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Griese M, Seidl E. Persistent tachypnea of infancy, neuroendocrine cell hyperplasia of infancy, and pulmonary interstitial glycogenosis: "A3-Specific conditions of undefined etiology". Pediatr Pulmonol 2024. [PMID: 38818882 DOI: 10.1002/ppul.27102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Elias Seidl
- Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
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2
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Barber AT, Liptzin DR, Gower WA, Hinds DM. Pediatric Pulmonology 2022 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:2719-2724. [PMID: 37493100 DOI: 10.1002/ppul.26603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
The field of rare and diffuse pediatric lung disease continues to evolve and expand rapidly as clinicians and researchers make advancements in the diagnosis and treatment of children's interstitial and diffuse lung disease, non-cystic fibrosis bronchiectasis, and primary ciliary dyskinesia. Papers published on these topics in Pediatric Pulmonology and other journals in 2022 describe newly recognized disorders, elucidate disease mechanisms and courses, explore potential biomarkers, and assess novel treatments. In this review, we will discuss these important advancements and place them in the context of existing literature.
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Affiliation(s)
- Andrew T Barber
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Deborah R Liptzin
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Daniel M Hinds
- Department of Pediatrics, University of Iowa School of Medicine, Iowa City, Iowa, USA
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3
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Feld L, Voss L, Li ZN, Rice JL, Josephson M, Li Y, McGrath-Morrow S, Young LR. Clinical scope and healthcare utilization in childhood interstitial lung disease at a tertiary center. Pediatr Pulmonol 2023:10.1002/ppul.26600. [PMID: 37477505 PMCID: PMC10799970 DOI: 10.1002/ppul.26600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
Childhood interstitial lung disease (chILD) is a heterogeneous group of diffuse lung diseases that can be challenging to diagnose. With relative rarity of individual entities, data are limited on disease prevalence, care patterns, and healthcare utilization. The objective of this study was to evaluate chILD prevalence and review diagnostic and clinical care patterns at our center. A single-center, retrospective cohort study was conducted of patients receiving care at the Children's Hospital of Philadelphia (CHOP) between 1 January 2019 and 31 December 2021. Through query of selected ICD-10 billing codes relevant for chILD and medical chart review, a total of 306 patients were identified receiving pulmonary care during this period. Respiratory symptom onset was documented to have developed before 2 years of age for 40% of cases. The most common diagnostic categories included those with oncologic disease (21.2%), bronchiolitis obliterans (10.1%), and connective tissue disease (9.5%). Genetic testing was performed in 49% of cases, while 36% underwent lung biopsy. Hospitalization at CHOP had occurred for 80.4% of patients, with 45.1% ever hospitalized in an intensive care unit. One-third of children had required chronic supplemental oxygen. Seven (2.3%) patients died during this 3-year period. Collectively, these data demonstrate the scope of chILD and extent of health care utilization at a large volume tertiary care center. This approach to cohort identification and EMR-driven data collection in chILD provides new opportunities for cohort analysis and will inform the feasibility of future studies.
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Affiliation(s)
- Lance Feld
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Laura Voss
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Genetics, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Zeyu Nancy Li
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica L. Rice
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maureen Josephson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Yun Li
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology & Informatics, and Department of Pediatrics Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sharon McGrath-Morrow
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa R. Young
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Gabitova NK, Cherezova IN, Arafat A, Sadykova D. Interstitial Lung Disease in Neonates: A Long Road Is Being Paved. CHILDREN (BASEL, SWITZERLAND) 2023; 10:916. [PMID: 37371148 DOI: 10.3390/children10060916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023]
Abstract
Background: Interstitial lung disease (ILD) is one of the most difficult conditions in pulmonology due to difficulties in diagnosing, classifying, and treating this condition. They require invasive approaches to diagnose (e.g., lung biopsy), non-applicable methods (e.g., lung function tests in newborns), or potentially non-accessible methods (e.g., genetic testing in not-well-equipped facilities, and several weeks are required for results to be announced). They represent a heterogeneous group of diseases in which the alveolar epithelium, parenchyma, and capillaries of the lungs are damaged, which leads to changes in the pulmonary interstitium, proliferation of connective tissue, and thickening of the alveolar-capillary membranes and alveolar septa. These changes are accompanied by impaired oxygen diffusion, progressive respiratory failure, and radiographic signs of bilateral dissemination. Although adult and child classifications for ILD have evolved over the years, classification for ILD in neonates remains a challenge. Case presentation: Here we discuss ILD in neonates briefly, and report two rare cases of ILD (a male white neonate, two-day-old with fibrosing alveolitis, and another male white neonate, one-day old with desquamative interstitial pneumonitis), with these diagnoses initially thought to be presented only in adulthood. Lung biopsy and histopathological findings of the two neonates have shown mononuclear cells in the alveolar spaces, and thickening of the alveolar walls confirmed the diagnosis of fibrosing alveolitis in one neonate, and desquamation of the large mononuclear cells in the intra-alveolar space in the other neonate, with the diagnosis of desquamative interstitial pneumonitis being confirmed. Interstitial lung disease lacks a consensus guideline on classification and diagnosis in neonates, rendering it one of the greatest challenges to pediatricians and neonatologists with remarkable morbidity and mortality rates. Conclusions: Fibrosing alveolitis and desquamative interstitial pneumonitis (DIP) are not adult-only conditions, although rare in neonates, histopathological examination and clinical practice can confirm the diagnosis. Based on our clinical practice, prenatal and maternal conditions may serve as potential risk factors for developing IDL in neonates, and further studies are needed to prove this hypothesis.
