bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibrosing alveolitis and desquamative interstitial pneumonitis
Authors: Sharief N. , Crawford O. F. , Dinwiddie R.
Published: March 2007

We report the experience with and evaluation of treatment strategies in fibrosing alveolitis and desquamative interstitial pneumonitis (FNDIP) over the last 16 years by a review of all cases referred to a tertiary referral center. There were 25 cases, 16 boys and 9 girls (mean age at onset, 2.3 years; range, 7 days to 11.6 years). In each case the diagnosis was confirmed by open lung biopsy at a mean age of 3.3 years (range, 7 weeks to 15.1 years). Presenting features were tachypnea (19), cyanosis (15), cough (12), exertional dyspnea (7). recurrent chest infections ± wheezing (9), and clubbing (8). Four patients recovered without antiinflammatory medication. The others received specific treatment. Of 11 patients given only prednisolone, six improved, two did not, and three died despite treatment. Of five patients receiving only chloroquine, four responded. Five patients received both prednisolone and chloroquine; one died, two responded well. There was poor progress in the remaining two. Of the 10 patients receiving chloroquine six (60%) showed a good response. A younger presentation carried a worse prognosis, but chest radiology at presentation and outcome were not interrelated. Those with mild histological changes all survived, but severe desquamation or fibrosis at biopsy was not related to outcome. In four cases there was a family history (16%). Patients with FNDIP probably represent a disease spectrum of multiple etiology with a variable prognosis and response to treatment. Pediatr Pulmonol. 1994; 17:359–365. © 1994 Wiley‐Liss, Inc.
Cerebral abscess as a complication of cystic fibrosis
Authors: Cooper David Michael , Russell Louise Emire , Henry Richard Leigh
Published: March 2007

Two male patients with cystic fibrosis (CF), both 18 years old, developed frontal lobe brain abscesses. Both patients presented with histories of intermittent headache over several days and occasional vomiting. Headache was not more evident in the mornings and not associated with visual disturbance in either patient. Neither was hypertensive nor had visual disturbance. Both patients had documented pansinusitis and nasal polyposis. Both men had had few admissions for pulmonary exacerbations, and neither was significantly malnourished. The abscess in neither patient grew Pseudomonas species. Pediatr Pulmonol. 1994; 17:149–154. © 1994 Wiley‐Liss, Inc.
Comparison of supine and prone noninvasive measurements of breathing patterns in fullterm newborns
Authors: Adams Jose A. , Zabaleta Ignacio A. , Sackner Marvin A.
Published: March 2007

The current study was undertaken to ascertain whether shift from supine to prone posture alters the pattern of natural breathing in healthy fullterm newborns. Breathing patterns were measured in the supine and prone posture in 20 healthy fullterm infants using calibrated, noninvasive respiratory inductive plethysmography (RIP). The values for breathing pattern components in supine and prone postures expressed as means (± SD) were, respectively, tidal volume (VT), 14.1(± 3.2) and 18.9(± 4.9)mL; mean inspiratory flow 26.7(± 11.5) and 32.8(± 13.0)mL/s; and minute ventilation 232(± 75) and 288(± 96)mL/kg/min (P < 0.01). Less thoracoabdominal incoordination, expressed as the labored breathing index (LBI), occurred with shift from supine to prone posture in infants studied in the active behavioral stage, changing from 2.0(± 0.5) to 1.3(± 0.4) (P < 0.01). Placement of a facemask‐pneumotachograph system increased V, measured with RIP by 26% in the supine, and 18% in the prone posture. Neither respiratory rate nor inspiratory time (Ti) changed with the postural shift. Therefore, change from supine to prone posture improved ventilation and increased respiratory drive as expressed by VT/Ti. Further, thoracoabdominal incoordination which took place during active sleep in the supine posture, lessened with change to the prone posture.Pediatr Pulmonol. 1994; 18:8–12. © 1994 Wiley‐Liss. Inc.
Plasma interleukin‐1α and β, tumor necrosis factor‐α, and lipopolysaccharide concentrations during pulmonary exacerbations of cystic fibrosis
Authors: Wilmott Robert W. , Frenzke Marie , Kociela Vikki , Peng Lee
Published: March 2007

Earlier studies have reported the presence of inerleukin‐1 (IL‐1) and tumor necrosis factor (TNF) in the plasma of patients with cystic fibrosis (CF), but the results have been inconsistent. To investigate the relationships among plasma IL‐1α, IL‐1β, TNF, lipopolysaccharide (LPS), and clinical status, measurements were made before and after 14 days of intravenous antibiotic therapy in 13 patients with CF. In addition, whole blood cytokine production rates were measured in 18 hr cultures stimulated with 10 μg/mL LPS or sterile saline (control). On admission, patients with CF had significantly greater plasma levels of LPS and IL‐1α compared with 20 healthy adult controls. In response to antibiotic therapy, the patients had statistically significant increases in weight, oxygen saturation, chest radiograph score, and forced expiratory volume in 1 second. They had significant decreases in pulse rate, residual volumeitotal lung capacity ratio, white blood count, neutrophil count, LPS concentration, and resting energy expenditure per kg body weight. There were no significant changes in the plasma concentrations of IL‐1α, IL‐1β, or TNF and no significant changes in the basal or stimulated whole blood production rates of IL‐1α, IL‐1β, or TNF. The immunological variables did not correlate significantly with clinical measurements of severity or the presence of fever. It is likely that in CF local pulmonary effects of cytokines are of more pathophysiologic significance than systemic effects. Pediatr Pulmonol. 1994; 18:21–27. © 1994 Wiley‐Liss. Inc.
Endoscopic unroofing of a bronchogenic cyst
Authors: Dab Isi , Malfroot Anne , Van de Velde Anne , Deneyer Michel
Published: March 2007

