Elevated inflammatory markers at preschool age precede persistent wheezing at school age.

Pediatr Allergy Immunol. 2011 Dec 23;

Authors: van de Kant KD, Jansen MA, Klaassen EM, van der Grinten CP, Rijkers GT, Muris JW, van Schayck OC, Jöbsis Q, Dompeling E

Abstract
To cite this article: van de Kant KDG, Jansen MA, Klaassen EMM, van der Grinten CP, Rijkers GT, Muris JWM, van Schayck OCP, Jöbsis Q, Dompeling E. Elevated inflammatory markers at preschool age precede persistent wheezing at school age. Pediatr Allergy Immunol 2011: DOI: 10.1111/j.1399-3038.2011.01244.x ABSTRACT: Background:  Wheeze is a heterogeneous symptom in preschool children. At preschool age it is hard to predict whether symptoms will pass or persist and develop into asthma. Our objective is to prospectively study whether inflammatory markers in exhaled breath condensate (EBC) and pre- and post-bronchodilator interrupter resistance (Rint) assessed at preschool age, are associated with wheezing phenotypes at school age. Methods:  Children (N = 230) were recruited from the Asthma DEtection and Monitoring (ADEM) study. At preschool age [mean (SE): 3.3 (0.1) yr], pre- and post-bronchodilator Rint was assessed. EBC was collected using a closed glass condenser. Inflammatory markers (IL-2, IL-4, IL-8, IL-10, sICAM) were measured using multiplex immunoassay. Wheezing phenotypes at 5 yr of age were determined based on longitudinal assessment. Children were classified as: never (N = 47), early-transient (N = 89) or persistent wheezers (N = 94). Results:  Persistent wheezers had elevated levels of all interleukins at preschool age compared to children who never wheezed (p < 0.05). EBC markers did not differ between the persistent and transient wheezers. There was no marked difference in Rint between wheezing phenotypes. Conclusions:  We demonstrated that 5 yr old children with persistent wheeze already had elevated exhaled inflammatory markers at preschool age compared to never wheezers, indicating augmented airway inflammation in these children.

PMID: 22192238 [PubMed - as supplied by publisher]

Comparison of oxygenation among different supplemental oxygen methods during flexible bronchoscopy in infants.

J Chin Med Assoc. 2011 Dec;74(12):556-60

Authors: Soong WJ, Lee YS, Tsao PC, Yang CF, Jeng MJ

Abstract
BACKGROUND: Supplemental oxygen (O(2)) is mandatory during flexible bronchoscopy (FB) in infants, but there are limited studies that deal with the efficacy of different O(2) delivery methods. This study aims to compare the oxyhemoglobin saturation in infants during FB among three different O(2) delivery methods, as measured by pulse oximeter (SpO(2)).
METHODS: A prospective study enrolled infants with two criteria: (1) less than 2 years old; and (2) needing FB examination. All infants received intravenous sedation and topical anesthesia. They were randomly placed into the following three groups: (1) nasal cannula (NC; 0.5L/kg/min); (2) nasal prongs with continuous positive airway pressure (NP-CPAP; 5-10L/min, pressure 5 cmH(2)O); and (3) nasopharyngeal catheter (NPC; 0.3-0.5L/kg/min). SpO(2), heart rate, blood pressure and respiratory rate were measured and compared at different stages: (1) prior to the FB (baseline); the FB tip at (2) the nose tip; (3) the pharynx; (4) the carina and (5) 30 minutes after the FB.
RESULTS: A total of 75 infants, with 25 infants per group, were enrolled during a 2-year period. There were no significant differences in basic characteristics and baseline SpO(2). After the designated O(2) was delivered, SpO(2) decreased significantly (p<0.05) when the FB tip was advanced from the nostril to the pharynx, and further decreased (p<0.01) when at the carina in all groups, especially in the NC group. After FB, SpO(2) returned to baseline levels in all three groups. The NC group had the lowest SpO(2) at the pharynx (p<0.01) and carina (p<0.01). The NP-CPAP and NPC groups had better SpO(2).
CONCLUSION: Supplemental O(2) via NPC is a simple and cost-effective method to maintain good SpO(2) during FB examination of infants.

PMID: 22196471 [PubMed - in process]

Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations.

Eur J Pediatr. 2011 Dec 28;

Authors: Paes B, Mitchell I, Li A, Lanctôt KL

Abstract
Palivizumab utilization, compliance, and outcomes were examined in infants with preexisting medical diseases within the Canadian Registry Database (CARESS) to aid in developing guidelines for potential "at-risk" infants in the future. Infants who received ≥1 dose of palivizumab during the 2006-2010 respiratory syncytial virus (RSV) seasons at 29 sites were recruited and utilization, compliance, and outcomes related to respiratory infection/illness (RI) events were collected monthly. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for premature infants ≤35 completed weeks gestational age (GA) who met standard approval criteria (group 1) compared to those with medical disorders (group 2) using Cox proportional hazards regression models with adjustment for potential confounding factors. Of 7,339 registry infants, 4,880 were in group 1 and 952 in group 2, which included those with Down syndrome (20.3%), upper airway anomalies (18.7%), pulmonary diseases (13.3%), and cystic fibrosis (12.3%). Group 2 were older at enrolment (10.2 ± 9.2 vs. 3.5 ± 3.1 months, p < 0.0005), had higher GA (35.9 ± 6.0 vs. 31.0 ± 5.4 weeks, p < 0.0005), and were less compliant with treatment intervals (69.4% vs. 72.6%, p = 0.048). A greater proportion of group 2 infants were hospitalized for RI (9.0% vs. 4.2%, p < 0.0005) and RSV (2.4% vs. 1.3%, p = 0.003) (unadjusted). Being in group 2 was associated with an increased risk of RI (HR = 2.0, 95%CI 1.5-2.5, p < 0.0005), but not RSV hospitalization (HR = 1.6, 95%CI 0.9-2.8, p = 0.106). In infants receiving palivizumab, those with underlying medical disorders, though not currently approved for prophylaxis, are at higher risk for RI events compared with preterm infants. However, risk of RSV hospitalizations is similar.

PMID: 22203430 [PubMed - as supplied by publisher]

The objective of this study was to assess discordance between commercially-available tests for latent tuberculosis in a low prevalence population, including the impact of nontuberculous mycobacteria. Methods This was a cross-sectional comparison study among 2,017 military recruits at Fort Jackson, South Carolina from April to June 2009. Several tests were performed simultaneously with a risk factor questionnaire, including: 1) QuantiFERON®-TB Gold In-Tube test, 2) T-SPOT®.TB test, 3) tuberculin skin test, and 4) Battey skin test using purified protein derivative from the Battey bacillus. Measurements and Main Results In this low-prevalence population, the specificities of the three commercially-available diagnostic tests were not significantly different. Of the 88 subjects with a posit...