. A genetic predisposition to atopy is mentioned in some studies and is contested by others. Lung function abnormalities and increased bronchial responsiveness (BR) have been described after infantile bronchiolitis. We investigated children who had had the clinical syndrome of bronchiolitis during infancy and compared them with asthmatic and healthy children of the same age regarding bronchial caliber, smooth muscle tone, and responsiveness to histamine. Lung function was measured by forced oscillometry. We found that most children with current symptoms had either decreased baseline bronchial caliber, increased bronchial smooth muscle tone, or increased BR. These patients are comparable to mild asthmatics. The children without current symptoms are comparable to healthy children in these respects. Recurrent respiratory symptoms after bronchiolitis should be regarded as mild asthma and treated as such. Pediatr Pulmonol 1987; 3; 38–44.
Comparison of the occlusion and inflation techniques for measuring total respiratory compliance in sick, intubated infants
Authors: Heaf D. P. , Turner H. , Stocks J. , Helms P.
Published: March 2007

Respiratory system compliance (Crs) can be used to assess lung stiffness in sick, intubated infants, avoiding the use of an esopnageal balloon. Crs was assessed in a group of 15 sick, intubated infants using the occlusion and inflation techniques. The occlusion technique gave satisfactory results in 13 infants. Apneic pauses following occlusion were obtained in infants up to 10 months of age. Satisfactory measurements of Crs were obtained in all 15 infants usinq the inflation technique, but difficulty was experienced in obtaining data over the tidal volume range in three of them. A close agreement was found between the two methods of measuring Crs in the ten infants in whom a direct comparison was possible. Pediatr Pulmonol 1987; 3:78–82.
Effects of nebulized fenoterol, associated with ipratropium or steroids, on the heart rate of infants under one year of age with acute wheezing
Authors: Mallol Javier , Muñoz Ricardo , Puppo Homero , Ulloa Victor , Toro Olivia , Girardi Guido , Barrueto Luis
Published: March 2007

The main objective of this study was to evaluate the effect of fenoterol alone or associated with ipratropium bromide or steroid on the heart rate in young children. Ninety‐four infants less than 1 year of age were randomly allocated to receive nebulized fenoterol alone, fenoterol plus ipratropium bromide, fenoterol plus corticosteroids, or normal saline solution. An increase in heart rate was observed in all four groups. The increases were statistically significant (P < 0.001) in all three treatment groups, and no difference between them was observed (F = 0.65, NS). However, the heart rate remained within clinically acceptable limits. We conclude that nebulized fenoterol alone or combined with ipratropium or steroids can be safely used in the treatment of wheezy infants. Pediatr Pulmonol 1987; 3:83–85.
Therapeutic evaluation of piperacillin for acute pulmonary exacerbations in cystic fibrosis
Authors: Reed Michael D. , Stern Robert C. , Myers Carolyn M. , Klinger Jeffrey D. , Yamashita Toyoko S. , Blumer Jeffrey L.
Published: March 2007

The efficacy and pharmacokinetics of piperacillin monotherapy were studied in 46 patients with cystic fibrosis. Two patients were dropped from the study within 24 hr of enrollment because of drug‐associated nausea and vomiting. Initially fourteen older patients (> 12 years) receiving piperacillin 450 mg/kg/day underwent a preliminary evaluation. Based on the results, 30 younger patients (⩽ 12 years) randomized in a double‐blind fashion received either 600 or 900 mg/kg/day of piperacillin in six divided doses. Pharmacokinetic parameter estimates for t1/2, Vdss, and Cl were similar for first dose and steady‐state evaluations. In 27 patients, approximately 43% of the administered dose was recovered in the urine after 4 hr. Piperacillin CiR averaged 49% of the total Cl. No difference in overall clinical efficacy could be identified between 600 and 900 mg/kg/day of piperacillin using two different objective scoring systems. Although a reduction in sputum Pseudomonas colony counts was greater following the 900 mg/kg/day regimen, this appeared to be independent of clinical effect. In 14 patients (32%), a distinct adverse serum‐sicknesslike reaction was observed. The incidence of this reaction appeared to increase as the dose of piperacillin increased. All signs and symptoms of this reaction resolved within 36 hr of discontinuing piperacillin administration but recurred immediately on rechallenge in four patients. All patients with the adverse reaction were subsequently treated with β‐lactam antibodies without ill effect. Overall, clinical improvement appeared to be independent of the piperacillin dose. Our data support the use of total daily piperacillin dosages not exceeding 600 mg/kg. Pediatr Pulmonol 1987; 3:101–109.
Changes in cerebrospinal fluid homovanillic acid in children with Ondine's curse
Authors: Hedner J. , Hedner T. , Breese G. R. , Lundell K. H. , Lundberg D. , Lundström N. R. , Østergaard E. , McCown T. J. , Mueller R. A.
Published: March 2007