Flexible fiberoptic bronchoscopy (FFB) has become common practice for pediatric pulmonologists, allowing easier detection of certain abnormalities at an earlier stage. We report the endoscopic diagnosis of a large mediastinal bronchogenic cyst and its successful endoscopic unroofing in a symptomatic baby. Pediatr Pulmonol. 1994; 18:46–50 © 1994 Wiley‐Liss. Inc.
Assessment of the ability of young children to use a powder inhaler device (Turbuhaler)
Authors: Goren Avner , Noviski Natan , Avital Avraham , Maayan Channa , Stahl Elisabeth , Godfrey Simon , Springer Chaim
Published: March 2007

The purpose of the study was to determine the age at which young asthmatic children could master the use of a new powder inhaler device (Turbuhaler).

We studied 59 children with asthma between the ages of 3 and 6 years who consecutively attended the asthma clinic of the pediatric department. Efficiency of inhalation and the pharmacological effect of the terbutaline in the inhaler were measured by scores for inhalation technique and clinical response.

None of the 3‐year‐old children used the device efficiently, but 43% of the 4‐year‐old, 67% of the 5‐year‐old, and 80% of the 6‐year‐old children used the inhaler correctly. Although inhaler technique was not perfect in the younger age group, 50% of the 3‐year‐old children demonstrated clinical improvement of asthma symptoms after inhalation. In the older age groups, 79%, 92%, and 100% of the 4, 5, and 6‐year‐old children demonstrated clinical improvement of asthma symptoms after inhalation.

It is concluded that the new mode of dry powder delivery system (Bricanyl Turbuhaler) can be used in young asthmatic children who are 4 years of age and above. Pediatr Pulmonal. 1994;18:77–80. © 1994 Wiley‐Liss, Inc.
Reversal of bronchial obstruction in children with mild stable asthma by aerosolized furosemide
Authors: Chin Terry , Franchi Luis , Nussbaum Eliezer
Published: March 2007

Aerosolized furosemide has been shown to prevent the worsening of different variables in pulmonary function testing, following exercise or bronchial provocation with numerous agents. To investigate if aerosolized furosemide has a bronchodilator effect, we performed two prospective, randomized, placebo‐controlled, double‐blinded and crossover studies of four aerosol regimens in children with mild chronic asthma. In a pilot study examining three different doses of furosemide in 11 children, the dose of 1.0 mg/kg resulted in a mean maximum increase of 30.0 ± 6.8% in forced expiratory flow between 25 and 75% vital capacity (FEF25–75), compared with a 3.1 ± 6.8% increase after aerosolized normal saline. The effect was observed after 10 minutes with a mean percent change of 17.7 ± 1.7% from baseline, that persisted to 30 minutes (19.3 ± 3.7%) and was significantly greater than that seen following aerosolized placebo (1.4 ± 2.9% and 0.7 ± 3.4%. respectively; P < 0.05). We then compared the effect of furosemide with that of aerosolized albuterol (0.15 mg/kg) in 18 patients. There was no statistically significant difference in the improvement observed in forced expiratory volume in 1 second (FEV1) for albuterol (15.0 ± 2.7%) compared with furosemide (12.1 ± 2.9%) or in FEF25–75 (42.9 ± 9.0% versus 26.3 ± 6.7%). The addition of albuterol to furosemide resulted in a 17.2 f 5.9% increase in FEV, and a 51.1 2 13.9% increase in FEF25–75. Our results indicate that aerosolized furosemide has a bronchodilator effect in children with mild stable asthma.Pediatr Pulmonal. 1994;18:93–98. © 1994 Wiley‐Liss, Inc.
Flat chest in survivors of bronchopulmonary dysplasia
Authors: De Boeck K. , Smith J. , Van Lierde S. , Van Gijsel D. , Devlieger H.
Published: March 2007

Pulmonary mechanics as well as chest wall width and depth were measured in 52 1‐year‐old survivors of newborn lung disease. Of the 52 patients examined, 22 had developed bronchopulmonary dysplasia (BPD). Chest wall depth was significantly less in the patients who survived with development of BPD compared with those who did not develop BPD. Pulmonary resistance and chest wall width‐to‐depth ratio were significantly increased in the patients with BPD. Because the chest wall of infants is highly compliant, we suggest that the flatter chest in patients with BPD could result from the abnormal pulmonary mechanics.Pediatr Pulmonol. 1994;18:104–107. © 1994 Wiley‐Liss, Inc.
Frequency distribution of breath sounds as an indicator of bronchoconstriction during histamine challenge test in asthmatic children
Authors: Malmberg L. Pekka , Sorva Ritva , Sovijärvi Anssi R. A.
Published: March 2007