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Affiliation(s)
- N Kh Gabitova
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
| | - I N Cherezova
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
| | - Ahmed Arafat
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
- Department of Pediatrics, NICU Division, Ismailia Medical Complex, Egypt Healthcare Authority, Ismailia 41511, Egypt
| | - Dinara Sadykova
- Department of Pediatrics, School of Medicine, Kazan State Medical University, 420012 Kazan, Russia
- Children's Republican Clinical Hospital, 420012 Kazan, Russia
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Miraftabi P, Kirjavainen T, Suominen JS, Lohi J, Martelius L. Children's interstitial lung disease: Multidetector computed tomography patterns and correlations between imaging and histopathology. Eur J Radiol 2023; 165:110886. [PMID: 37267893 DOI: 10.1016/j.ejrad.2023.110886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/08/2023] [Accepted: 05/19/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Childhood interstitial lung disease (chILD) is an umbrella concept covering a wide range of rare lung diseases, many of which are unique to childhood. The diagnosis is based on clinical presentation, multidetector computed tomography (MDCT), genetic testing, lung-function testing, and lung biopsy. Because knowledge of the usefulness of MDCT pattern recognition in ChILD is at present limited, we examined the occurrence of MDCT patterns in children with histologically confirmed interstitial lung disease. METHOD We searched the biopsy, MDCT, and clinical information database of a single national paediatric referral hospital for 2004-2020. Data were from affected children under age 18. MDCT images we reanalysed while blinded to the identity and referral information. RESULTS We included 90 patients, of whom 63 (70 %) were male. The median age at biopsy was 1.3 years (interquartile range 0.1-16.8). Biopsy findings fell into 26 histological classes covering all nine chILD classification categories. We recognized six distinct MDCT patterns: neuroendocrine cell hyperplasia of infancy (23), organizing pneumonia (5), non-specific interstitial pneumonia (4), bronchiolitis obliterans (3), pulmonary alveolar proteinosis (2), and bronchopulmonary dysplasia (n = 2). Of the total 90, in 51 (57 %) children, none of these six MDCT patterns appeared. Of those 39 children with a recognizable MDCT pattern, in 34 (87 %), that pattern predicted their final diagnosis. CONCLUSIONS Among cases of chILD, we identified a specific predefined MDCT pattern in only 43 %. However, when such a recognizable pattern occurred, it was predictive of the final chILD diagnosis.
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Affiliation(s)
- Päria Miraftabi
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland.