The cerebrospinal fluid (CSF) concentrations of three acid monoamine metabolites, two purines, and a group of amino acids were determined in two children with chroniccentral alveolar hypoventilation (Ondine's curse). The levels of all assayed neuroactive substances, metabolites, and amino acids, with one exception, were normal compared to an age‐matched group of neurologically healthy children. The levels of the dopamine metabolite homovanillic acid in the children with Ondine's curse were approximately 2.4 times higher than expected for age range. The present findings may indicate a link between central nervous system dopamine activity and chronic central alveolar hypoventilation. Among other possible explanations, the changes seen might represent a primary alteration in dopamine activity or may reflect a change in dopamine turnover resulting from the chronic hypoventilation. Pediatr Pulmonol 1987; 3:131–135.
Acute bronchiolitis: Predisposing factors and characterization of infants at risk
Authors: Carlsen Kai‐HÅKon , Larsen Stig , Bjerve ØIvind , Leegaard Jens
Published: March 2007

Fifty‐one infants hospitalized because of acute bronchiolitis and 24 control children were prospectively followed until 2 years of age. Respiratory syncytial virus was detected initially in 31 index children parainfluenza virus in two, and rhinovirus in one. More index children were born during the months April through September, and six index children had neonatal respiratory complications. The index children were breast‐fed for shorter periods, lived in more crowded homes, and had more siblings. No significant differences were found for atopic background and atopic illness at 2 years of age. The index children had more respiratory infections and episodes of bronchopulmonary obstruction during the follow‐up period (60% with three or more episodes). To characterize the hospitalized children, a discriminant analysis was performed. A discriminant function classified 47 of 51 index children as belonging to the index group and 21 of 24 control children to the control group.
Sodium cromoglycate and carbachol‐induced bronchoprovocation in asthmatic children
Authors: Barbato A. , Pisetta F. , Mesirca P. , Ragusa A. , Zacchello F.
Published: March 2007

Ten children with mild bronchial asthma underwent bronchial challenge with carbachol on three consecutive days; using a double‐blind technique, they were given inhaled saline placebo on the first day and placebo or sodium cromoglycate (SCG) on the second and third days 15 min prior to the bronchial provocation test with carbachol. We did not find any significant difference between the baseline and placebo values, but we did obtain a statistically significant difference when comparing baseline with post‐SCG and placebo with post‐SCG values. These results demonstrate a protective effect of SCG on carbachol‐induced bronchospasm in asthmatic children.
Is there a place for rigid bronchoscopy in the management of pediatric lung disease?
Authors: Godfrey S. , Springer C. , Maayan C. H. , Avital A. , Vatashky E. , Belin B.
Published: March 2007

A review of 364 rigid bronchoscopies in children is presented of whom 55% were younger than 3 years old. The commonest diagnoses in the under 1 year old group were related to congenital anomalies, in the 1–3 year group to inhaled foreign bodies, and in the over 3 year group to bronchiectasis. It is noted that some 30–40% of the tests could have been undertaken with a flexible bronchoscope, but it is suggested that the advantages of the flexible instrument in children with lung disease, as distinct from upper airway disease, are less than in adult practice. Clear benefits for the management of the patient should be obvious before undertaking bronchoscopy in children, and careful consideration should be given to the type of instrument most likely to provide the results desired.
Hypercarbic ventilatory responses of infants at risk for SIDS
Authors: Coleman J. Michael , Mammel Mark C. , Reardon Christine , Boros Stephen J.
Published: March 2007

We examined the hypercarbic ventilatory responses (HVR) of 143 infants at risk for sudden infant death syndrome (SIDS) and 34 normal control infants. Sixty‐five of the atrisk infants had experienced apparent life‐threatening events (ALTE), and 78 were siblings of SIDS victims. Twenty‐three (35%) of the ALTE infants experienced subsequent apnea; one died of SIDS. Seven (9%) of the SIDS siblings experienced subsequent apnea; two ultimately died of SIDS. In the HVR studies, we measured tidal volume (VT), minute ventilation (VE), frequency of breathing (f), and end‐tidal PCO2 (PETCO2) at rest and while breathing 2% and 4% CO2. Mean HVR values for the ALTE, sibling, and control groups were all similar. The mean HVR values for those at‐risk infants who experienced subsequent apnea were not different from those who did not experience subsequent apnea. However, those infants experiencing subsequent apnea had higher mean VT/kg values (P < 0.01) and lower mean PETCO2 values (P < 0.001) than those who did not. The SIDS siblings had significantly lower resting VT/kg values than either the near‐miss infants or normal controls (P < 0.01).