In order to study changes in respiratory sounds associated with acute bronchoconstriction and ‐dilatation, breath sounds of 11 children with asthma (age range, 10–14 years) were recorded at the chest and at the trachea during histamine challenge test and after subsequent bronchodilatation. The changes in frequency spectra of breath sounds were compared with simultaneous changes in forced expiratory volume in 1 second (FEV1). In seven children who responded to histamine with a decrease in FEV, of more than 15%, there was a significant relationship between percentage change in FEV1 (ΔFEV1) and percentage change in median frequency (ΔF50) of expiratory breath sounds recorded at the chest (r = 0.865; β = −0.706, P = 0.0001) and at the trachea (r = 0.888; β = 1.12, P = 0.0001). The association between breath sound intensity and FEV1 was weaker. Based on ANOVA, the increase of F50 during the challenge test was significantly larger in children who responded to histamine than in those who were non‐responsive (P = 0.0016). At the chest, a decrease of 15% in FEV1 corresponded to an increase of 8% in expiratory F50. The provocative dose of histamine inducing a decrease of 15% in FEV1 (PD15FEV1) and the provocative dose causing an increase of 8% in F50 (PD8F50) were significantly related (r = 0.927, P = 0.003). We conclude that spectral analysis of breath sounds can be used to indicate airway obstruction during bronchial challenge tests in children, and may be adapted for tests in pre‐school children. The results suggest that the same mechanisms that induce airflow limitation due to inhaled histamine may generate an increase in frequency content of breath sounds in children with asthma.Pediatr Pulmonol. 1994;18:170–177. © 1994 Wiley‐Liss, Inc.
The absorption and effect of dietary supplementation with omega‐3 fatty acids on serum leukotriene B4, in patients with cystic fibrosis
Authors: Kurlandsky Lawrence E. , Bennink Maurice R. , Webb Phyllis M. , Ulrich Pamela J. , Baer Lawrence J.
Published: March 2007

The substitution of omega‐3 (n‐3) fatty acids for omega‐6 (n‐6) fatty acids generates eicosanoids with diminished inflammatory effects. As the lungs of patients with cystic fibrosis (CF) are in a state of chronic inflammation in which increased amounts of eicosanoids are found, n‐3 supplementation may reduce this level of inflammation and result in clinical improvement. The absorption and clinicals effects of n‐3 vs. n‐6 fatty acids in CF were measured in a prospective, randomized, double‐blind, crossover study in which 14 patients with CF (age: 6–16 years, mean 10.5 years; baseline Shwachman‐Brasfield scores: 41–88, mean 76.7) received 6 weeks of n‐3 ethyl ester concentrate from menhaden oil (100–131 mg/kg/day, mean 112.8) or n‐6 fatty acids from safflower oil (102–132 mg/kg/day, mean 113.3), followed by a washout period of 6 weeks, and then 6 weeks of the other supplement. Analysis by gas chromatography showed that n‐3 supplementation resulted in increased eicosapentaenoic acid (20:5n‐3) in platelet phospholipids, from 0.14 to 2.16%. P <0.05 and in increased docosahexaenoic acid (22:6n‐3), from 1.33 to 3.72%, P <0.05. Clinical effects were evaluated at weeks 0, 6, 12, and 18, and analyzed for differences among the n‐3, n‐6, and washout periods. No adverse effects were reported or observed. No statistically significant differences were found (ANOVA, P >0.05) in Shwachman‐Brasfield scores, sweat test, weight change, or forced expiratory volume and flow (FEV1, FEF25,75%, and FVC) percentiles. Tumor necrosis factor was not measurable in any serum sample. Serum leukotriene B4 (LTB4) levels were significantly reduced by n‐3 fatty acids, mean reduction (−177 pg/mL) compared to n‐6 fatty acids (+63 pg/mL) P < 0.05. These results show that both n‐3 fatty acids are absorbed and incorporated into platelet phospholipids in patients with CF and reduced serum LTB4. No significant clinical differences or adverse effects were found.Pediatr Pulmonol. 1994;18:211–217. ©1994 Wiley‐Liss, Inc.
Nap studies underestimate the incidence of gastroesophageal reflux
Authors: Graff Michael A. , Kashlan Fawaz , Carter Michael , Rovell Kristine , Ramos D. Glen
Published: March 2007

Shorter nap (1 and 4 hr) pH studies inaccurately diagnosed gastroesophageal reflux (GER) in a group of infants evaluated for apparent life threatening events (ALTE) and recurrent apnea. Twenty‐five infants with a postconceptional age of 42 ± 8 SD weeks, were evaluated by 12‐hr polysornnography (PSG). Prior to the start of the 12‐hr study, a 1‐hr Tuttle Test was performed. By means of the 12‐hr study 11 infants were diagnosed as having GER while the Tuttle Test incorrectly diagnosed 6 infants, 5 as having no GER and 1 as having GER when no GER was present (P < 0.05). No differences in the amount of periodic breathing (PB) or apnea density (AD) were found between the two studies. In addition, the first 4 hr of the 12‐hr PSG segment following the first feeding was evaluated separately. In the 4‐hr segment, two of the infants were incorrectly diagnosed as not having GER. In this study, nap studies failed to diagnose all of the infants with GER. Therefore, we conclude that an infant cannot be accurately diagnosed as not having GER without prolonged pH recording.Pediatr Pulmonol. 1994;18:258–260. ©1994 Wiley‐Liss, Inc.
A new radiographic scoring system for bronchopulmonary dysplasia
Authors: Weinstein Marie R. , Peters Mary Ellen , Sadek Mona , Palta Mari ,   For The Newborn Lung Project
Published: March 2007

