bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent wheezing and gastroesophageal reflux in infants
Authors: Eid Nemr S. , Shepherd Ross W. , Thomson Michael A. 
Published: March 2007

AbstractWe have evaluated the presence of gastroesophageal reflux (GER) and the effect of its treatment in 12 infants (mean age, 7 months; range, 4–11 months) with persistent wheezing not responding to bronchodilators and anti‐inflammatory asthma medications. All patients had GER on cineradiography and significant acid reflux on 24 hour pH monitoring (percentage of time pH < 14 ranged from 6.1 to 47%). All infants were initially treated with prokinetic agents and with receptor histamine antagonists in addition to aggressive pulmonary therapy. Six patients treated medically had substantially decreased use of asthma medications, completely discontinuing them within 2–4 months. Two patients, though significantly improved, require intermittent asthma therapy. Four patients responding poorly to GER and asthma treatment for 2 months to 2 years had fundoplications. These had an excellent outcome over 1–4.5 years follow‐up; only one patient required further asthma medications. Pulmonary function testing was done in six patients before and after 6–8 weeks of therapy indicating significant improvement in peripheral airflow: terminal flow/peak tidal expiratory flow (TEF25/PTEF), and percentage of total expiratory time to reach peak tidal expiratory flow (Tp/Te or Tme/Te).Our experience suggests that evaluation for GER should be considered in infants with persistent wheezing. Aggressive medical and possibly surgical therapy for GER may resolve persistent wheezing.Pediatr Pulmonol. 1994; 18:39–44. © 1994 Wiley‐Liss. Inc.
A new device for ambulatory cough recording
Authors: Munyard Paul , Busst Carolyn , Logan‐Sinclair Ron , Bush Andrew 
Published: March 2007

AbstractNocturnal cough reporting on diary cards has been shown to be unreliable and inconsistent. Whether subjective reporting of daytime cough is equally unreliable remains unknown. We have, therefore, developed a new and easily portable device (RBC‐7) that records electromyographic (EMG) and audio cough signals for at least a 24‐hr period, with a capacity of over 48 hr. Additional information is obtained from electrocardiographic (ECG) signals, and from an accelerometer indicating the level of the subject's activity. The RBC‐7 can be set up with the aid of a notebook computer at the subjects home, school or workplace. Initial studies utilizing a prototype device were performed to determine the optimal position of the EMG leads and the microphone. The optimal position for the EMG leads was determined as the positive electrode in the sixth intercostal space (ICS) in the midclavicular line on the left, the negative electrode in the same position on the right, and the reference electrode in the midline over the abdomen. This position was shown to give the highest EMG voltages and the greatest difference in voltages between cough and other signals. The optimal microphone position for signal strength and comfort was over the first ICS, either right or left, close to the sternum. Recordings were performed simultaneously in 20 subjects with conventional tape recorders and the multiparametric cough monitoring system (RBC‐7). Conventional tape recordings limited the duration of the studies due to the inherent restrictions. No significant difference in the number of single coughs recorded by each system was detected (correlation coefficient = 0.996). The RBC‐7 offers a unique opportunity to obtain objective information on cough in ambulatory subjects over at least a 24‐hr period, and to relate cough to time, activity and heart rate, while normal activities are pursued.Pediatr Pulmonol. 1994;18:178–186. © 1994 Wiley‐Liss, Inc.
Effect of dexamethasone and oxygen exposure on neonatal rat lung retinoic acid receptor proteins
Authors: McMenamy Kandi R. , Anderson Marni J. , Zachman Richard D. 
Published: March 2007

