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 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many adult diseases have their roots in infancy or even prenatally. If events that initiate these diseases, as opposed to those that propagate the disease state, are to be understood, then the difficult area of how ethically to research problems in infancy must be tackled. Furthermore, the predisposition to archetypally 'pure' adult problems such as chronic obstructive pulmonary disease, may lie antenatally, the effects being masked until the lung starts to age. An additional factor is that the success of paediatricians, for example in ensuring the survival of extremely premature, low birth weight infants leads to adult survivors with potentially a whole new morbidity. The first prerequisite to making progress is a sound understanding of the development of the normal lung and how adverse environmental and genetic influences, such as exposure to environmental tobacco smoke and maternal atopy, respectively, may affect growth. This paper focuses on three key areas: the implications of different pre-school wheezing phenotypes for adult disease; the importance of very early life events in cystic fibrosis; and the long term consequences of chronic lung disease of prematurity. Finally, the ethical principles that must underpin future research in pre-school children is discussed, as well as the means we might use to further our understanding of the relevant early disease processes.
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PMID:Asthma research: the real action is in children. 1591 55

Efficient mixing of inspired gas with the resident gas of the lung is an essential requirement of effective respiration. This review focuses on one method for quantifying ventilation inhomogeneity: the multiple-breath inert gas washout (MBW). MBW has been employed as a research tool in adults and school age children for more than 50 years. Modifications allowing data collection in infants and preschoolers have been described recently. Indices of overall ventilation inhomogeneity, such as the lung clearance index and moment ratios, are raised in many infants with lung disease of prematurity, and in young children with cystic fibrosis. These indices may be more sensitive than other lung function measures for the early detection of airway disease. We describe, for the first time, a development of the MBW analysis that allows calculation of acinar and conductive zone inhomogeneity indices in spontaneously breathing children. Although methodological and analytical issues remain, the future clinical and research applications of MBW justify accelerated research in this field.
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PMID:Gas mixing efficiency from birth to adulthood measured by multiple-breath washout. 1599 57

Respiratory pathology can be relatively frequent during pregnancy. One third of pregnant woman may experience worsening of their asthma condition. Pulmonary tromboembolism is 5 times more frequent in pregnancy. Bacterial, viral and fungal pneumonias are badly tolerated during pregnancy, provoking mother-foetal morbidity, respiratory insufficiency, low born-weight or prematurity. Non-treated tuberculosis may increase maternal mortality and preterm birth by 4 and 9 times respectively. Pregnancy is counter-indicated in women with cystic fibrosis and severe pulmonary function. Despite therapeutic progresses already made, pulmonary hypertension is associated to over 30% of mother-foetal morbidity and mortality. Approximately 1 in 1,000-1,500 pregnancies is affected by mother cancer. High rates of lung cancer morbility in women bring new and important challenges to therapy.
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PMID:[Pregnancy and lungs]. 1749 34

Bronchiolitis is a leading cause of hospitalisation in infancy, with respiratory syncytial virus (RSV) being the most common pathogen. Younger age, especially infants younger than 3 months of age, environmental factors and genetic susceptibility, are associated with increased risk of hospitalisation. Most importantly, conditions such as prematurity, in particular if associated with chronic lung disease, congenital heart disease, lung disease such as cystic fibrosis, neuromuscular disease or impairment, or congenital or acquired immune deficiencies, are associated with increased risk of RSV hospitalisation and severe RSV lung disease. In these high risk populations, a 3- to 10-fold increase in the rate of RSV hospitalisation has been observed, justifying RSV-specific prophylaxis with palivizumab during the first, and in the populations at highest risk, the second RSV season. Studies have demonstrated a significant reduction (approximately 50%) in the rate of RSV hospitalisation in high-risk infants treated with palivizumab during the RSV season.
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PMID:Special populations. 1965 96