Objectives: To develop a simple, clinically meaningful radiographic score for bronchopulmonary dysplasia (BPD). To investigate its reliability, validity, and usefulness and to compare it to the Edwards score. Working hypothesis: Our radiographic scoring of BPD is reliable, correlates with respiratory support, and provides a necessary standardization in comparing severity of respiratory disease between hospitals. Study design: Prospective cohort study. Patient selection: The study included all neonates (n = 366) with birth weight below 1501 g admitted to 7 neonatal intensive care units, who had chest radiographs taken at age 25–35 days. Methodology: A simple radiographic scoring system was developed. Scores ranging from 0 to 6 were assigned based on standard radiographs and descriptors of degree of abnormality. All radiographs taken between days 25 and 35 of age (n = 1087) were graded by a radiologist and a neonatologist. Radiographs from a stratified random sample of 37 neonates (10%) were also scored by the method of Edwards (n = 128 radiographs). A respiratory support index was constructed for days 25–35 and correlated with the radiographic score. Results: Between‐reader correlation was r = 0.87 for our score and r = 0.88 for the Edwards score. The two scores correlated with each other at r = 0.94. The respiratory support index correlated with our radio‐graphic score at r = 0.75 overall, and r = 0.56 to 0.88 within hospitals. Higher postnatal corticosteroid use was found at the hospitals with the lower correlations. Conclusions: Our radiographic scoring is reliable, valid, and gives results similar to the Edwards score. Radiographs play a standardizing role in assessing severity of BPD between hospitals.Pediatr Pulmonol. 1994;18:284–289 © Wiley‐Liss, Inc.
Relationship between lung function results in the first year of life and respiratory morbidity in early childhood in patients born prematurely
Authors: Giffin F. , Greenough A. , Yüksel B.
Published: March 2007

The relationship between lung function results at 6 months and 1 year of age to respiratory symptoms in the first 3 years of life in prematurely born population has been determined. In 88 infants (median gestational age, 29 weeks) thoracic gas volume (TGV) and airway resistance (Raw) was measured and specific conductance (SGaw) calculated at 6 months and 1 year of age. During 3 years of prospective follow‐up neither TGV measured at either 6 months or 1 year, nor Raw and SGaw at 6 months, differed significantly between infants who were asymptomatic or symptomatic. At 1 year, however, Raw and (SGaw) were significantly higher and lower respectively in patients who were symptomatic than in those who were asymptomatic in any of the 3 years. An elevated Raw (≥50 cmH2O/L/s) measured at 1 year, but not at 6 months, was associated with a significant relative risk of symptoms in the first, second, and third year of life. We conclude that in prematurely born patients an abnormal airway resistance at 1 year predicts symptoms in early childhood.Pediatr Pulmonol. 1994;18:290–294 © Wiley‐Liss, Inc.
The relationship between tPTEF:tE and specific airway conductance in infancy
Authors: Dezateux C. A. , Stocks J. , Dundas I. , Jackson E. A. , Fletcher M. E.
Published: March 2007

This study examines the association between the time taken to achieve peak tidal expiratory flow as a proportion of total expiratory time tPTEF:tE and specific airways conductance (SGaw) in healthy infants and those with prior physician diagnosed, associated, lower respiratory illness with wheezing (prior LRI) during the first year of life. We compared tPTEF:tE and (SGAW) the latter estimated during both initial inspiration (II) and end‐expiration (EE), in 168 infants (94 males), measured on 220 occasions. Mean (range) tPTEF:tE was 0.321 (0.150–0.522) in 73 healthy infants aged less than 3 months (mean, 7.8 weeks), in whom mean (range) EE(SGaw), and plethysmographic thoracic gas volume at functional residual capacity (FRCpleth) were 2.47 s−1 kPa−1 (0.6–5.8) and 141 mL (87–204), respectively. Both tPTEF:t E and EE(SGaw), were significantly lower in older infants with prior LRI (n = 79; mean age, 50.0 weeks) compared to a similarly aged group of healthy infants (n = 68; mean age, 48.5 weeks), the mean difference [95% confidence intervals (Cl)] being −0.039 (−0.013, −0.064) and −0.48 s−1 kPa−1 (−0.24, −0.72), respectively. A significant but weak association between tPTEF:t E, and EE(SGaw),was found among infants above 3 months of age, irrespective of prior wheezing status. However, this relationship was not significant in healthy younger infants, in whom a significant but weak association with FRCpleth was found. Further work is needed to elucidate the factors influencing tidal expiratory flow patterns in infancy.Pediatr Pulmonol. 1994;18:299–307 © Wiley‐Liss, Inc.
Therapeutic methods repeatability of response to hypertonic saline aerosol in children with mild to severe asthma
Authors: Riedler Josef , Reade Tom , Robertson Colin F.
Published: March 2007

Non‐isotonic aerosols are being used more commonly to perform bronchial provocation tests. In contrast to histamine and methacholine challenge tests they appear to have higher specificity and a higher predictive value. The aim of the present study was to assess the reproducibility of the response to challenge with 4.5% hypertonic saline administered via an ultrasonic nebulizer in children with mild to severe asthma.

Seventeen children with asthma aged 10 to 14 years completed two or three challenge tests at the same time of day within a 10 day period. Of these 17 children 9 had mild, 4 moderate, and 4 severe asthma. Children inhaled 4.5% hypertonic NaCl from an ultrasonic nebulizer with an output of 1.9 to 2.5 mL/min (Timeter) using the protocol developed by Anderson with modifications. A fall in forced expiratory volume in 1 second (FEV1) from baseline of 15% or more was considered a positive response and PD15, was calculated.

In 16/17 subjects a greater than 15% fall in FEV1 occurred consistently on all study days. One subject with moderate asthma had a less than 15% fall in FEV1 on both study days. The coefficient of repeatability for PD15 was 1.8. This equals 0.85 of a doubling dose difference between the two or three measurements of PD15. The cumulative time of aerosol inhalation causing a fall in FEV1 2 15%) (PT15) showed a coefficient of repeatability of 1.59, similar to 0.67 doubling dose difference. The PD15 and PT15 were highly significantly correlated. The 4.5% NaCl challenge test yields good reproducibility in children with mild to severe asthma under laboratory conditions.Pediatr Pulmonol. 1994;18:330–336 © Wiley‐Liss, Inc.
Chloroquine treatment of interstitial lung disease in children
Authors: Avital A. , Godfrey S. , Maayan C. H. , Diamant Y. , Springer C.
Published: March 2007

