bluuebunny/crossref_metadata_2025 huggingface dataset:
Formoterol and salbutamol metered aerosols: Comparison of a new and an established beta‐2‐agonist for their bronchodilating efficacy in the treatment of childhood bronchial asthma
Authors: von Berg Andrea , Berdel Dietrich
Published: March 2007

In this placebo‐controlled, double‐blind, single‐dose study the new beta‐2‐agonist formoterol (one puff, 12 μg) was intraindividually compared with salbutamol (one puff, 100 μg) for onset, magnitude, and duration of bronchodilating efficacy in 15 young asthmatics aged 5 to 14 years with mild to severe asthma. All but one had regular antiasthmatic medication before beginning the study, but none was oral steroid dependent. Both medications produced rapid bronchodilatation within 10 minutes, reflected by a decrease in specific airway resistance (sRaw) with maximum effects at 10 minutes (salbutamol, 51%) and 30 minutes (formoterol, 60%). Significant bronchodilation was present at 10 minutes to 2 hours after inhalation of salbutamol and at 30 minutes to 8 hours after formoterol. Mean percent improvement over baseline was higher for formoterol at all measured times from 30 minutes to 12 hours, when 55% mean decrease in sRaw was still present. The effect of salbutamol was a less than 10% mean decrease in sRaw after 6 hours. The differences in sRaw decrease between the two medications were statistically significant at 4 to 10 hours after inhalation. Neither medication administered as an aerosol caused cardiac side effects. Both had a rapid onset of action and a comparable maximal effect. However, at the doses studied, formoterol produced a larger decrease in sRaw from baseline for longer periods after inhalation than did salbutamol. Pediatr Pilmonol. 1989; 7:89–23.
Fiberoptic bronchoscopy in the neonate
Authors: Finer Neil N. , Etches Philip C.
Published: March 2007

Over a 37 month period 113 flexible fiberoptic bronchoscopies were perfomed in 77 neonates, using a variety of instruments. Thirty‐six examinations were done via an endotracheal tube or tracheostomy. In addition to elective examination of the infant's airway, bronchoscopy has been found valuable in the management of emergency situations such as suspected tube blockage or malposition and difficult intubations. A video recording system is useful for teaching and documentation of abnormal findings. Pediatr Pilmonol. 1989; 7:116–120.
Clinical characteristics of respiratory syncytial virus infections in healthy versus previously compromised host
Authors: Meert Kathleen , Heidemann Sabrina , Lieh‐Lai Mary , Sarnaik Ashok P.
Published: March 2007

In an effort to delineate the clinical characteristics of respiratory syncytial virus (RSV) infection in the compromised host, we compared children with bronchopulmonary dysplasia (BPD), congenital heart disease (CHD), premature birth, failure to thrive, and gastro‐esophageal reflux to previously healthy children. During a four‐year period, 262 patients were admitted to the hospital with RSV infection diagnosed by a rapid RSV antigen detection test. Children with BPD or CHD had more hospital days and supplemental oxygen days than the previously healthy group (P < 0.05). Patients with BPD also had more ICU days, ventilator days, and NPO days, as well as a higher physiologic stability index and therapeutic intervention score than the previously healthy group (P < 0.05). Premature infants were more likely to present with apnea from RSV (P < 0.001). Patients with underlying illness tended to be older, although significant difference was demonstrated only for the BPD group (7.0±5.3 vs. 3.5±3.3, P < 0.05). Patients with BPD and CHD had more nosocomial infections than the previously healthy group (P < 0.0001) and death occurred only in patients with underlying illness. We conclude that previously compromised patients are at risk for more severe and prolonged RSV disease. Earlier diagnosis and therapeutic intervention may be necessary in such patients to improve outcome.Pediatr Pulmonol. 1989; 7:167‐170.
Treatment of Pseudomonas lung infection in cystic fibrosis with piperacillin plus tobramycin versus ceftazidime monotherapy: Preliminary communication
Authors: de Boeck K. , Smet M. , Eggermont E.
Published: March 2007

Twenty‐one patients with cystic fibrosis and chronic Pseudomonas lung infection were treated at random with ceftazidime, 150 mg/kg/day, or with piperacillin, 300 mg/kg/day, and tobramycin, 10 and more mg/kg/day for 14 days. On admission and at discharge, body weight, erythrocyte sedimentation rate, white blood cell count, and differential were determined. Pulmonary function analysis and chest X‐rays were also obtained on both occasions as was sputum bacteriology. After hospitalization, the patients were followed in the outpatient department for 14–26 months. Both treatments were associated with significant improvement in most of the parameters that were studied, but neither treatment was superior. Pediatr Pilmonol. 1989; 7:171–173.
Determining optimum inspiratory time during intermittent positive pressure ventilation in surfactant‐depleted cats
Authors: Mammel Mark C. , Boros Stephen J. , Bing Dennis R. , Holloman Keith K. , Connett John R.
Published: March 2007

