Pediatric Respirology and Critical Care Medicine最新文献

{"title":"Nasal high-flow therapy in infants and children","authors":"D. Franklin, A. Schibler","doi":"10.4103/PRCM.PRCM_22_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_22_17","url":null,"abstract":"This review highlights and summarizes the current evidence and knowledge of nasal high flow therapy management in infants and children. This review outlines the distinct differences in the use of NHF therapy between children and adults. A comprehensive literature review has been performed reviewing the relevant physiological studies and current evidence of support measures in these children. Despite the quick uptake of nasal high flow therapy in the clinical area there has been limited high-grade evidence, with new studies showing beneficial results with the use of nasal high flow therapy in acute respiratory disease and children.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122371602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air pollution as a risk factor for increasing hospitalizations of preschool wheeze in Hong Kong","authors":"Kaganov SIu, Chin-pang Wong, R. Lee, Jack Pak-Yeung Chan, Shuk-yu Leung, E. Chan, K. Kwok, Ada Yip, Rupert Phillips, D. Ng","doi":"10.4103/PRCM.PRCM_23_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_23_17","url":null,"abstract":"Background: Wheeze has been reported to affect one-third of preschoolchildren. While different wheeze patterns have been shown to predict future asthma risk, limited data are available on the risk factors for preschool wheeze in Asia. Methods: Preschool children admitted to hospitals through emergency departments for wheeze, from 2004 to 2015 in Hong Kong, were retrospectively identified. Potential risk factors for admissions over the same period were retrieved (i.e., air pollutants, preterm delivery, and maternal age). Results: A total of 46,258 patients meeting the inclusion criteria were identified during the 12-year period. The preschool wheeze admission rate increased by 34% over the past 12 years, with an average year-on-year rise of 4.2%. Environmental nitrogen dioxide (NO2) concentration was significantly associated with an increase in admission for preschool wheeze (r = 0.63, P = 0.028). Univariate regression analysis was performed on potential risk factors. Annual average NO2concentration (P = 0.007) and maternal age more than 40 years (P = 0.012) were significant risk factors. For multivariable regression analysis, annual average NO2concentration (β = 0.18, 95% confidence interval = 0.06–0.30) was the only independent factor associated with preschool wheeze admission. Conclusions: The increase of NO2concentration is a significant risk factor for the increase in hospitalizations for preschool wheeze in Hong Kong.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125586296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenges for paediatric respirologists","authors":"D. Ng","doi":"10.4103/PRCM.PRCM_1_18","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_1_18","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131374382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ventilator-associated pneumonia in children using disposable and nondisposable ventilator circuits","authors":"P. Srisan, Kallayanee Meechaijaroenying","doi":"10.4103/PRCM.PRCM_21_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_21_17","url":null,"abstract":"Aims: The aim of the study was to compare the incidence of ventilator-associated pneumonia (VAP), mortality, and ventilator circuit-related cost associated with patients using disposable ventilator circuit to those associated with patients using nondisposable ventilator circuit. Setting and Design: A prospective randomized controlled study in a 10-bed Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health between November 2011 and October 2012. Subjects and Methods: Children aged 1 month to 18 years who were ventilated >48 h were enrolled. Patients were randomized to be ventilated with a disposable or nondisposable heated wire ventilator circuit. Statistical Analysis Used: Statistical analysis was performed using SPSS version 17.0. The P < 0.05 was considered statistically significant. Results: Ninety-eight patients were enrolled. Of these, 48 were administered the disposable ventilator circuit, whereas 50 were administered the nondisposable ventilator circuit. The VAP rate was 20.53/1000 ventilator days for the former (n = 7) compared to 30.77/1000 ventilator days (n = 12) for the latter (odds ratio: 1.85; 95% confidence interval: 0.66–5.19, P = 0.24). The mortality rates were 2.1% in the disposable and 12% in the nondisposable circuit groups (P = 0.06). The unit cost of the disposable circuit (US dollar [USD] 51.60) was higher than that of the nondisposable circuit (USD 37.90). However, the total cost for the nondisposable group was higher due to the required use of more units (63 circuits for the disposable group vs. 95 circuits for the nondisposable group). Conclusions: The type of ventilator circuit is not likely to affect the VAP rate and mortality in children. The unit cost of a disposable circuit is higher than that of a nondisposable circuit. The total cost depends on the number of circuits used in each patient.