Seven children aged 3 months to 11 years with histologically confirmed interstitial lung disease (ILD) [6 with desquamative interstitial pneumonitis (DIP) and 1 with chronic interstitial pneumonitis] were treated with chloroquine, 10 mg/kg/day. One patient, diagnosed late in the course of the disease, died after three weeks of treatment, despite the addition of systemic corticosteroids. Another patient responded to combined therapy with chloroquine and prednisone and had a normal lung biopsy after 6 months of treatment. He underwent surgical repair of mitral valve stenosis and died after extensive brain infarction. The other 5 patients responded well to chloroquine therapy with major improvement in oxygenation within a few weeks and in lung function over the next few months. They remained well clinically and physiologically, including a normal response to incremental exercise, during a mean follow‐up period of 9.8 years (range 3.5 to 15.7 years). None of the patients has developed retinopathy or any other ocular complication. Bronchoalveolar lavage was a useful tool for evaluation of the activity of the disease (predominance of neutrophils) in 3 out of 4 patients. We suggest that chloroquine should be considered as an effective treatment in ILD in children. Incremental exercise test may be helpful for routine follow‐up and evaluation of the efficacy of a specific treatment.Pediatr Pulmonol. 1994;18:356–360. ©1994 Wiley‐Liss, Inc.
The effect of nasal occlusion on the initiation of oral breathing in preterm infants
Authors: deAlmeida Victor L. , Alvaro Ruben A. , Haider Zia , Rehan Virender , Nowaczyk Bogdan , Cates Don , Kwiatkowski Kim , Rigatto Henrique
Published: March 2007

The ability to switch from nasal to oral breathing in response to nasal obstruction is crucial for survival, and has been suggested to be an important mechanism in preventing sudden infant death syndrome (SIDS). To know whether the ability to switch from nasal to oral breathing is uniformly present during the early neonatal period, we examined the effects of slow and fast nasal occlusions on the establishment of oral breathing in preterm infants. Slow occlusions were used to mimic more closely occlusions occurring spontaneously. We studied 17 healthy preterm infants [birth weight, 1830 ± 27 g (mean ± SE); study weight, 1800 ± 109 g; gestational age, 32 ± 1 weeks; postnatal age, 12 ± 2 days]. We used a nosepiece with a nasal occluder and a flow‐through system to measure ventilation. A CO2, sampling catheter at the mouth was used to detect oral breathing. Of 58 occlusions, 29 were slow [resistance increasing slowly from 0 to infinite (occlusion)], and 29 were fast (infinite elastance applied in <1 sec). Oral breathing was always established following slow and fast occlusions. In 44% of the slow occlusions, oral breathing started before complete occlusion. Arousal was observed in 12/58 (17%) of all occlusions, occurring primarily after initiation of oral breathing. Oxygen saturation and respiratory rate decreased significantly following occlusions, from 96 i 0.6 to 87 ± 1.2% and 49 ± 2.8 to 38 ± 2 breaths/min, respectively. These findings suggest (1) preterm infants usually establish oral breathing in response to nasal airway occlusion; (2) this switch to oral breathing is preceded by a decrease in O2 saturation and in respiratory frequency; and (3) arousal does not always precede the switch to oral breathing as is traditionally accepted.Pediatr Pulmonol. 1994;18:374–378. ©1994 Wiley‐Liss, Inc.
Sputum peroxidase activity correlates with the severity of lung disease in cystic fibrosis
Authors: Regelmann Warren E. , Siefferman Chris M. , Herron Jean M. , Elliott Greg R. , Clawson C. Carlyle , Gray Beulah H.
Published: March 2007

Patients with cystic fibrosis (CF) of the same age differ significantly in their degree of pulmonary disease. Based on preliminary observations, we postulated that the activity of my‐eloperoxidase would be significantly increased in patients with greater structural lung damage than in those with less lung damage. Acid extracts of weighed sputum samples were assayed for lactoferrin concentrations by ELISA. Activities of peroxidase, cathepsin G, and elastase (with and without proteinase 3) were determined by kinetic analysis using chromogenic substrates. The patients were divided into quartiles based on their Brasfield chest‐radiograph score. Patients in the first quartile (least amount of structural lung abnormality) were compared to those in the fourth quartile. The concentration of lactoferrin, a specific (secondary) granule protein of neutrophils, did not differ between the two patient groups. However, the activities of the neutrophil primary granule proteins, peroxidase, elastase, and elastase plus proteinase 3, were significantly elevated in the group with the most structural lung abnormality. Sputum albumin concentration was used to estimate leakages of plasma proteins into the airways. Peroxidase activity, but not the activity of cathepsin G, of elastase, or of elastase plus proteinase 3, correlated significantly with albuminig sputum in both quartile groups. To confirm the association of sputum peroxidase activity with differences in lung structure and to test its correlation with lung function, spirometry was performed in a second group of patients during the week prior to the time of sputum sampling. In this second group, increased sputum peroxidase activity was associated with worse Brasfield scores and with decreased percent‐predicted forced expiratory volume in 1 sec. Lactoferrin concentration again did not differ between the groups. Bacterial factors also did not differ. The results indicate that the degree of lung damage in patients with CF was more closely related to sputum peroxidase activity than to age, gender, CFTR genotype, or sputum bacterial parameters. Further study is required to determine whether or not peroxidase activity in the airway causes this lung damage. © 1995 Wiley‐Liss, Inc.
Effect of maternal smoking during pregnancy on passive respiratory mechanics in early infancy
Authors: Brown Randall W. , Hanrahan John P. , Castile Robert G. , Tager Ira B.
Published: March 2007