AbstractRetinol deficiency in animal models results in histopathologic airway changes that appear similar to those found in human premature infants with bronchopulmonary dysplasia (BPD). Dexamethasone (DEX), a steroid now often used in the treatment of BPD, might potentially affect lung vitamin A homeostasis since it alters serum and liver retinoid stores in certain models.Our objective was to determine the effect of DEX on neonatal rat lung retinoid status and the binding of retinoic acid (RA) to cytosolic and nuclear receptor proteins. We examined this effect both in room air and when the animals breathed 95% oxygen (O2)Twenty‐four 1‐day‐old rat pups received either 1 μg/g DEX subcutaneously, an equal volume of normal saline (NS) subcutaneously at 0 (start experiment time), 24, and 48 hours, or no injection at all, and were sacrificed at 72 hours. Twelve rats in each treatment group were housed in room air and 12 in each group were exposed to 95% O2, for the 3 day period. Lung and liver were analyzed for retinyl palmitate (RP). Nuclear retinoic acid receptor (RAR) and cellular retinoic acid binding protein (CRABP) were measured by specific binding assays.DEX decreased liver RP by 33–55% and rat pup lung RP by over 60%; it also decreased lung RAR binding (mean dpm/μg protein ± SEM) in both room air and oxygen groups: Air (11.2 ± 1.0) vs. Air/DEX (4.6 ± 1.3, n = 6; P <0.01), and O2, (18.2 ± 0.6) vs. O2/DEX (3.2 ± 0.6, n = 6; P <0.001). Binding of RAR was higher in O2‐ vs. air‐exposed pups (18.2 ± 0.6, n = 6 vs. 11.2 ± 1.0, n = 5, P <0,001). While CRABP binding in DEX‐treated neonatal pup lungs was decreased in both air/DEX vs. air and O2/DEX vs. O2 exposed groups, the decrease did not reach significance. However, the combination of O2/DEX significantly decreased CRABP binding (O2DEX, 30 ± 13, n = 3) when compared with air (109 ± 13, n = 5) and air/saline (133 ± 13, n = 6) (P <0.05). Binding of CRABP was also significantly lower in O2‐exposed neonatal pup lungs (55 ± 10, n = 4) than those exposed to air (109 ± 13, n = 5)This is the first report of DEX decreasing RP stores in neonatal rat lung and liver. We speculate that in sick premature infants receiving DEX, retinoids are mobilized from storage tissues to be utilized by tissue in need, such as during injury repair. This work also demonstrates a new possible interaction mechanism between DEX and retinoids at the functional level of RA binding proteins; DEX lowered RAR and CRABP binding activity.Pediatr Pulmonol. 1994;18:232–238. ©1994 Wiley‐Liss, Inc.
Exosurf rescue surfactant improves high ventilation‐perfusion mismatch in respiratory distress syndrome
Authors: Billman Daniel , Nicks Joanne , Schumacher Robert 
Published: March 2007

AbstractObjective: To assess ventilation/perfusion (V̇A/Q̇) mismatch of the high type, following rescue surfactant therapy for respiratory distress syndrome. Hypothesis: Surfactant therapy reduces such mismatch. Design: Randomized, double‐blind, placebo‐controlled study, assessing V̇A/Q̇ with the arterial‐alveolar difference of CO2 tension c. This difference was determined with capnometry and arterial blood gases, using the equation: (P(a‐A)CO2) equals arterial CO2 minus alveolar CO2 partial pressure. Setting: A level III nursery. Patients: Ten intubated infants with respiratory distress syndrome. Intervention: Infants were randomized to each receive two doses of surfactant or two doses of air placebo. Results: P(a‐A)CO2 improved after surfactant and worsened after placebo (P = 0.0021), comparing slopes of 12‐hr regression lines. A similar pattern occurred with oxygenation. These changes in P(a‐A)CO2 and in oxygenation were minimally correlated within the surfactant group. Conclusion: Exosurf rescue surfactant reduced V̇A/Q̇ mismatch of the high type, over several hours.Pediatr Pulmonol. 1994;18:279–283 © Wiley‐Liss, Inc.
High frequency chest compression therapy: A case study
Authors: Butler Sarah , O'Neill Brenda 
Published: March 2007

AbstractA new device, the ThAIRapy® Bronchial Drainage System, enables patients with cystic fibrosis to self‐administer the technique of high frequency chest compression (HFCC) to assist with mucociliary clearance. We review the literature on HFCC and outline a case study of a patient currently using the ThAIRapy® Bronchial Drainage System. While mucociliary clearance and lung function may be enhanced by HFCC therapy, more research is needed to determine its efficacy, cost benefits, and optimum treatment guidelines. Although our initial experience with the patient using this device has been positive, we were unable to accurately evaluate the ThAIRapy® Bronchial Drainage System. © 1995 Wiley‐Liss, Inc.
Cardiorespiratory adaptation during sleep in infants and children
Authors: Gaultier Claude 
Published: March 2007