We did not find depressed HVR values in infants at risk for SIDS. On the contrary, those infants who experienced subsequent apnea had evidence suggesting relative hyperventilation. SIDS siblings had evidence suggesting relative hypoventilation. These findings are interesting and thought‐provoking. However, HVR studies do not appear to be sensitive, specific, or appropriate for the general screening of infants at risk for SIDS.
Changing patterns in neonatal respiratory diseases
Authors: Field D. J. , Milner A. D. , Hopkin I. E. , Madeley R. J.
Published: March 2007

Using the current Nottingham Health District, England, as a geographically defined population we have investigated the changing patterns of neonatal respiratory diseases. We have categorized all newborns who developed a respiratory problem during either 1977 or between April 1, 1983, and March 31, 1984 using a system based on that of Hjalmarson (Acta Paediatr Scand 1981; 70:773–783). There has been no change in the incidence of any of the disease types. However, the gestation of babies in two groups, idiopathic respiratory distress syndrome (IRDS) and minimal respiratory disturbance (requiring added oxygen for less than 6 hours), has shown a significant reduction. Overall, mortality for infants developing IRDS has shown a slight decrease, and for infants between 29 and 32 weeks gestation, mortality has shown a significant reduction. Overall, requirements for oxygen therapy and ventilation have shown a threefold increase, while hours in receipt of continuous positive airways pressure (CPAP) have increased sevenfold.
Pulmonary function at 1 year of age in survivors of neonatal respiratory distress: A multivariate analysis of factors associated with sequelae
Authors: Moriette G. , Gaudebout C. , Clement A. , Boule M. , Bion B. , Relier J. P. , Gaultier C.
Published: March 2007

We studied pulmonary function 1 year after neonatal respiratory distress (RD) in 54 infants who had been treated at birth in the same neonatal intensive care unit. RD was related to hyaline membrane disease in 36 cases (group 1) and to other causes in 18 cases (group II). Compared with predicted values, dynamic lung compliance (CL) was lower (< −2 SD) and total pulmonary resistance (RL) was higher (+ 2 SD) in 18 (33%) and 12 (22%) infants, respectively. The relationships between these functional abnormalities at 1 year of age and the characteristics of the neonatal respiratory disease were assessed using a multifactorial analysis (multiple correspondences analysis). We found that elevated RL (> +2 SD) at 1 year of age was very significantly related with hyaline membrane disease, involving both high rate of positive pressure ventilation and prolonged intubation, and with the presence of both tachypnea and abnormal chest X rays at the time of discharge. Compared with elevated RL, the relationships between low CL (< −2 SD) and the same neonatal characteristics were less significant; in particular, there was no strong link between low CL and hyaline membrane disease. Finally, birth before 30 weeks gestation was an index of severity.
Effect of sleep state on chest wall movements and gas exchange in infants with resolving bronchopulmonary dysplasia
Authors: Rome Ellen S. , Miller Martha J. , Goldthwait David A. , Osorio Ivan O. , Fanaroff Avroy A. , Martin Richard J.
Published: March 2007

During active sleep, neonates exhibit asynchronous chest wall movements, which have been associated with a small but significant decrease in oxygenation. To determine the effects of maturation and residual chronic lung disease on both these phenomena, we studied 11 preterm infants with resolving bronchopulmonary dysplasia (BPD) and compared these infants to ten healthy preterm infants all at time of discharge. Synchrony of chest wall (upper rib cage and abdominal) movements, sleep state, O2 saturation, and transcutaneous CO2 (TcPco2) were recorded during both active (AS) and quiet sleep (QS). Sleep state was determined by electroencephalographic and behavioral criteria. Normal preterm infants displayed asynchronous chest wall movements only in AS, whereas, in infants with BPD, asynchrony predominated in both sleep states, although O2 saturation and TcPco2 did not differ between sleep states in either group. The O2 saturation during AS was lower in the BPD group than in the group of normal infants (92% vs 96%; P < 0.02), whereas TcPco2 was higher in the BPD group unrelated to sleep state. We conclude that infants with resolving BPD exhibit asynchronous chest wall movements in both AS and QS, and that change in sleep state from QS to AS is not associated with a detrimental fall in oxygenation in these infants.
Are sex, age at diagnosis, or mode of presentation prognostic factors for cystic fibrosis?
Authors: Hudson Irene , Phelan P. O.
Published: March 2007