This study compares two methods of selecting inspiratory time (Ti) during mechanical ventilation. One selects a standard Ti producing a brief inspiratory pressure plateau (P). The other uses simultaneous pressure, flow and tidal volume (VT) waveforms, generated by a computer‐assisted lung mechanics analyzer, to reduce Ti to the point where Vt ceases to accumulate and flow returns to zero. This method does not produce a pressure plateau (NP). Following saline lung washout, ten intubated, paralyzed surfactant‐depleted cats were ventilated with pressure‐preset infant ventilators at constant measured VT and rates. Five animals were initially ventilated with P (Ti = 0.98±0.02 s) and five with NP (Ti = 0.77±0.10 s). Ti was then varied to produce P or NP by using a four‐period crossover design. All other ventilator variables remained constant. Intravascular pressures, thermodilution cardiac outputs, arterial and mixed venous blood gases and oxygen saturations, airway pressures, Ti, VT, and gas flows were measured; respiratory system mechanics, alveolar‐arterial oxygen gradients, and intrapulmonary shunts were determined for each study period. When P and NP states were compared, only mean airway pressures differed (10.1 vs. 8.9 cmH2O; P<0.001). Blood gas values, intravascular pressures, cardiac output, and respiratory system mechanics were all similar. Under the conditions of this study, there was no advantage to prolonging Ti beyond the point where VT ceased to accumulate. Pediatr Pulmonol 1989; 7:223–229.
Safety of aerosol tobramycin administration for 3 months to patients with cystic fibrosis
Authors: Smith Arnold L. , Ramsey Bonnie W. , Hedges Donna L. , Hack Barbara , Williams‐Warren Judy , Weber Allan , Gore Edmond J. , Redding Gregory J.
Published: March 2007

To determine the potential toxicity of prolonged aerosol tobramycin administration, 22 patients with cystic fibrosis were monitored while receiving inhaled tobramycin three times a day for 12 weeks. Prior to, four times during administration and approximately 6 weeks after discontinuation of treatment, we assessed pulmonary function, weight, height, body temperature, eighth cranial nerve function, serum creatinine, blood urea nitrogen, urinary creatinine clearance, plasma iothalamate clearance, urinary β‐2 microglobulin concentration, and Pseudomonas aeruginosa density in sputum. There was no detectable laboratory evidence of nephrotoxicity. Neither a decrease in auditory acuity (range 250–20,000 Hz) nor vestibular dysfunction was detected. Pulmonary function tests significantly improved during the first month in all subjects (P < 0.05) but returned to enrollment values by the end of the 12th week of administration of tobramycin aerosol. Sputum P. aeruginosa density initially decreased from a mean of 107 cfu/gm to a mean of 104 cfu/gm after 2 weeks of aerosol tobramycin administration and remained significantly below the enrollment value throughout. Coincident with the reduced bacterial density, a reduction in cough frequency and sputum production, as well as a weight gain was observed. Seventy‐three percent of the patients with sputum P. aeruginosa isolates susceptible to tobramycin on enrollment yielded resistant organisms during aerosol administration. However, 1 year later all sputum P. aeruginosa isolates obtained from patients were susceptible to tobramycin. We conclude that thrice daily aerosol tobramycin administration for 3 months is not associated with detectable eighth cranial nerve or renal toxicity. Transient emergence of tobramycin resistant P. aeruginosa may occur. Pediatr Pulmonol 1989; 7:265–271.
Changes in airflow obstruction and oxygen saturation in response to exercise and bronchodilators in cystic fibrosis
Authors: Macfarlane Peter I. , Heaf David
Published: March 2007

The airway response to exercise and inhaled terbutaline was assessed in 25 patients with cystic fibrosis (CF), seeking evidence for the possible deleterious effects of bronchial muscle relaxation. We postulated that “early” and “late” flows, taken from the full maximum expiratory flow volume curve, might move paradoxically in patients with unstable airways. Oxygen saturation was measured continuously; desaturation occurred early in exercise with partial recovery thereafter. This was unrelated to changes in expiratory airflow measurements. Both during and after exercise, and after inhaled bronchodilator, changes in expiratory airflow measurements were strikingly variable. Changes in individual measurements should be interpreted in relationship to the within‐subject variability of the test in patients with CF. During exercise, there was a significant increase in mean FEV1; this was most marked in patients with worst lung function. Two patients (both with severe lung disease) showed paradoxical changes in early and late flows. After exercise, only two patients showed the asthmatic pattern of postexercise bronchoconstriction. After inhaled bronchodilator, the group as a whole showed small but statistically significant increases in expiratory airflow measurements. Those with highest baseline FEV1 had the greatest bronchodilator response; this is the opposite of the pattern observed in asthma. Paradox did not occur after bronchodilators and only one patient showed a significant fall in late expiratory airflow.

This pattern of expiratory airflow changes is compatible with the concept of airway instability in which any beneficial effects of bronchial tone reduction are canceled out by the effects of compression of damaged airways rendered more compliant by loss of bronchial wall tone. We did not observe any clinically important deleterious effects from this mechanism. Pediatr Pulmonol 1990; 8:4‐11.
Correlation of IgE antibody titer to Aspergillus fumigatus with decreased lung function in cystic fibrosis
Authors: Nicolai Thomas , Arleth Sissi , Spaeth Anne , Bertele‐Harms Rose‐Marie , Harms H. Karsten
Published: March 2007

Obstructive pulmonary disease is a typical feature of cystic fibrosis (CF) and is often associated with bronchial hyperreactivity. Positive skin‐test reactions to Aspergillus fumigatus antigens are frequently seen even in nonatopic patients with CF. Full‐fledged allergic bronchopulmonary aspergillosis (ABPA) has been estimated to occur in 10% of patients with CF. The relationship between lung function and presence of IgE antibodies to Aspergillus antigens in patients without ABPA is not clear.

In 148 outpatients with CF (aged 6–34 years) specific immunoglobulin E (IgE) to Aspergillus fumigatus antigens, basic lung‐function parameters, and bronchial response to salbutamol were measured. Multiple regression was performed for age, weight as percentile for actual height (indicating general condition), and Aspergillus RAST. Aspergillus IgE was present in 46% of patients; 19% had RAST class 3 or 4.