We studied the effect of prenatal maternal cigarette smoking on passive expiratory mechanics in 53 healthy infants tested early in infancy (mean ± SD, 5.1 ± 1.5 weeks). Maternal smoking was measured by: 1) questionnaire reports of the number of cigarettes smoked per day; and 2) urine cotinine concentrations (corrected for creatinine) at each visit. Respiratory system mechanics were assessed by the single‐breath occlusion‐passive‐flow‐volume maneuver. In ten infants born to smoking mothers the time constant of the respiratory system was 23% reduced [0.34 vs. 0.44 s; 95% confidence interval (CI), −45% + 1%; P = 0.06]. This was related to an estimated 13% decrease in respiratory system compliance (4.86 vs. 5.62 Ml/cmH2O; 95%Cl, −33% + 6%; P = 0.18) and a 10% reduction in respiratory system resistance (0.073 vs. 0.081 cmH H2O/mL/s; 95%Cl, −42% + 22%; P = 0.56). Functional residual capacity (FRC), measured by helium‐dilution, was also decreased by 13% (78 vs. 90 mL; 95%Cl, −27% + 0.3%; P = 0.06) in smoke‐exposed infants. Forced expiratory flow rates at FRC obtained by thoraco‐abdominal compression were reduced by 28% in infants of smoking mothers (VFRc, 99 vs. 138 rnlis; 95%Cl, −54% + 2%; P = 0.04), as reported previously in a larger sample from this population. This study was limited by small numbers of infants exposed to smoking during pregnancy and by ethnic imbalance among the smoking‐exposed and unexposed groups. Nevertheless, it suggests that the diminished forced expiratory flows observed in infants exposed in utero to maternal tobacco smoking (UTS) are not attributable to increases in lung compliance, resistance, or a delay in passive lung emptying. Rather, the data support the hypothesis that UTS exposure may cause a reduction in airway size as well as alterations in the growth and/or maturation of passive mechanical properties of the respiratory system in healthy newborns. © 1995 Wiley‐Liss, Inc.
Effective argon‐FRC with a rebreathing technique in children with acute asthma
Authors: Yiallouros Panayiotis K. , Milner Anthony D.
Published: March 2007

In children with asthma the measurement of functional residual capacity (FRC) with standard dilution techniques requires long rebreathing times of the inert gas, i.e., helium, to reach alveolar units with long time constants. A modification of the argon‐freon‐22 rebreathing technique enables argon to dilute in the readily accessible lung volume and potentially can give a measurement of FRC. However, the rebreathing tests cannot be prolonged for more than 1 min thus allowing argon to reach only the rapidly accessible lung units which are grossly useful in gas exchange (effective FRC, EFRC). The aim of this study was to measure the EFRC and standard lung function in children with acute severe asthma, assess their response to nebulized salbuta‐mol, and evaluate the relations of the EFRC response to baseline spirometric measurements. Twenty‐four asthmatic children who were admitted to the hospital with an acute asthma attack had spirometry and triplicate EFRC measurements before and after treatment with nebulized salbutamol. Eighteen patients had repeated the respiratory tests 50 days later when they had fully recovered. A significant proportion (28.9%) of the argon traces obtained at baseline before treatment did not equilibrate. However, in the great majority of these tests the oscillation of the argon traces over the last 3 breaths of the test was < 5% of the simultaneous argon concentration. The EFRC values derived from the argon traces with minimal oscillation (< 5%) were reduced during the acute asthma attack when compared with the paired values obtained after recovery (P = 0.03). The administration of salbutamol caused a fall from the baseline EFRC (P = 0.05). There was a significant correlation between the EFRC and FVC values (expressed as percentage of normal) in all 3 of the test occasions. The changes in the pretreatment and posttreatment EFRC values induced by recovery were correlated to the corresponding changes in the spirometric indices. In conclusion, rebreathing techniques can give quick measurements of EFRC in patients with acute asthma. The changes induced by recovery in baseline and postsalb‐utamol EFRC follow the pattern of the corresponding spirometric indices changes and not the expected typical FRC pattern. © 1995 Wiley‐Liss, Inc.
In vitro assessment of infant pulmonary function equipment
Authors: Jackson Elizabeth A. , Coates Allan L. , Gappa Monika , Stocks Janet
Published: March 2007

Commercially available automated pulmonary monitors are used increasingly in neonatal intensive care units. However, detailed information regarding the static and dynamic accuracy of these monitors is rarely available. Collaboration between scientists, clinicians, and manufacturers is essential to establish improved technical standards and protocols for testing of equipment and for the development of more reliable neonatal pulmonary monitors. The aim of this study was to develop a protocol for the in vitro assessment of commercial infant pulmonary function equipment which could be applied within the laboratory to provide rapid feedback to the manufacturer. A recently released neonatal pulmonary monitor, the Bicore CP100 (software version 3.3), was selected for the development of this protocol. The deadspace and resistance of the measuring device were determined. The flow and airway pressure measuring systems were evaluated alone and connected to a tracheal tube for both static accuracy and frequency response. The pressure— volume relationship of the esophageal balloon was determined and its static accuracy and frequency response were assessed. The algorithms for on‐line calculations were checked and their correct application confirmed by examination of an ASCII data print out. Finally, the pulmonary monitor was tested during intermittent positive pressure ventilation of a neonatal lung model of known compliance and resistance. © 1995 Wiley‐Liss, Inc.
Influence of clinical and ventilatory parameters on morphology of bronchopulmonary dysplasia
Authors: Gorenflo M. , Vogel M. , Herbst L. , Bassir C. , Kattner E. , Obladen M.
Published: March 2007