AbstractThe cardiorespiratory control system undergoes functional maturation after birth. Until this process is completed, the cardiorespiratory system is unstable, placing infants at risk for cardiorespiratory disturbances, especially during sleep. The profound influence of states of alertness on respiratory and cardiac control has been the focus of intense scrutiny during the last decade. The effects of rapid‐eye movement (REM) sleep on various mechanisms involved in cardiorespiratory control are of particular significance during the postnatal period since newborns spend much of their time in this sleep state. In fullterm newborns, REM sleep occupies more than 50% of total sleep time, and this percentage is even greater in preterm newborns. From term to six months of age, the proportion of REM sleep decreases.2 Since respiratory and cardiac disturbances are known to occur selectively during REM sleep, the predominance of REM sleep may be a risk factor for abnormal sleep‐related events during early infancy.3 Awareness of these developmental changes in sleep patterns is important for clinicians dealing with problems such as apparent life‐threatening events (ALTE), sudden infant death syndrome (SIDS), and/or cardiorespiratory responses to respiratory disorders. Our current understanding of respiratory and cardiac control rests mainly on studies conducted during the first months of life. There is a paucity of data on late infancy and early childhood. The present paper will review available data on how sleep affects 1) ventilatory mechanics, in particular of the upper airways and the chest wall; ventilation and apnea; gas exchange; chemoreceptor function; and arousal responses; 2) changes in heart rate and heart rate variability, and the occurrence and mechanisms of bradycardia. © 1995 Wiley‐Liss, Inc.
Gender differences in lung growth
Authors: Hibbert M. , Lannigan A. , Raven J. , Landau L. , Phelan P. 
Published: March 2007

AbstractAnnual measurements of lung volumes and forced expiratory flows were made in 281 boys and girls from 8 to 12 years and in another cohort of 287 from 12 to 20 years to measure longitudinal lung growth. Gender differences in growth of lung function were documented, with girls generating greater volume‐standardized maximal expiratory flows until age 18.5 years. Beyond that age boys generated higher expiratory flows in proportion to total lung capacity (TLC). There was a time lag of up to 1 year between the age of peak growth velocity in lung volume and peak growth velocity in height. Age at peak growth in flow lagged another year behind that in volume. This was noted more in boys than girls. Dysanaptic lung growth was found with differing rates of growth of maximal expiratory flow compared with TLC or vital capacity (VC). © 1995 Wiley‐Liss, Inc.
Spirometric reference values for white European children and adolescents: Polgar revisited
Authors: Quanjer Ph. H. , Borsboom G. J. J. M. , Brunekreef B. , Zach M. , Forche G. , Cotes J. E. , Sanchis J. , Paoletti P. 
Published: March 2007

AbstractWe analyzed six spirometric data sets collected in the Netherlands, Austria, the United Kingdom, Spain, and Italy. The objectives were to establish whether (1) it was possible to describe spirometric indices from childhood to adulthood, taking into account the adolescent growth spurt, and (2) there are systematic differences in ventilatory function between children and adolescents in different parts of Western Europe. The study comprised 2,269 girls and 3,592 boys, aged 6–21 years. The range in standing height was 110–185 in girls, 110–205 in boys. The model applicable to all data sets was In FVC or In FEV1 = a + (b + c · A)· H, where H = standing height and A = age; this model prevents the phase shift between the adolescent growth spurt in length and lung volume from leading to an age‐dependent bias in predicted values. There was surprising agreement between most of the data sets; systematic differences are probably due to technical factors arising from ATPS‐BTPS corrections and from defining the end of breath with pneumotachometer systems. Taking those into account, prediction equations for FVC, FEV1, and FEV1%FVC were developed with “lower limits of normal” which should be applicable to children and adolescents of European descent. It is proposed that the approach of analyzing available data sets should also be applied to other ventilatory indices, data collected in adults and elderly subjects, or in other ethnic groups, and that an international data base be set up to that end. © 1995 Wiley‐Liss, Inc.
The Yentl syndrome in childhood asthma: Risk factors for undertreatment in Swiss children
Authors: Kühni Claudia E. , Sennhauser Felix H. 
Published: March 2007

AbstractRecent prevalence data for childhood asthma in Switzerland suggest a substantial underdiagnosis which seems to be more pronounced in girls. We further analysed our data trying to specify risk factors for underdiagnosis and undertreatment. Our special interest was focused on female sex as there is evidence for a sex‐dependent diagnosis and treatment of chronic disease in adults, called the Yentl syndrome. The data are derived from a parent completed questionnaire survey of a stratified cluster sample of schoolchildren aged 7, 12, and 15 years. Besides the 12 months prevalence of asthma symptoms and bronchodilator treatment, the lifetime prevalence of an asthma diagnosis was noted. With a response rate of 97%, a total of 4353 completed questionnaires were analysed. While age was not associated with undertreatment (except for exercise‐induced symptoms in adolescents), the lack of a formal diagnosis of asthma and atypical asthma symptoms other than wheeze such as chronic night cough were confirmed as significant risk factors for undertreatment. Of all boys reporting asthma symptoms 31% received bronchodilator treatment compared with only 15% of the symptom‐reporting girls (P < 0.001). For all particular asthma‐related symptoms (except wheeze), significantly more boys than girls (approximately double) received treatment. The physiological and psychological bases for these findings are discussed and suggest that gender is an important risk factor for under‐diagnosis and under‐treatment of asthma. Our research indicates that the Yentl syndrome may exist for childhood asthma. © 1995 Wiley‐Liss, Inc.
Validation of the phase angle technique as an objective measure of upper airway obstruction
Authors: Hammer J. , Newth C. J. L. , Deakers T. W. 
Published: March 2007