Independent negative correlations of Aspergillus RAST with FEV1, FEF50%, FEF25%, RV, Chrispin Norman score, and sRaw (P<0.05) were found. Bronchodilator sensitivity did not correlate significantly with age and weight percentile. However, Aspergillus RAST did correlate significantly with bronchodilator response measured by sRaw (P <0.05). High titers of Aspergillus RAST might serve as a selective criterion for patients to be included in future studies evaluating broncholytic or antiphlogistic therapies. Pediatr Pulmonol 1990; 8:12‐15.
Brush cells in the human fetal trachea
Authors: DiMaio Mary F. , Kattan Meyer , Ciurea Doina , Gil Joan , Dische Renate
Published: March 2007

We performed a morphologic examination of human fetal lung tissue, using scanning and transmission electron microscopy, in order to establish the presence of brush cells in extrapulmonary and intrapulmonary airways, and developing acinar epithelium. Brush cells, characterized by a border of regular straight microvilli containing a filamentous core, were observed within the tracheal epithelium of a 19–20 week gestational age fetus. These cells constituted 0.5% of the total epithelial cell population. Brush cells were not seen within the bronchial, bronchiolar or developing acinar epithelium. Our study shows that brush cells occur infrequently but normally in the developing tracheal epithelium of the second trimester fetus. Pediatr Pulmonol 1990; 8:40‐44.
Differential rates of lung growth as measured longitudinally by pulmonary function in children and adolescents
Authors: Sherrill Duane , Holberg C. J. , Lebowitz M. D.
Published: March 2007

A sample population of 67 males and 71 females with longitudinal lung function and other anthropometric measurements from all non‐Hispanic white children in the Tucson Epidemiological Study of Airway Obstructive Diseases (AOD) was studied to evaluate biological determinants of the rate of lung growth. Groups within gender were defined by the following factors: 1) maximum height, 2) age at maximum forced expiratory volume at 1 second (FEV1), 3) % predicted initial FEV1or FEV1/FVC ratio. Only groups defined by low initial function (FEV1or FEV1/FVC ≤ 85% predicted versus >85% predicted) showed statistically significant differences from those with more “normal” function by comparing their maximum % of predicted FEV1s and FEV1/FVC ratios. The longitudinal FEV1data by age for the latter groups were characterized by a mathematical model (polynomial smoothing spline) yielding optimal fitted curves and an estimate of each group's growth velocity curve. The statistical comparisons between these fitted curves indicate that subjects with low initial pulmonary function continued to have significantly lower FEV1values for males older than 13.12 years and for females between 8.23 and 15.3 years. At post‐hoc analysis persistent wheezing was more likely in the initially more impaired group. Disease at the end of follow‐up was not related to initial functional status. Pediatr Pulmonol 1990; 8:145‐154.
Clinical observations of children with pleuropneumonia due to Mycoplasma pneumoniae
Authors: Nagayama Yoko , Sakurai Nobukiyo , Yamamoto Koshi
Published: March 2007

A comparative study on the clinical presentation of Mycoplasma pneumoniae infection was performed in 56 patients with pleuropneumonia and those who had pneumonia without pleural effusion. The latter consisted of 773 cases; their age distribution reached a peak at 3–5 years of age in males and at 4–6 years in females. The 56 cases with pleuropneumonia were distributed among children of all ages. Pneumococcal infection was demonstrated by blood culture in one of 56 cases. Serological tests revealed a higher prevalence of mixed viral infections among children with pleuropneumonia (18/44) than with pneumonia but no effusion (69/419). There was a tendency toward a severe and prolonged course of illness with strong indications of infection among pleuropneumonia cases. Complications such as exanthema or liver dysfunction were observed more frequently among pleuropneumonia cases than among simple pneumonia cases. These results suggest that other pathogenic agents or unknown host reactions to these agents may modify the clinical picture of pleuropneumonia caused by M. pneumoniae. Pediatr Pulmonol 1990; 8:182‐187.
Effect of the thermodynamics of an infant plethysmograph on the measurement of thoracic gas volume
Authors: Sly Peter D. , Lanteri Celia , Bates Jason H. T.
Published: March 2007

Adult plethysmographs have frequency responses that are essentially flat over the range of frequencies encountered in the measurement of thoracic gas volume (TGV). An infant plethysmograph is necessarily much smaller than an adult model. This means that there is a smaller mean distance over which heat diffusion must occur between the air in the plethysmograph and its walls. This in turn leads to a much reduced thermal time constant. We examined the effects of thermal time constant of a 60 L infant plethysmograph on measurements of TGV in infants. The thermal time constant was measured by rapidly injecting 20 mL of air into the plethysmograph, and found to be 0.16 ± 0.09 s when the box was empty. We calculated from this time constant that measurements of TGV should be quite dependent on the frequency at which the associated panting maneuvers are performed. TGV was measured in 5 infants less than 6 months old in the recovery phase following acute viral bronchiolitis. When we performed a digital correction of the measurements, to compensate for the thermal time constant of the plethysmograph, the TGV values decreased by a mean of 12%. Agitating the air in the plethysmograph with a fan decreased the thermal time constant of the box and reduced measured TGV by a mean of 8.4%. These results indicate that thermodynamics of infant plethysmographs can be an important source of error in TGV measurements. Pediatr Pulmonol 1990; 8:203‐208.
Reintroduction of continuous negative pressure ventilation in neonates: Two‐year experience
Authors: Cvetnic William G. , Cunningham M. Douglas , Sills Jack H. , Gluck Louis
Published: March 2007