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134055651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Babies who don't get better: When it's not respiratory distress syndrome","authors":"S. Donn","doi":"10.4103/PRCM.PRCM_28_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_28_17","url":null,"abstract":"Most preterm and late preterm infants who require mechanical ventilation for respiratory failure resolve their disease process and can be extubated. A small percentage, however, continues to exhibit respiratory failure and remain ventilator dependent. There are myriad conditions that the clinician needs to consider, some of which are treatable, but some of which are lethal. Strategies for diagnosis and management are discussed herein.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134189487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Airway disease and environmental aeroallergens in eczematics approaching adulthood","authors":"Ellis Kam Lun Hon, Mei-juan Liu, B. Zee","doi":"10.4103/PRCM.PRCM_18_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_18_17","url":null,"abstract":"Background: Atopic eczema (AE) is one of the most common skin diseases affecting children and adults worldwide. The “Atopic March” paradigm suggests AE is part of a complex condition with related airway disease. Objective: This study aimed to evaluate the prevalence of airway disease, environmental aeroallergens, and review factors associated with eczema severity and quality of life (QoL) when AE patients approached adulthood. Methods: Patients who were diagnosed with AE at a young age were included in the study and followed up till their adolescence at pediatric dermatology clinics from 2000 to 2017. Demographic characteristics, clinical laboratory parameters, treatment history, personal atopic history, as well as disease outcomes assessed by Nottingham Eczema Severity Score (NESS) and Children Dermatology Quality Life Index (CDLQI) were reviewed. Results: Three hundred and eighty-three patients (55.4% males) with latest NESS at mean (standard deviation) age 16.23 (2.50) years were reviewed. Personal history of asthma (45%), allergic rhinitis (74%), and family history of atopy were prevalent. Seventy-two percent of the patients were skin prick testing positive for house dust mite, 27% for cockroach, 33% for cat fur, and 13% for dog fur. Fourteen percent reported “smokers in family”. Multiple logistic regression showed “food avoidance ever” (adjusted odds ratio [OR] =3.00, 95% confidence interval [CI] =1.08–8.32; P = 0.035) and log-transformed immunoglobulin E (IgE) (adjusted OR = 1.45, 95% CI = 1.09–1.92; P = 0.011) were significantly associated with more severe AE. Linear regression showed “food avoidance ever” (β = 1.79, 95% CI = 0.34–3.24; P = 0.016), higher log-transformed IgE (β = 0.62; 95% CI = 0.22–1.03; P = 0.003), dog dander sensitization (β = 2.07, 95% CI = 0.24–3.89; P = 0.027), and severe disease (β = 2.97, 95% CI = 2.26–3.68; P < 0.001) were significantly associated with QoL impairment. Conclusions: A number of patients do not grow out of their eczema, and many of them have allergic rhinitis and asthma co-morbidities. Toward adulthood, AE severity and QoL are associated with food avoidance and high IgE, but generally independent of family or personal history of airway disease and allergen sensitization. Blood IgE measurement may help assess the risk for more severe eczema when patients are becoming adults.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121146369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of vibrating mesh nebulizer in the treatment of infants with acute bronchiolitis: A randomized, controlled trial","authors":"I-Ping Wu, Ming-Yi Chien, Hsiu-Feng Hsiao, Eric Chen, Yun-Yueh Liu, Chang-Wei Chou, S. Lai","doi":"10.4103/PRCM.PRCM_17_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_17_17","url":null,"abstract":"Background: Bronchiolitis is a disease that is predominantly caused by the infection of peripheral airway due to respiratory syncytial virus (RSV). The occurrence is highly prevalent among childhood stage with seasonal outbreak peak during fall and spring. Treatment of bronchiolitis invariably involves lengthy hospitalization, which places significant socio-economic burden on family caregivers and healthcare system. Aerosolizing hypertonic saline using small-volume jet nebulizer (SVN) remains as one of the effective therapies to alleviate symptoms in infants with acute bronchiolitis. However, such approach not only restraints treatment to hospitalization and can irritate patients with loud noise. It is unclear whether an alternative aerosol therapy that offers similar efficacy yet enhances portability, convenience and quiet operation is available. Materials and Methods: Herein we showed that a vibrating mesh nebulizer (VMN) offered quiet delivery and undisturbed nebulization yet harnessed similar improvement in clinical symptoms in contrast with SVN when treating hospitalized infants with acute bronchiolitis. Results: A total of 64 hospitalized infants (<12 months of age) with acute bronchiolitis were enrolled. Subjects were randomly assigned to SVN (n=32) and VMN (n=32) groups and had received the same aerosol treatment protocol during hospitalization. Besides respiratory rate, the initial overall severity score; hospital stay duration; and intravascular-line day for both groups (SVN vs VMN) were similar. The data were 4.30±1.44 vs 4.92±1.3; 3.97±1.88 vs 3.94±1.66 days; 2.31±1.47 vs 2.16±1.46 days correspondingly. However, a higher satisfaction score (4.8/5) was shown in a corresponding questionnaire indicating user preference in VMN due to enhanced portability, ease of clean and operation, and less-noise. These advantages could potentially facilitate bronchiolitis treatment and follow-up maintenance at home. Conclusion: In sum, the treatment outcome for infants with acute bronchiolitis was equivalent between SVN and VMN. Easy portability and simple operation features of VMN may present a much favored therapeutic option for home care users.