AbstractThoraco‐abdominal asynchrony (TAA) during upper airway obstruction (UAO) in small children can be documented by phase angle analysis of the Lissajous figure from the output of a noncalibrated respiratory inductance plethysmograph. Phase angle measurements have not been related to levels of inspiratory resistance, nor to the effect of breathing a 79% helium‐21% oxygen mixture (heliox) during inspiratory resistance. We examined the effects of graded inspiratory loading (5–1000 cm H2O/L/sec) on TAA as measured by phase angle in 10 male, anesthetized, and intubated Rhesus monkeys, breathing room air and heliox. Phase angles increased with inspiratory loading from a baseline value of 22 ± 3° to 165 ± 8° at 1,000 cm H2O/L/sec resistance and correlated significantly with the level of inspiratory loading (r = 0.82). Endtidal carbon dioxide PETCO2 increased from 39 ± 1 to 49 ± 3 mm Hg at the highest load, but correlated only weakly with phase angle measurements (r = 0.60) and the level of inspiratory loading (r = 0.56). By changing to heliox breathing at the highest tolerated resistance, PETCO2 dropped significantly from 49 ± 3 to 40.5 ± 4 mmHg (P < 0.001) with no significant change in phase angles: 169 ± 13° and 165 ± 8°, respectively (P > 0.05). We conclude that heliox therapy for acute alveolar hypoventilation during UAO improves ventilation, but does not decrease TAA at high inspiratory resistance. Continuous monitoring of the relative changes in phase angles is useful to observe the severity of UAO in the early stages. However, phase angle analysis does not predict the development of hypercapnia secondary to inspiratory load. Pediatr Pulmonol. © 1995 Wiley‐Liss, Inc.
Preservation of pulmonary function in the ventilated neonatal piglet with normal lungs
Authors: Easa David , Finn Kuuleialoha C. , Balaraman Venkataraman , Sood Sneha , Wilkerson Stephen , Takenaka Wayne , Mundie Thomas G. 
Published: March 2007

AbstractLittle attention has been focused on the progressive pulmonary deterioration which occurs in mechanically ventilated infants with normal or mildly abnormal lungs. We hypothesized that lung function would deteriorate over a 24‐hr period in anesthetized neonatal piglets with normal lungs mechanically ventilated at 2 cm H2O PEEP (2PEEP group). We further hypothesized that an intermittent lung inflation procedure consisting of 15 out of 60 min of increasing lung distention (4,8,12 cm H2O PEEP), with the remaining 45 min at 2 cm H2O PEEP (Inflation group) would prevent this deterioration in lung function, similar to piglets mechanically ventilated continuously at 6 cm H2O PEEP (6PEEP). Results indicate that 2PEEP piglets experienced progressive deterioration in lung function, including dynamic lung compliance (‐42%) and lung resistance (+55%). In contrast, Inflation piglets and GPEEP piglets had no deterioration in lung function. Hemodynamics were similar between groups, although they were the most stable in the 6PEEP group. Histopathological changes were not significantly different. We conclude that (1) prolonged mechanical ventilation at 2 cm H2O PEEP in neonatal piglets resulted in progressive deterioration in pulmonary function, (2) intermittent lung inflation or continuous 6 cm H2O PEEP prevented deterioration, and (3) functional changes occurred without changes in histopathology. Lung inflation strategies other than PEEP can be used to prevent deterioration in lung function which accompanies prolonged mechanical ventilation in anesthetized nonspontaneously breathing piglets with normal lungs. © 1995 Wiley‐Liss, Inc.
Pulmonary hypertension in respiratory distress syndrome
Authors: Golan A. , Zalzstein E. , Zmora E. , Shinwell E. S. 
Published: March 2007