Continuous negative pressure ventilation utilizes subatmospheric pressure around the thorax to improve oxygenation. It has not been routinely used since the mid‐1970s. We treated 37 infants with the combination of continuous negative pressure (CNP) and intermittent mandatory ventilation (IMV), after failing to attain a Pa of ≥50 torr on IMV alone. Lung diseases included pulmonary interstitial emphysema (PIE), respiratory distress syndrome (RDS), and pulmonary artery hypertension (PAH) due either to meconium aspiration syndrome (MAS) or other causes (non‐MAS). All infants had evidence of severe parenchymal pulmonary disease, or pulmonary artery hypertension resulting in persistent hypoxemia and hypotension. In the PIE group, CNP was started later in the course of the disease, and both positive pressure and oxygen were maintained for a longer period. The group of infants with non‐MAS PAH required CNP and positive pressure ventilation for the shortest period of time. The infants with PIE also had a greater incidence of bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH). In addition, three patients with PIE died. In the non‐MAS patients with PAH, no complications and no deaths occurred. The response to CNP was a rapid improvement in oxygenation in all groups with the greatest increase of Pa in the non‐MAS PAH infants: from 30 torr prior to the initiation of CNP to 140 torr within 30 minutes. No significant changes in pH or Pa occurred in any group. Significant decreases in ventilator rate, mean airway pressure (Paw) and FI in peak inspiratory pressure were possible by 12 hours of CNP. CNP and Paw were decreased from −5 cm H2O and 12.8 cm H2O prior to initiation of CNP to −1 cm H2O and 5.0 cm H2O at 72 hours of treatment. FI at 72 hours was decreased to a mean of 0.57. Combined CNP and IMV ventilator therapy improved oxygenation with lessened Paw in infants with refractory hypoxemia due to MAS and PAH and in larger infants with RDS. While we cannot advocate the routine use of CNP, it would appear to have a role in the management of infants who have failed conventional ventilator therapy. Pediatr Pulmonol 1990; 8:245‐253.
Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated newborns
Authors: Rigal E. , Roze J. C. , Villers D. , Derriennic M. , David‐Melon V. , Lacroix‐Mechinaud F. , Mouzard A.
Published: March 2007

The precise diagnosis of lower respiratory tract infection in the critically ill newborn remains a difficult challenge. The bronchoscopic protected specimen brush (PSB) is a reliable method in intubated adults. Because the bronchoscopic procedure is not generally available for young children, Zucker proposed a blind technique for introducing the PSB into the distal airways. His results were promising but were not compared with any bacteriologic reference method. Therefore, we wanted to evaluate this technique in comparison with the open lung biopsy (OLB) when it could be ethically accomplished. Eleven PSB were collected simultaneously with an OLB. The sensitivity of the PSB procedure was 100%, its specificity 88%, its positive predictive value 66%, and its negative predictive value 100%. There were no complications secondary to the PSB procedure. In this short study, the PSB procedure using a blind technique is safe and feasible to obtain uncontaminated specimens in intubated and ventilated newborns, and is largely accurate in identifying the bacterial etiologic agent of lower respiratory tract infection. Pediatr Pulmonol 1990; 8:268‐272.
Respiratory system compliance assessed by the multiple occlusion and weighted spirometer method in non‐intubated healthy newborns
Authors: Merth Istvan T. , Quanjer Philip H.
Published: March 2007

In 28 healthy newborn infants (median age 3.5 days), we compared the weighted spirometer (WS) with the multiple occlusion (MO) method for measuring respiratory system compliance (Crs). The MO method was unsuccessful in 8 infants. On average the two methods gave comparable results for compliance (Crs,ws = 40.4 ± 13.8 and Crs,MO = 45.2 ± 10.4 mL·kPa−1) in the remaining 20 infants; however, within‐individual differences were often considerable, so that the methods did not give interchangeable results. Individual pressure‐volume curves almost always intercepted the volume axis below the functional residual capacity with the MO technique, compatible with dynamic elevation of end‐expiratory lung volume (EEL) due to inspiratory muscle activity during expiration. A (small) negative volume intercept occurred in less than 50% of curves with the WS method; in these cases it probably reflects alinearity of the compliance curve, an alteration in laryngeal braking or in respiratory muscle control of EEL, or all of these. Both methods provide valuable means for the non‐invasive determination of respiratory system compliance in newborn infants, the differences in Crs being small and of minimal physiological significance; however, for individual follow‐up they should not be used interchangeably. Pediatr Pulmonol 1990; 8:273‐279.
Correspondence between forced oscillation and body plethysmography during bronchoprovocation with carbachol in children
Authors: Buhr Wernfrid , Jörres Rudolf , Berdel Dietrich , Làndsér Ferenc J.
Published: March 2007

We compared dose–response curves obtained with the forced oscillation technique (FOT) and with body plethysmography during bronchoprovocation in children.

In 40 stable asthmatic children (age, 5–16 yr) we performed challenges with doubling concentrations of inhaled carbachol (0.15–10 mg/mL) until specific airway resistance SRaw had increased by 100% (PC100SRaw). The FOT‐response was assessed by total respiratory system resistance (Rrs, cmH2O·1−1·s) and reactance (Xrs, cmH2O·1−1·s) from 8 to 26 Hz, expressed as mean Rrs (Rrs), mean Xrs (Xrs), Rrs at 8 Hz (Rrs8), and mean slope of Rrs (dRrs/df). Dose–response curves were analyzed for threshold concentrations (TC) causing a 3 SD change from baseline and sensitivity indices (SI) defined as differences between baseline and postchallenge values (at PC100SRaw) divided by baseline SD.

Median TC of Rrs8, Rrs, Xrs, dRrs/df, and SRaw was 0.21, 0.30, 0.34, 0.41, and 0.42 mg/mL, respectively, indicating a slightly higher sensitivity for FOT. Median SI values of SRaw and Xrs (12.0 and 8.2; difference n.s.) were significantly higher than those of the other parameters.