Data on 622 patients with cystic fibrosis born in Victoria, Australia from 1955 to 1980 and on 344 surviving patients in the care of a specialist clinic on June 30, 1983 were analyzed for factors associated with better survival and a less rapid progress of lung disease. Presentation with predominantly gastrointestinal symptoms, other than meconium ileus, was associated with an improved prognosis, whereas presentation with predominantly respiratory symptoms was associated with a worse prognosis. While infants diagnosed before the age of 6 months as a result of routine testing because of a family history of the disease seemed to have less rapid progress of lung disease, their ultimate survival did not seem to be better than that of patients presenting symptomatically after the newborn period. The sex of the patients did not appear to have prognostic significance. Age at diagnosis did not affect rate of progress of lung disease or survival when infants dying within 6 months of birth were excluded. There was a close association between the extent of lung disease at diagnosis and current lung disease. Failure to reverse extensive disease at diagnosis or deterioration of lung disease in the first year after diagnosis was associated with a less favourable course.Pediatr Pulmonol 1987; 3:288–297.
Recovery from hypopnea in preterm lambs: Effects of breathing air or oxygen
Authors: Hutchison Alastair A.
Published: March 2007

The aim of this study was to determine if resuscitation from hypopnea when breathing oxygen resulted in a slower recovery than that seen when breathing room air. Hyperoxia, in preterm human neonates and lambs, decreases minute ventilation (V̇I), but no study has shown this effect during recovery from apnea or hypopnea, a common clinical setting. Thus, recovery from hypopnea was studied in eight unanesthesized preterm lambs, breathing spontaneously via an endotracheal tube placed into a tracheostomy. Hypopnea, defined here as a decrease in V̇I from baseline greater than 50%, was induced by instillation of distilled water onto the larynx. After a baseline 30 sec when V̇I heart rate, and arterial blood gas were measured, a standard hypopnea stimulus was given over 30 sec. The lambs then breathed air or oxygen during a 2‐min recovery period, which started with 15 sec of artifical ventilation. The degree of recovery at 2 min was less in the oxygen (O2) breathing group: V̇I (ml/kg/min) = 381 ± 27 in air and 270 ± 18 in O2, P < 0.01; pH = 7.38 ± 0.005 in air and 7.34 ± 0.008 in O2, P < 0.01; arterial carbon dioxide tension (Pa mrnHg) = 45.0 ± 1.3 in air and 49 ± 1.3 in O2 P < 0.01; base excess = 2.1 ± 0.6 in air and 1.1 ± 0.5 oxygen, P < 0.01. By 2 min a return to baseline values of V̇I, pH, and Pa was noted only in the air breathing group, where the arterial oxygen tension also returned to normal. The heart rate recoveries at 2 min were not different and, in both groups, were less than their baseline values. Resuscitation with O2 in contrast to room air, delays ventilatory recovery from hypopnea. Pediatr Pulmonol 1987; 3:317–323.
Bronchiolar obstruction associated with repeated aspiration of vegetable material in two children with cerebral palsy
Authors: Gadol Charles L. , Joshi Vijay V. , Lee Eun Young
Published: March 2007

Chronic reactive bronchiolar obstruction has not been noted to occur with repeated aspiration of food materials. In this report, we describe two autopsy cases of children aged 8 years and 22 months with cerebral palsy, one with documented and treated esophageal reflux, and both with histories of repeated aspiration pneumonia. In each case, the lungs showed multiple nodules of hyalinized tissue and organized exudate obstructing the bronchiolar lumina, with multinucleated foreign body‐type giant cells surrounding intraluminal vegetable particles. It is suggested that chronic bronchiolar obstruction was a significant contributing cause of respiratory insufficiency and consequent morbidity in these patients with cerebral palsy.
Forced vital capacity and maximal respiratory pressures in patients with mild and moderate scoliosis
Authors: Szeinberg Amir , Canny Gerard J. , Rashed Nashed , Veneruso Giuseppina , Levison Henry
Published: March 2007

Summary. Lung function and maximal respiratory pressures of 24 adolescent females with mild‐to‐moderate idiopathic scoliosis (spinal curvature 10‐60°) were determined and compared with 38 age‐ and sex‐matched controls. Twelve patients with moderate scoliosis (Cobb angle 35‐60°) had significantly reduced mean values for FVC (% predicted) and maximal inspiratory pressure (MIP), as compared to the controls. Twelve patients with mild scoliosis (Cobb angle <35°) had normal mean values for FVC and maximal respiratory pressures, but five individual patients had FVC values less than 80% predicted. All but one of the patients with mild scoliosis had normal MIP values. FVC (% predicted) was significantly correlated with the degree of spinal curvature (r = ‐0.466; P<0.05) but was not related to MIP. These results indicate that reduced FVC values do occur in patients with mild‐to‐moderate idiopathic scoliosis and suggest that these low FVC values can be attributed to the rib cage deformity rather than to an inability to generate adequate inspiratory pressures.