Our aim was to assess multiple factors which contribute to bronchopulmonary dysplasia (BPD) in prematurely born neonates. Specific morphologic features might relate to cumulative oxygen dose Barotrauma, prematurity, infection, and persistent ductus arteriosus (PDA). Seventy‐two patients dying from BPD as defined by the histopathologic criteria of Stocker were analyzed retrospectively. Median (range) gestational age was 28 (25‐35) weeks, and median survival was 16 (5‐386) days. The infants were ventilated for 15 (5‐149) days with a mean inspired oxygen fraction (FiO2,) of 0.78. The cumulative oxygen dose and mean airway pressures were determined. The presence of neonatal infection, PDA, and interstitial lung emphysema (ILE) was assessed. Baseline lung disease was estimated as proposed by Palta. At autopsy, the degree of hyaline membranes, epithelial cell necrosis, emphysema, atelectasis, interstitial cell proliferation, and lung fibrosis was scored semiquantitatively (0 to 3+). The influence of neonatal infection, PDA, gestational age, survival, oxygen dose, or barotrauma on morphological findings was examined by multivariate analysis. We found “acute” BPD in 22, “reparative” in 34 and long‐standing‐healed in 16 cases. ILE within the first week was associated with interstitial cell proliferation and lung fibrosis in infants surviving more than 28 days. Initial barotrauma contributes to lung fibrosis in infants with BPD. © 1995 Wiley‐Liss, Inc.
Vitamin A status and airway infection in mechanically ventilated very‐low‐birth‐weight neonates
Authors: Shenai Jayant P. , Chytil Frank , Parker Robert A. , Stahlman Mildred T.
Published: March 2007

Vitamin A (retinol) plays an important role in immunity. Respiratory and enteral infections in children are associated with low serum vitamin A concentrations that improve during recovery. To test the hypothesis that airway infection in very‐low‐birth‐weight (VLBW) neonates likewise may be associated with a change in vitamin A status, we examined 20 VLBW neonates (selection criteria: birth weight 700–1300 g, gestational age 26–30 weeks, need for supplemental oxygen and mechanical ventilation for >72 hr after birth) who were enrolled in the control group of a randomized clinical trial of vitamin A supplementation reported earlier. We studied changes in weekly measurements of plasma concentrations of vitamin A and retinol‐binding protein (RBP) during 4 weeks following enrollment in the trial (postnatal day 4) and compared changes between periods with and without airway infections. Seventeen infants had 22 episodes of documented airway infection. Staphylococcus epidermidis was the predominant organism. Plasma vitamin A concentrations decreased during 19 out of 22. With airway infection (mean change: −4.1 to −18.6 μg/dL), while they increased during 37 out of 58 periods without airway infection (mean change: −0.2 to +5.8 μg/dl; P < 0.001). The mean (±SD) plasma vitamin A concentrations before, during, 1 week after, and 2 weeks after an episode of airway infection were 20.9 ± 8.3, 9.7 ± 4.1,12.8 ± 8.9, and 16.2 ± 7.2 μg/dL, respectively. The mean value during airway infection was significantly lower than those before and two weeks after airway infection (P < 0.05). All of the individual plasma vitamin A concentrations during airway infection were low (<20.0 μg/dL). Airway infection had no significant effect on plasma RBP concentrations. We conclude that airway infection in mechanically ventilated VLBW neonates is associated with low plasma vitamin A concentrations that improve during recovery. We speculate that the depletion of marginal liver stores of vitamin A from its increased tissue utilization during airway infection may account for this change in the vitamin A status. Further studies are needed to establish the cause and effect relationship between vitamin A deficiency and airway infection in these infants. © 1995 Wiley‐Liss, Inc.
The cost of childhood asthma to Australian families
Authors: Toelle Brett G. , Peat Jennifer K. , Mellis Craig M. , Woolcock Ann J.
Published: March 2007

There have been no estimates of the actual cost of asthma care to Australian families. Previous estimates have been of the total cost to the community and have relied upon data collected by government departments and agencies. It was the aim of this investigation to estimate the cost of childhood asthma from the parents perspective in Australian families. A total of 238 asthmatic children aged 8–12 years were identified through prevalence studies of asthma in Sydney and Belmont, N.S.W. Children were selected if they had wheezed in the previous 12 months, had used asthma medicines or had airway hyperresponsiveness when tested. The study sample had wide range of asthma severity. Data were collected retrospectively and prospectively. Parents completed questionnaire which asked about health insurance and special asthma equipment costs in the previous 12 months. Every 2 weeks for total of 3 months between February and June parents completed further questionnaires which assessed costs incurred because of their child's asthma, together with time spent obtaining treatment. Items included doctor consultations and tests, alternative practitioner consultations and tests, medications and alternative therapies purchased, hospital and ambulance use, and the cost of childcare as consequence of asthma. We collected two or more months of prospective data from total of 193 children. The mean annual cost of asthma to the family was A$212.48 per asthmatic child and 13.4 hr were spent obtaining treatment. For the group of children who had not visited doctor in the previous year, the mean annual cost was A$85.60 and 13.1 hr were spent obtaining treatment. For the group of children who had been admitted to hospital in the previous year, the mean annual cost was A$884.34 and 153.0 hr were spent obtaining treatment. We conclude that the cost of asthma and the time spent obtaining treatment increases with increasing severity of the illness. In cases in which the child's asthma is severe enough to require hospitalisation in the previous 12 months, the cost to the family may be considerable. © 1995 Wiley‐Liss, Inc.
Tryptase immunoreactive mast cell hyperplasia in bronchopulmonary dysplasia
Authors: Lyle Robert E. , Tryka A. Francine , Griffin W. Sue , Taylor Bonnie J.
Published: March 2007