Multiple regression analysis revealed only the absolute change of Xrs (ΔXrs), baseline Rrs and age as significantly (P < 0.001) correlated with the percentage change of SRaw (Δ%SRaw). Best correlation (r = 0.86) with Δ%SRaw was found for the function: FOT score = −102.5 · ΔXrs · exp(−0.196 · Rrs + 0.038 · age). Provocative concentrations estimated by this FOT score differed from PC100SRaw by less than one (two) concentration steps in 34 (40) out of 40 children.

We conclude that FOT is as sensitive as plethysmography during bronchoprovocation and that with the FOT score practically equivalent dose–response curves to those of SRaw can be obtained in children. Pediatr Pulmonol 1990; 8:280‐288.
Pulmonary function testing prior to extubation in infants with respiratory distress syndrome
Authors: Veness‐Meehan Kathleen A. , Richter Susan , Davis Jonathan M.
Published: March 2007

Pulmonary function testing was performed just prior to extubation on 50 infants mechanically ventilated for treatment of respiratory distress syndrome. All infants were ready for extubation as defined by clinical criteria. Pulmonary mechanics and energetics were measured by a computerized technique that consists of a pneumotachometer to measure flow rates and an esophageal balloon and differential transducer to estimate transpulmonary pressure. Tidal volume, minute ventilation, dynamic lung compliance, pulmonary resistance, and resistive work of breathing were then calculated by high speed microcomputer processing.

Successful extubation was defined as > 72 hours without respiratory decompensation requiring reinstitution of ventilatory support. Thirty‐six (72%) infants were successfully extubated and 14 (28%) infants failed extubation. Infants in the success and failure groups were matched for birth weight, gestational age, age at study, weight at study, weight at study relative to birth weight, use of nasal continuous positive airway pressure (CPAP), and methylxanthines.

No statistically significant differences in pulmonary mechanics were seen between the two groups. Data suggests that successful withdrawal of mechanical ventilation may be related to multiple factors such as central inspiratory drive, diaphragmatic endurance, and chest wall stability, in addition to improved lung mechanics. Pulmonary function testing criteria alone may not be useful in determining optimal timing of extubation in premature infants. Pediatr Pulmonol 1990; 9:2–6.
Dynamic responses to tube breathing during the first 10 days of life
Authors: Upton C. J. , Milner A. D. , Stokes G. M. , Wilson A. J.
Published: March 2007

To assess whether there is a maturation of the response to tube breathing during the first 10 days of life, we have measured the dynamic ventilatory responses of nine term infants (34 studies) to added tubes equivalent to two anatomical dead spaces. Such a method allows an assessment of the baby's ability to increase dead space ventilation in response to an added stress.

There was a significant improvement with age over the first 10 days in the babies' ability to reach “expected” values of minute ventilation when the tubes were added (P = 0.003). The rates at which 63% and maximum adaptation were achieved also increased significantly with age (P < 0.005). The rate to 63% adaptation appeared to be faster in active compared with quiet sleep (P < 0.05).

The dynamic responses to tube breathing improve over the first 10 days of life. This is likely to be due to a maturation of peripheral chemoreceptor control, although improving lung mechanics may also be important. Pediatr Pulmonal 1990; 9:72–79.
Longitudinal response of pulmonary function to bronchodilators in cystic fibrosis
Authors: Pattishall Edward N.
Published: March 2007

Previous studies have found that between 0 and 95% of patients with cystic fibrosis (CF) have a significant response to bronchodilators. These studies have been limited by small numbers and the measurement of response at one point in time. We analyzed the response to bronchodilators of patients with CF in a longitudinal and cross‐sectional manner using pulmonary function data from 1980 to 1988. Overall, the proportion of patients with a positive response to bronchodilators was relatively large but not consistent over time. Of 573 tests in 127 persons, a positive response occurred in 68 tests of 51 patients. A negative response occurred in 19 tests of 17 patients. Only nine patients had a positive response in more than one third of their tests. The cross‐sectional analysis showed variability similar to previous cross‐sectional studies. Although a large proportion of patients with CF had a response to bronchodilators, the response was not consistent and may have been related to the number of tests performed. Continued longitudinal testing is necessary for valid decisions for bronchodilator use and for documenting the length, variability, and clinical significance of these responses. Pediatr Pulmonal 1990; 9:80–85.
Neonatal pulmonary oxygen toxicity in the rat and lung changes with aging
Authors: Thibeault Donald W. , Mabry Sherry , Rezaiekhaligh Mo
Published: March 2007

The aims of this study were to determine if neonatal hyperoxia exposure causes permanent lung damage and to define the relationship between neonatal lung oxygen toxicity and aging. Sprague‐Dawley newborn rats (n = 85) breathed 100% oxygen (O2) or room air (RA) during the first 8 days of life, and then RA. At 2 and 22 months of age we assessed right ventricular (RV) systolic pressure (RVSP), RV weight, saline and air pressure‐volume curves, volume density of lung parenchyma and nonparenchyma, parenchymal air space (PAS), mean linear intercept (Lm), number of small arteries/mm2 and the extent of their medial muscularization.

Aging in RA did not affect the RVSP, RV weight, the number of small arteries/mm2, or their muscularization. The maximal lung volume/g of dry lung and the elastic recoil pressure between 40 and 90% maximal lung volume decreased. The volume density of lung parenchyma increased but the fraction of the lung parenchyma that was PAS decreased and that of the alveolar septa and Lm increased.