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127831755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors for symptoms of attention deficit and hyperactivity in primary snoring children","authors":"M. Chan, S. Cherk, K. Kwok, Shuk-yu Leung, J. Ng, R. Lee, Tracy M. Ma","doi":"10.4103/PRCM.PRCM_15_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_15_17","url":null,"abstract":"Aim: Primary snoring was reported to affect 7.2% of school children in Hong Kong, and emerging evidence suggested that neurobehavioural symptoms were more frequently found among this group of children. The current study investigated the prevalence of symptoms of attention deficit hyperactivity disorder (ADHD) i.e., attention deficit, hyperactivity and impulsivity (ADHI), in Chinese children with primary snoring. Materials and Methods: Polysomnography results and relevant clinical notes for all Chinese children aged 4–18-year performed from January 2009 to December 2010 in our sleep laboratory were retrospectively reviewed. Data of the Chinese version of modified Epworth Sleepiness Scale and C-domain of Paediatric Sleep Questionnaire were analysed. Results: In primary snorers, the presence of excessive daytime sleepiness (EDS) and higher apnoea–hypopnea index (AHI) were risk factors for symptoms of AD with adjusted odds ratio of 3.2 (95% confidence interval [CI] = 1.2–8.1) and 4.7 (95% CI = 1.1–20.7), respectively. Primary snorer with AD symptoms had higher AHI, 0.32 ± 0.31 compared those without symptoms, 0.21 ± 0.29, P = 0.038. EDS was an independent risk factor for ADHI with odds ratio of 4.7 (95% CI = 1.1–20.0). Conclusion: Early screening for symptoms of ADHD should be performed in children with primary snoring.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129948704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Habitual snoring is probably pathological in children","authors":"D. Ng","doi":"10.4103/PRCM.PRCM_19_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_19_17","url":null,"abstract":"","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132037606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of treatment options in paediatric sleep-disordered breathing","authors":"Yu-Shu Huang, C. Guilleminault","doi":"10.4103/PRCM.PRCM_5_17","DOIUrl":"https://doi.org/10.4103/PRCM.PRCM_5_17","url":null,"abstract":"The clinical presentation of paediatric obstructive sleep apnoea (OSA) is different from that reported in adults. Children with paediatric OSA have more disturbed nocturnal sleep than excessive daytime sleepiness and present with more behavioural problems such as hyperactivity. They have sleep-related issues such as nocturnal enuresis and sleep-terrors and psychiatric problems such as depression and insomnia. Adenotonsillectomy has been the recommended treatment for paediatric OSA, but this practice as the initial treatment for all children has been questioned. The orthodontic approaches have been studied in children. Preliminary studies have suggested that rapid maxillary expansion and mandibular advancement with functional appliances may be effective even in children. Mandibular advancement devices, however, are not recommended for pre-pubertal children. These devices have been used in children in the late-teens, but long-term follow-up data are still lacking. Another non-invasive treatment is myofunctional therapy that has not been widely investigated. In syndromic children and where hypoventilation during sleep is present, positive airway pressure ventilation can be given. Nasal allergies are common in children. Increased nasal resistance impacts on breathing during sleep. Therefore, the treatment of nasal allergies with anti-inflammatory agents is an integral part of the management of paediatric OSA. Another important aspect of paediatric OSA is the presence of a short lingual frenulum and less frequently, a short nasal frenulum. They have been shown to cause abnormal growth of oral-facial region leading to OSA. Gastroesophageal reflux is both a cause and consequence of OSA and should be treated if present. The recent advance in the understanding of the pathogenesis of paediatric OSA lends hope that early recognition and management of factors that lead to the development of OSA may reduce the frequency of this disease and its sequelae. However, these factors are mostly unknown or ignored by specialists and general paediatricians during the early childhood orofacial development.","PeriodicalId":273845,"journal":{"name":"Pediatric Respirology and Critical Care Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131267668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}