AbstractPulmonary hypertension was associated with nonresponse to surfactant in six premature infants with respiratory distress syndrome. The diagnosis was suspected on the basis of a discrepancy between the X‐ray findings and the severity of the clinical status as reflected by hypoxia despite maximal ventilatory support. The diagnosis of pulmonary hypertension was made by pre‐ and postductal oxygen saturation differences or by echodoppler cardiography, showing suprasystemic right ventricular pressures or right to left shunts through a patent foramen ovale or the ductus arteriosus. The response to surfactant was quantified by the arterial/alveolar (a/A) ratio difference before and 1 hr after therapy (“delta a/A ratio”); the delta a/A ratio was 0 ± 0.01, which indicates a nonresponse. A single dose of 1 mg/kg tolazoline was administrated and the response assessed by a/A difference. A delta a/A ratio of 0.11 ± 0.11 (range 0.02‐0.32) represented a dramatic response and enabled oxygenation in these severely ill infants. No significant side effects were observed. We conclude that pulmonary hypertension may be an important and reversible condition in certain cases of respiratory distress syndrome and has to be considered in infants who do not respond to surfactant. © 1995 Wiley‐Liss, Inc.
The use of capnography for recognition of esophageal intubation in the neonatal intensive care unit
Authors: Roberts William A. , Maniscalco William M. , Cohen A. Ross , Litman Ronald S. , Chhibber Ashwani 
Published: March 2007

AbstractFailure to recognize esophageal intubation can result in severe hypoxia and permanent neurologic injury. Capnography is a standard monitoring modality in the operating room but has not been utilized fully in other environments. We used capnography at the time of endotracheal intubation in the neonatal intensive care unit (NICU) to determine whether capnography could more quickly and accurately identify endotracheal tube position than other clinical indicators of endotracheal tube position. One hundred intubation episodes were studied in 55 neonates. Capnograms were obtained 15 and 120 sec following tube placement. Intubating personnel were blinded to the capnographic data and determined endotracheal tube location (trachea vs. esophagus) by clinical criteria only. The sensitivity and specificity of capnography and clinical examination for identification of tube position were analyzed, and the time required for establishing by clinical confirmation whether the tube was in the trachea or not was compared to that required for capnography. Forty of 100 intubation attempts resulted in esophageal intubation. Capnography correctly identified these errant tube placements in 39 of 40 instances and did so in 1.6 sec (SD ± 2.4). Capnography failed to identify successful endotracheal intubation on only one occasion. Clinical indicators of tube position required 97.1 sec (SD ± 92.6) to identify an esophageal intubation and failed to identify successful endotracheal intubation in 5 of 60 cases. We conclude that capnography is a valuable adjunct to clinical examination to demonstrate whether an endotracheal tube is placed correctly in the trachea of neonates in the NICU. © 1995 Wiley‐Liss, Inc.
Does continuous positive airway pressure (CPAP) during weaning from intermittent mandatory ventilation in very low birth weight infants have risks or benefits? A controlled trial
Authors: Tapia José L. , Bancalari Aldo , González Alvaro , Mercado Maria E. 
Published: March 2007

AbstractObjective: The purpose of this study was to evaluate three ventilator weaning strategies and to evaluate whether the use of continuous positive airway pressure (CPAP) via a nasopharyngeal or endotracheal tube would increase the likelihood of extubation failure in very low birth weight (VLBW) infants. Study design: We studied prospectively 87 preterm infants (mean ± SD; birth weight: 1078 ± 188 g; gestational age: 28.8 ± 2.2 weeks) who were in the process of being weaned from intermittent mandatory ventilation (IMV). Infants were assigned by systematic sampling to one of the following three treatment groups: (1) direct extubation from IMV (D.EXT) (n = 30); (2) preextubation endotracheal CPAP (ET‐CPAP) for 12–24 hr (n = 28); or (3) postextubation nasopharyngeal CPAP (NP‐CPAP) for 12–24 hr (n = 29). Failure was defined as the need for resumption of mechanical ventilation within 72 hr of extubation due to frequent or severe apnea and/or respiratory failure (pH < 7.25, PaCO2 > 60 mm Hg, and/or requirement for oxygen FiO2 > 60%). Results: There were no significant differences in failure rates among the three procedures. Failures were 2/30 (7%) in D.EXT; 4/28 (14%) in ET‐CPAP; and 7/29 (24%) in the NP‐CPAP. There were also no differences in FiO2, PaO2, and respiratory rates before and after discontinuation of IMV among the three groups. PaCO2 values were slightly higher in the NP‐CPAP group 12–24 hr after weaning from IMV. Conclusion: We were unable to demonstrate a clear difference in extubation outcome by use of CPAP administered via an endotracheal or nasopharyngeal tube when compared to direct extubation from low‐rate IMV in VLBW infants. © 1995 Wiley‐Liss, Inc.