The O2‐treated rats at 60 days of age had increased RVSP and RV weights with a decrease in the small arteries/mm2. The lung parenchymal volume density and PAS increased and the density of alveolar septa decreased. The Lm increased and the alveoli/mm2 and elastic recoil pressure decreased. The lung damage seen in the O2‐treated rats at 60 days persisted and in addition underwent the changes seen in the aging controls. However, the extent of muscularization of the arteries decreased. We conclude that neonatal hyperoxia causes permanent functional and structural changes of the lung but these do not interact with aging; that is, the effects of O2 toxicity and aging are additive but not synergistic. Pediatr Pulmonal 1990; 9:96–108.
Effect of altering smooth muscle tone on maximal expiratory flows in patients with tracheomalacia
Authors: Panitch Howard B. , Keklikian Esteban N. , Motley Raymond A. , Wolfson Marla R. , Schidlow Daniel V.
Published: March 2007

We obtained maximal partial expiratory flow‐volume (PEFV) curves using the rapid compression technique in three infants with intrathoracic tracheomalacia. Maximum flows were quantitated at functional residual capacity (V̇maxFRC). Studies were performed at baseline, after inhalation of methacholine (MCh) and after inhalation of albuterol. At baseline, all three patients had significantly lower than normal V̇maxFRC values, and two patients displayed expiratory flow limitation during tidal breathing. V̇maxFRC improved significantly after MCh administration, but fell back toward or below baseline after albuterol. Additionally, the ratio of forced to tidal flows at mid‐tidal volume (V̇mid(forced/tidal), a reflection of expiratory flow reserve, increased after MCh administration and decreased after albuterol. Two patients also received oral bethanechol: 2.9 mg/M2, q 8 hr for 10 days, after which PEFV curves were repeated. Both V̇maxFRC and V̇mid(forced/tidal) were increased over baseline after bethanechol administration, but decreased after albuterol. These results suggest that in patients with abnormally collapsible tracheae, stimulation of tracheal smooth muscle can improve airway stability, thereby increasing forced expiratory flows. Additionally, relaxation of airway smooth muscle by bronchodilators can have the opposite effect and exacerbate obstruction. Pediatr Pulmonal 1990; 9:170–176.
Bronchial reactivity and sex hormone: Study in a Turner's population
Authors: Villa M. P. , Bernardi F. , Burnaccini M. , Tura A. , Martelli M. , Mazzanti L. , Bergamaschi R. , Cacciari E.
Published: March 2007

Respiratory function and bronchial reactivity was studied by carbachol challenge in 41 patients with Turner's syndrome and in 46 controls. In patients and controls the personal and family history of atopic illnesses was evaluated; reactivity to skin allergen tests was studied in patients only. Patients with Turner's syndrome had less allergy skin test reactivity; no difference was found in allergic symptoms between patients and controls despite the patients having a more positive family history of atopy (P < 0.05). Respiratory function variables were higher in patients than in controls, and bronchial reactivity as expressed by the results of carbachol testing was higher in Turner's patients than in controls (P < 0.01). Bronchial reactivity was significantly reduced after 6 months of estrogenic therapy (P < 0.05) in subjects with Turner's syndrome, while the same did not occur in patients who did not receive estrogen treatment. This study of pulmonary function and bronchial reactivity in Turner's patients may help understand the effects of sex hormones in the regulation of bronchial tone and of bronchial response to constrictive agents. Pediatr Pulmonal 1990; 9:199–205.
Measurements of pulmonary mechanics prior to the elective extubation of neonates
Authors: Balsan Michael J. , Jones Judith G. , Watchko Jon F. , Guthrie Robert D.
Published: March 2007

We measured total respiratory system compliance (CRS) and resistance (RRS) by the passive expiratory flow technique prior to the elective extubation of 61 neonates with a history of respiratory distress syndrome. Successful trials of extubation were characterized by a higher mean value of CRS when compared to trials that led to reintubation (1.52 vs. 1.10 mL/cm H2O, P = 0.004). Low values of CRS (0.9 mL/cm H2O or less) were invariably associated with extubation failure, whereas high values of CRS (1.3 mL/cm H2O or greater) were associated with extubation success in 94% of patients. A higher mean value of RRS was recorded in the group of infants who failed extubation when compared to those who were successful (0.22 vs. 0.17 cm H2O/mL/s, P = 0.042). We propose that measurements of pulmonary mechanics, particularly CRS, may by useful in identifying infants who will be at risk for extubation failure. Pediatr Pulmonal 1990; 9:238–243.
Effect of inhaled beclomethasone dipropionate on bronchial hyperreactivity in asthmatic children during maximal allergen exposure
Authors: Boner A. L. , Piacentini G. L. , Bonizzato C. , Dattoli V. , Sette L.
Published: March 2007

In this double blind study we evaluated the effect of a 2 months long treatment with inhaled beclomethasone dipropionate (300 μg/day) on methacholine responses in asthmatic children, during a period of maximal allergen exposure. Baseline values of methacholine PC20‐FEV1 were 0.66 ± 0.22 mg/mL (mean ± SEM) in 10 children treated with the active drug and 0.78 ± 0.21 mg/mL in 10 children treated with placebo. After 1 month of treatment PC20‐FEV1 was 1.91 ± 0.64 and 0.80 ± 0.33 mg/mL, respectively, in the groups treated with beclomethasone versus placebo. A statistically significant reduction in bronchial hyperreactivity (PC20‐FEV1, 5.49 ± 1.86 mg/mL) but no systemic side effects were observed after 2 months of treatment with beclomethasone dipropionate. This is compared with a PC20‐FEV1 of 1.38 ± 0.52 mg/mL in the placebo group. The results confirm the effect of inhaled corticosteroids in reducing bronchial hyperreactivity, even during a period of maximal allergen exposure. Pediatr Pulmonol 1991; 10:2–5.
Ultrastructural ciliary defects in children with recurrent infections of the lower respiratory tract
Authors: Barlocco Ezio G. , Valletta Enrico A. , Canciani Mario , Lungarella Giuseppe , Gardi Concetta , Margherita De Santi M. , Mastella Gianni
Published: March 2007