The authors were given the charge of providing a vision of the future in paediatric respirology. Themes selected for being ripe for this visionary analysis include bronchopulmonary dysplasia (BPD), asthma, cystic fibrosis (CF), lung infections, obstructive sleep disordered breathing (OSDB) and pulmonary diagnostics and monitoring. A profound reduction or elimination of BPD is seen. Given the strong genetic component of this disease, genetic biomarkers will likely be identified that will permit much earlier recognition of BPD susceptibility and potentially the ability to modify disease course by altering gene expression. The ultimate prevention of BPD will be to prevent prematurity, but recognition of both the genetic basis of BPD and the inflammatory background should lead to improved prevention and therapy. A clear understanding and definition of asthma phenotypes will lead to more specific and targeted therapy, earlier detection and prevention, better monitoring of severity and adherence to therapy, lower mortality and decreased inappropriate diagnosis of asthma. The greatest opportunities in asthma care will likely come through tools to improve adherence to effective therapy. Also, areas are identified where better therapies are needed such as in patients with severe mucus hypersecretion (secretory hyperresponsiveness) especially in those with life-threatening asthma. The future of CF is easier to foresee with early successes seen in clinical trials. After the expected ability to correct the CF transmembrane regulator, care will need to change and additional research will be needed. Additionally, the face of CF is changing with more adults than children presently having the disease. This will necessitate changes to our approach to treating this disease in a fortunately aging population. If we are going to affect the worldwide lung health of children, we will need to address respiratory infections particularly pneumonia, tuberculosis and HIV-associated infections. Preventive, diagnostic and treatment strategies will shape the future face of these problems. The availability of inexpensive, readily available, and rapid molecular techniques to identify true infection (including HIV and tuberculosis) may permit earlier use of effective therapy while preventing the inappropriate use of antibiotics for common viral diseases. Sleep medicine will continue to be an important aspect of paediatric pulmonology. The evaluation of OSDB cannot rely on full-night attended polysomnography due to limited access. Identifying reliable markers of end organ dysfunction in children with OSDB may permit more rapid identification of patients in need of intervention like CPAP and assisted breathing. In addition, management options, as an alternative to adenotonsilectomy, are listed with a call for further research. Pulmonary diagnostics and monitoring will see the development and refinement of tools like the lung clearance index and the analysis of exhaled gases, volatiles and dissolved biomarkers of inflammation as techniques that might help clinicians identify both the initiation of inflammation while it is more amenable to therapy, and to identify more readily the early changes associated with chronic lung diseases in children. The authors hope that these visionary articles will generate comments, arguments, inspiration, and perhaps even motivate funding agencies.
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PMID:The future in paediatric respirology. 2040 21

Survival rates for extremely preterm (<28 weeks' gestational age) infants have increased and are approaching 3 in 4 with the advent of modern perinatal and neonatal intensive care. In contrast with some children with chronic diseases such as cystic fibrosis, most survivors of extreme prematurity have no ongoing health issues. However, as a group, they do have higher rates of adverse health outcomes, and more of them will present to pediatricians over time and, ultimately, to adult physicians as they grow older. Pediatricians can aid the transition to adult health care by being aware of the nutritional, cardiovascular, respiratory, motor, cognitive, psychiatric, and functional outcomes into adulthood of survivors of extreme prematurity.
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PMID:Adult outcome of extremely preterm infants. 2067 13

Adenoviruses which are one of the causative agents of acute respiratory tract infections at all age groups worldwide, can lead to epidemic, endemic or sporadic infections year-round. Adenovirus infections in lower respiratory tract can be presented as bronchitis, bronchiolitis and pneumonia. The aim of this study was to investigate the presence of adenoviruses as the etiologic agent of lower respiratory tract infections (LRTIs) in children by cell culture, polymerase chain reaction (PCR) and direct fluorescence antibody (DFA) test. The results of the laboratory tests were evaluated in the light of patients' clinical findings. The study consisted of 206 patients aged between 0-5 years old and who were admitted to the hospital with the complaints of LRTI between January 2011 and April 2012. The clinical, radiological and laboratory findings of the patients were recorded. Nasopharyngeal specimens were taken with flocked swab from all patients and adenoviruses were investigated by shell-vial cell culture, real-time PCR and DFA test, simultaneously. Of all the samples 89.3% were taken in January, February and March and 38% of the patients have one or more chronic underlying diseases as chromosomal abnormalities, congenital heart disease, heart failure, asthma, cystic fibrosis, leukemia, kidney failure and prematurity. Adenovirus was detected in 12 (5.8%) of the samples by PCR, seven (3.4%) of the samples by cell culture method. While seven samples were found positive with both PCR and cell culture, 194 samples yielded negative results in both tests. Five samples, which were found positive by PCR, were not grown in cell culture method. Twelve of the 153 samples examined with DFA test, could not be evaluated due to insufficient amount of cells, however 2.8% (4/141) of the samples were found positive for adenovirus antigens by DFA method. Those samples were also positive ones in the other two methods. Compared with cell culture, the sensitivity, specificity, positive and negative predictive values of PCR were 100%, 97.5%, 58.3% and 100%, respectively; those values were 57%,100%,100% and 97.7%, respectively for DFA testing. Compared to PCR the sensitivity of cell culture is very low (16.6%) after three days of incubation, however, it increased to 58.3% after five days' of incubation. There was no significant relationship between adenovirus positivity and the presence of chronic diseases, the radiological findings and the laboratory findings. Of all adenovirus positive samples 83.3% were obtained in January, February and March. Our data indicated that the etiological agent was adenovirus in approximately 6% of children with LRTI. The most important step for the isolation of adenovirus from respiratory tract, is high quality and sufficient amounts of sample. The flexible flocked swabs made it easy to take nasopharyngeal swab from children. Although cell culture is still the gold standard for the diagnosis of adenovirus infections, PCR which is a fast method with high sensitivity and specificity can also be used. However, specific care should be taken during the DNA extraction stage, since the amount of the nucleic acid in the sample is critical for the best results. Even though the low sensitivity of DFA restricts its use in routine diagnosis of adenovirus infections, it should always be kept in mind that the quality of the clinical samples is most reliably evaluated by this method.
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PMID:[Investigation of adenoviruses in children with lower respiratory tract infections]. 2362 28