Bronchopulmonary dysplasia (BPD), the most common cause of chronic lung disease in prematurely born infants, is histologically characterized by various degrees of airway and alveolar septal fibrosis. Tryptase, serine protease specific to mast cells, has been shown to have potent fibroblast mitogenic properties and in addition has been shown to be increased in adult fibrotic lung disorders. Based on this analogy, the distribution of pulmonary mast cells exhibiting tryptase immunoreactivity was investigated by immunoperoxidase staining in autopsy specimens of infants dying with BPD. Morphologically normal lung specimens from similarly aged infants dying of sudden infant death syndrome (SIDS) served as controls. Tryptase–positive mast cell counts were performed at 250× from at least 10 random fields in bronchial, peribronchiolar, and alveolar regions. Compared to controls, in lung sections exhibiting typical histologic features of long‐standing BPD, tryptase positive cells were significantly increased in bronchial (23.9 ± 3.6 vs 14.4 ± 2.3) and peribronchiolar (15.3 ± 3.2 vs 4.63 ± 0.6) regions compared to controls (P < 0.05, Student's t test). In particular, alveolar regions exhibiting moderate to severe degrees of septal fibrosis exhibited dramatic increase in the number of tryptase‐positive cells (9.83 ± 1.89 vs 0.34 ± 0.18, P = 0.003). These findings of tryptase‐positive mast cell hyperplasia in BPD suggest potential roles of mast cells as well as tryptase in the pathogenesis of this disease. © 1995 Wiley‐Liss, Inc.
Bronchial artery embolization in the management of hemoptysis in cystic fibrosis
Authors: Cipolli M. , Perini S. , Valletta E. A. , Mastella G.
Published: March 2007

Massive hemoptysis and/or recurrent expectoration of measurable amounts of blood are common complications of chronic bronchopulmonary infections in cystic fibrosis (CF). When conservative treatment fails to control bleeding, surgery or bronchial artery embolization (BAE) is frequently considered. We present our experience and long‐term follow up of BAE in 14 CF patients (age range 15–39 years) with massive (6 subjects) and/or recurrent (8 subjects) hemoptysis not responsive to medical treatment. Seven had chronic hypercapnic respiratory failure. After angiographic evaluation, polyvinyl alcohol particles (halon) were injected to embolize obviously enlarged bronchial arteries. Seventeen procedures were performed in 14 patients and 36 bronchial arteries were embolized. All the patients stopped bleeding immediately upon BAE. Most of the patients had postembolization fever, dysphagia, and transient chest pain which were managed symptomatically. After median follow‐up period of 10.5 months (range 0.5–38 months), no recurrence of hemoptysis was observed in 8 patients who are still alive. In 3 patients hemoptysis recurred and they underwent reembolization after 3,22, and 25 months, respectively. Three subjects died of respiratory failure within 5 months from BAE. Presently, 50% of patients studied had a ≥ 1 year interval free of major hemoptysis after the first BAE. Our experience indicates that massive and/or recurrent hemoptysis in C:F patients can be safety and effectively managed by BAE if the procedure is performed by skilled practitioner. The procedure was well tolerated and resulted in prolonged and satisfactory bleeding control in most patients. © 1995 Wiley‐Liss, Inc.
Effects of streptozotocin‐induced diabetes on postpneumonectomy lung growth and connective tissue levels
Authors: Ofulue A. Felix , Thurlbeck William M.
Published: March 2007

Diabetes is generally accompanied by abnormal levels of growth hormone and adrenal steroids, hormones known to modulate postpneumonectomy (post‐PNX) compensatory lung growth. Thus, we examined the possibility that diabetes may affect post‐PNX lung growth processes. Left PNX was performed in young diabetic rats (streptozotocin‐induced; 75 mg/kg body weight) (DM‐PNX) and in control rats (C‐PNX), for comparison with sham‐operated control rats (C‐SHAM). The rats were permitted free access to food and water. Examination at day 7 after surgery showed that right lung absolute dry weight and absolute DNA, collagen and elastin contents were increased in C‐PNX and DM‐PNX rats (but only C‐PNX values reached those of both lungs in C‐SHAM rats). Body weights (BW) of DM‐PNX rats were lower than those of C‐PNX and C‐SHAM rats. Lung DNNBW in C‐PNX and DM‐PNX rats were comparable, and matched values for both lungs in C‐SHAM rats. Lung dry weight/BW, collagen/BW, and elastin/BW in DM‐PNX rats exceeded values in C‐PNX rats and even more for values of both lungs in C‐SHAM rats. Data of another experiment, comparing DM‐PNX rats with body weight‐matched (by food limitation) PNX and control rats (WMC‐PNX and WMC‐SHAM rats, respectively) indicated comparable lung absolute DNA contents in DM‐PNX and WMC‐PNX rats (which matched values for both lungs in WMC‐SHAM rats), however, lung absolute collagen and elastic contents were greater in the DM‐PNX rats. These findings demonstrate that an underlying diabetic state per se does not prevent post‐PNX compensatory hyperplastic lung growth, but can result in increased connective tissue contents. © 1995 Wiley‐Liss, Inc.
Symptomatic increase in intracranial pressure following pancreatic enzyme replacement therapy for cystic fibrosis
Authors: Nasr Samya Z. , Schaffert Denise
Published: March 2007

A newly diagnosed 5‐month‐old infant with cystic fibrosis (CF) developed signs and symptoms of increased intracranial pressure (ICP) within days of starting pancreatic enzyme replacement therapy. Symptoms promptly resolved on two occasions after stopping enzyme replacement. At 10 months of age, enzyme replacement was well tolerated. © 1995 Wiley‐Liss, Inc.