One hundred fifty‐four children with recurrent or chronic infections of the lower respiratory tract compatible with the diagnosis of primary ciliary dyskinesia (PCD) were evaluated for the presence of ultrastructural ciliary abnormalities. Studies were performed on multiple samples of respiratory mucosa obtained by nasal and bronchial brushing. Twenty‐eight children showed ultrastructural ciliary defects compatible with the diagnosis of PCD: Twenty‐four presented dynein arm deficiency (either as isolated defect or in association with microtubular abnormalities), two had ciliary aplasia, and two showed microtubular abnormalities. Eleven patients with PCD had situs viscerum inversus, bronchiectasis, and chronic sinusitis (Kartagener's syndrome); one child with Kartagener's syndrome had normal ciliary structure. The appearance of respiratory symptoms within the first month of life, the colonization by Haemophilus influenzae, and a history of recurrent rhinitis and otitis were characteristically present in children with PCD. The clinical status of those patients who reached adolescence was, in our experience, remarkably good. An early diagnosis with adequate prevention and therapy of respiratory infections may have an important role in minimizing irreversible lung damage. Pediatr Pulmonol 1991; 10:11–17.
Gastrin‐releasing peptide gene products in midtrimester human fetal lung with and without maternal smoking history during pregnancy
Authors: Chen M. F. , Lewis S. J. , Jagoe R. , Alexander N. , Van Noorden S. , Springall D. R. , Polak J. M.
Published: March 2007

A preliminary morphological study on human fetal lungs with positive maternal smoking history demonstrated alterations of the neuroepithelial bodies (NEBs). We studied human fetal lung tissue between the gestational ages of 12 weeks and 19 weeks, comprising 12 cases with a smoking history during pregnancy (Group 1) and eight cases without a smoking history during pregnancy (Group 2). We demonstrated, by immunocytochemistry, the presence of gastrin‐releasing peptide (GRP) gene products: GRP 14‐27 in all 20 cases, and C terminal peptide of pro‐GRP (C‐flanking peptide) in 17 cases. Quantification of the neuroepithelial cells (NECs) was made by computer‐enhanced image analysis using the Context Vision system, expressing 1) the total stained areas of the NECs per unit area of section and 2) the total staining areas of the NECs per unit area of airway epithelium, measured as the area of cytokeratin immunoreactivity in an adjacent section. The results show no statistically significant difference between groups 1 and 2 for either GRP 14‐27 or C‐flanking peptides. The apparent lack of influence of maternal smoking during pregnancy on the expression of GRP gene products in the NECs could be a reflection of inherently reduced reactivity of the cells during the gestation period studied. However, a larger series is needed before any conclusions can be made. Alternatively, the adverse effects of smoking might be reflected during the canalicular phase of lung development; an increased immunoreactivity appears to be present during that period. The expression of pro‐GRP gene products in the pulmonary NECs of older fetuses and neonates with maternal smoking history during pregnancy requires further study. Pediatr Pulmonol 1991; 10:30–35.
Do wheezy infants recovering from bronchiolitis respond to inhaled salbutamol?
Authors: Sly Peter D. , Lanteri Celia J. , Raven Joan M.
Published: March 2007

Wheezy infants, less than 6 months of age, were given either inhaled salbutamol or saline in a double‐blind study. A significant change in maximal flow at functional residual capacity (VmaxFRC) was defined as being greater than twice the coefficient of variation of the baseline measurements. There was no difference in the infants' response to saline or salbutamol. Wheezy infants, less than 6 months of age, do not have an increase in VmaxFRC following a single dose of inhaled salbutamol. Pediatr Pulmonol 1991; 10:36–39.
Measurement of respiratory system resistance by forced oscillation in normal children: A comparison with spirometric values
Authors: Lebecque P. , Desmond K. , Swartebroeckx Y. , Dubois P. , Lulling J. , Coates A.
Published: March 2007

In 377 children, the commercially available Siregnost FD‐5 was used to measure respiratory system resistance (Rrs) by forced oscillation at 10 Hz. The children were between 3 and 18 years of age and, by a detailed questionnaire and conventional pulmonary function testing in 335, they were shown to be representative of the normal pediatric population. There was a linear relationship between Rrs and height (Rrs = 13.9–0.064 × ht (cm), r = −0.87). Children less than 6 years of age had no trouble with using the forced oscillation technique. The smoking of tobacco in the house, the presence of carpets in the child's bedroom, or an atopic family history, alone or in combination, had no influence on Rrs or on any spirometric measure. Forced oscillation is useful in children too young to be able to cooperate with conventional pulmonary function testing. Pediatr Pulmonol 1991; 10:117–122.
Pulmonary manifestations of HIV infection in children
Authors: Marolda Joanne , Pace Bella , Bonforte Richard J. , Kotin Neal M. , Rabinowitz Jack , Kattan Meyer
Published: March 2007