The critical importance of adequate zinc status to human health, including normal growth and development, is indisputable. The high prevalence of zinc deficiency on a global basis and its importance to public health have been well documented through large-scale randomized controlled zinc supplementation trials. Similar evidence in the clinical setting, however, is much less widely available due to the nonspecific features of zinc deficiency and to the lack of sensitive biomarkers to detect zinc deficiency, especially that of a mild degree of severity. The current understanding of zinc homeostasis indicates that the primary determinants of zinc absorption are the amount of zinc ingested and dietary phytate, the latter having a major effect on zinc bioavailability. In normal as well as in many pathologic conditions, the gastrointestinal tract is the major site of zinc losses resulting from secretion of endogenous zinc into the lumen and subsequent excretion in the feces. The amount excreted is dependent on host status, the amount reabsorbed, and sometimes the presence of pathophysiologic conditions, including diarrhea and steatorrhea. Assessment in the clinical setting dictates that the clinician obtain a careful medical and diet history, recognize clinical presentations in which zinc adequacy may be compromised, and link this risk with nonspecific but plausible manifestations of deficiency. Examples discussed in this article include primary zinc deficiency due to dietary inadequacy (older breastfed infants or toddlers without zinc-rich complementary foods); genetically based deficiency (acrodermatitis enteropathica, acquired zinc deficiency of lactogenic origin), and acquired secondary deficiency in low birth weight and prematurity, gastrointestinal and hepatic disease, and cystic fibrosis. Evidence for efficacy of zinc therapy with pharmacologic doses for two conditions, Wilson's disease and viral upper respiratory infections, is also discussed.
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PMID:Update on zinc deficiency and excess in clinical pediatric practice. 2368 10

Respiratory syncitial virus (RSV) is the most common cause of lower respiratory tract infections (LRTI) in children worldwide and it is associated with significant childhood morbidity. Acute infection may result in respiratory failure with varying degrees of severity, and increasing evidence supports a role of RSV infection as a key determinant for the development of subsequent chronic respiratory disease. Independent predictors of RSV severity include; prematurity, congenital heart disease, cystic fibrosis, immune defects and neuromuscular disorders. Passive immunization with palivizumab has proven to be safe and effective for preventing RSV hospitalization in infants at higher risk of acquiring severe RSV infection, but its expense and cumbersome monthly intravenous delivery schedule make it inaccessible to many. Furthermore, implementing prophylaxis in 32- to 35-week-gestational age infants and the mode of its administration still represent areas of uncertainty. In this review, we describe several aspects of RSV infection and analyze recent advances in the assessment of cost-effective palivizumab prophylaxis.
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PMID:New perspectives in Respiratory Syncitial Virus infection. 2405 54

Sex-related differences in a variety of lung diseases in infants and young children are reviewed, including respiratory distress syndrome, and chronic lung disease of prematurity, lower respiratory tract illnesses and wheezing, asthma, diffuse, and interstitial lung diseases, and cystic fibrosis. Differences in anatomy and physiology, such as airway size, airway muscle bulk, airway reactivity, airway tone, and cough reflexes may explain much of these sex differences. Better understanding of sex-related lung differences could help personalize respiratory treatment.
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PMID:Sex and the lung: Observations, hypotheses, and future directions. 2590 65


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