We retrospectively reviewed the spectrum, course, and outcome of pulmonary diseases in 66 children with AIDS, hospitalized between 1982 and 1988, prior to the use of zidovudine. Fifty‐two of the 66 (79%) patients developed pulmonary problems. In fifty‐two percent of all patients, a pulmonary problem was the first symptom of HIV infection. The most common respiratory illness requiring hospitalization was an episode of respiratory distress with normal Pa and unchanged X‐ray with a 9.7 ± 6.8 days mean duration of hospitalization. Bacterial pneumonia, Pneumocystis carinii pneumonia (PCP) and pulmonary lymphoid hyperplasia/lymphoid interstitial pneumonia occurred in 30%, 32% and 22% of the patients, respectively. Bacterial pneumonia and PCP were associated with a high mortality rate. Sixty‐eight percent of the patients died within 24 months of the onset of pulmonary disease. In 50% of the children, pulmonary disease was a primary cause of death. The results of this study can be useful in developing prospective studies for the prevention and treatment of pulmonary complications of HIV infection. Pediatr Pulmonol 1991; 10:231–235.
Changes in lung mechanics and histamine responsiveness after sequential canine adenovirus 2 and canine parainfluenza 2 virus infection in beagle puppies
Authors: Quan Stuart F. , Witten Mark L. , Grad Roni , Ray C. George , Lemen Richard J.
Published: March 2007

We determined the effects of an immediately antecedent viral lower respiratory tract infection (LRI) on the severity of clinical illness, changes in lung function and airway histamine responsiveness produced by a subsequent LRI in 9–12 week old beagle puppies inoculated with canine adenovirus 2, followed in 2 weeks by inoculation with canine parainfluenza 2 virus (CAV2‐CPI2, n = 7). We compared their acute responses to puppies infected with CPI2 alone (n = 5), CAV2 alone (n = 7), and no infection (control, n = 6). Puppies inoculated with either virus alone developed a LRI 3 to 6 days after inoculation which resolved by 12–14 days after inoculation. However, the illness was more severe in the CAV2 group. In the CAV2‐CPI2 group, CPI2 infection following CAV2 infection resulted in a clinical illness nearly comparable to that observed with CAV2 alone. Whereas in control and CPI2 puppies, lung resistance (RL) decreased and dynamic lung compliance (Cdyn) increased during the study due to normal growth, RL increased and Cdyn remained unchanged in the CAV2 group. In contrast, RL did not change and Cdyn increased in the CAV2‐CPI2 group. Airway histamine responsiveness in the CAV2‐CPI2 group increased during infection with CPI2 and was similar to that observed with CAV2 alone. In contrast, infection with CPI2 alone produced a small, but non‐significant increase in histamine responsiveness. The duration of the increase in histamine responsiveness was not prolonged in the CAV2‐CPI2 group in comparison to CPI2 or CAV2 alone. However, the length of clinical illness was extended in the CAV2‐CPI2 group in comparison to the other infected groups. These data suggest that an immediately antecedent viral LRI can potentiate the clinical and physiologic effects of a subsequent viral LRI. Pediatr Pulmonol 1991; 10:236–243.
Relationship between response to inhaled salbutamol and methacholine bronchial provocation in children with suspected asthma
Authors: Bibi Haim , Montgomery Mark , Pasterkamp Hans , Chernick Victor
Published: March 2007

Fifty children (27 females, 23 males) ages 6–15 years who were referred for evaluation of suspected asthma had baseline FEV1 and FEF25‐75 of ⩾ 80% and FEF50 ⩾ 70% of predicted values. All had these tests repeated on the same day, after inhaling salbutamol. On a subsequent day PC‐20 (methacholine) was determined as an index of bronchial hyperreactivity (BH). Fourteen age‐matched healthy children (6 females, 8 males) were studied in a similar manner. There was no significant relationship between the PC20 and the change in FEF25‐75 or FEF50 following salbutamol. There was a negative correlation between the initial FEV1 (% predicted) and the percent change in FEV1 following salbutamol (P < 0.01). An increase in FEV1 of >6% occurred in 7/12 (58.3%) patients with PC20 ⩽ 0.25 mg/mL (Group I); in 7/24 (29.2%) patients with PC20 = 0.26–2.0 mg/mL (Group II); in only 1/14 (7.1%) patients with PC20 > 2.1 mg/mL (Group III) and in none of those asymptomatic (control) children with PC20 > 8.0 mg/mL (Group IV). All subjects who had a change in FEV1 > 6% after salbutamol had a PC20 < 8 mg/mL and this test detected the majority of patients with severe BH. However, although the sensitivity of the test was 100%, the predictive value was only 36%. We conclude that in the presence of a normal baseline FEV1 a change of > 6% following salbutamol inhalation is indicative of bronchial hyperreactivity. Pediatr Pulmonol 1991; 10:244–248.
Effect of vascular puncture on blood gases in the Newborn
Authors: Kim Eun H. , Cohen Ronald S. , Ramachandran Pramela
Published: March 2007

Continuous monitoring methods have shown changes of oxygenation in neonates during various procedures. However, actual changes in blood gases during vascular punctures have not been reported. We studied the effect of vascular puncture on arterial blood gases during routine venipuncture in 17 neonates who had indwelling arterial catheters. Arterial blood gases were analyzed before, during, and following recovery from venipuncture. Ventilator settings were not changed during the study, though oxygen concentration (Fi) was adjusted as indicated by continuous P or saturation monitors. During venipuncture, there was a significant fall in Pa from 38 ± 5 to 32 ± 7 mmHg (P < 0.0001) and in Pa from 75 ± 21 to 58 ± 23 mmHg (P < 0.0001). Following venipuncture, both values returned to baseline. The results of this study imply that blood gases obtained by intermittent arterial sticks may provide data that do not accurately reflect the neonates' respiratory status. Pediatr Pulmonol 1991; 10:287–290.