| | - Turkka Kirjavainen
- Department of Paediatrics, Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland
| | - Janne S Suominen
- Department of Paediatric Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jouko Lohi
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Finland
| | - Laura Martelius
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Finland
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Deutsch GH, Young LR. Lung biopsy in the diagnosis and management of chILD. Pediatr Pulmonol 2023. [PMID: 37154500 DOI: 10.1002/ppul.26454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
Children's interstitial and diffuse lung disease (chILD) comprises a large number of diverse entities ranging from disorders of lung development, maturation and function unique in infancy to immune-mediated, environmental, vascular and other conditions overlapping with adult disease. Pathologic evaluation of the lung has played a central role in characterizing many of these disorders, resulting in revised nomenclature and classifications to help guide clinical management(1-4). Technological advancements are rapidly uncovering genetic and molecular underpinnings of these conditions, as well as widening the phenotypes which bridge adult disease, often reducing the perceived need for diagnostic lung biopsy. As such the decision to get a lung biopsy in chILD is frequently for rapid ascertainment of disease in a critically ill child or when clinical presentation, imaging and laboratory studies fail to provide a cohesive diagnosis needed for treatment. While there have been modifications in surgical procedures for lung biopsy that minimize postoperative morbidity, it remains a high-risk invasive procedure, especially in a medically complex patient(5). Thus, it is essential that the lung biopsy be handled properly to maximize diagnostic yield, including close communication between the clinician, radiologist, surgeon, and pathologist before biopsy to determine best sampling site(s) and prioritization of tissue utilization. This review provides an overview of optimal handling and evaluation of a surgical lung biopsy for suspected chILD, with emphasis on specific conditions in which pathologic features play a critical role in providing an integrated diagnosis and guiding management.
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Affiliation(s)
- Gail H Deutsch
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle Children's Hospital, Department of Laboratories, Seattle, Washington, USA
| | - Lisa R Young
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Marczak H, Chruściel J, Kulus M, Krenke K. COVID-19 in patients with persistent tachypnea of infancy. Pediatr Pulmonol 2023; 58:934-940. [PMID: 36537617 PMCID: PMC9877685 DOI: 10.1002/ppul.26281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has raised substantial concern for patients with chronic lung diseases. The aim of this study was to evaluate the clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) in children with persistent tachypnea of infancy (PTI). METHODS Data on the history of COVID-19, including diagnosis and clinical course of the infection, were collected during the regular follow-up visits of children previously diagnosed with PTI. The diagnosis of COVID-19 was based on laboratory criteria recommended by the European Centre for Disease Prevention and Control. RESULTS Between January 1, 2021, and February 28, 2022, 62 patients with PTI (median age 3.7 years; 42 boys, 20 girls) were evaluated. COVID-19 was diagnosed in 38 patients (61.3%). Sixteen patients (42.1%) were asymptomatic, and 22 (57.9%) were symptomatic. The most common symptoms were rhinorrhea or nasal congestion, cough, and sore throat. Sixteen patients (42.1%) were classified as having a mild course of COVID-19, three children (7.9%) as moderate, and three children (7.9%) as severe. Follow-up performed after a median of 6 months (range 3-12 months) revealed that, after COVID-19, nearly all PTI patients returned to their prior status (32/38, 84.2%); 4 children (10.5%) suffered from exacerbating symptoms of PTI for 1 month. Two children (5.3%) became asymptomatic after COVID-19. CONCLUSION The course of SARS-CoV-2 infection in children with PTI is usually mild, and the risk of hospitalization is low. The course of PTI did not change after COVID-19 in most children, and only a few patients experienced an exacerbation.
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Affiliation(s)
- Honorata Marczak
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Chruściel
- Student Research Group of the Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kulus
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Popler J, Vece TJ, Liptzin DR, Gower WA. Pediatric pulmonology 2021 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:374-381. [PMID: 36426677 DOI: 10.1002/ppul.26227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022]
Abstract
The field of rare and diffuse pediatric lung disease is experiencing rapid progress as diagnostic and therapeutic options continue to expand. In this annual review, we discuss manuscripts published in Pediatric Pulmonology in 2021 in (1) children's interstitial and diffuse lung disease, (2) congenital airway and lung malformations, and (3) noncystic fibrosis bronchiectasis including primary ciliary dyskinesia. These include case reports, descriptive cohorts, trials of therapies, animal model studies, and review articles. The results are put into the context of other literature in the field. Each furthers the field in important ways, while also highlighting the continued need for further studies.
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Affiliation(s)
- Jonathan Popler
- Children's Physician Group-Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Timothy J Vece
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Deborah R Liptzin
- School of Public and Community Health, University of Montana, Missoula, Montana, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Dervaux M, Thumerelle C, Fabre C, Abou-Taam R, Bihouee T, Brouard J, Clement A, Delacourt C, Delestrain C, Epaud R, Ghdifan S, Hadchouel A, Houdouin V, Labouret G, Perisson C, Reix P, Renoux MC, Troussier F, Weiss L, Mazenq J, Nathan N, Dubus JC. Long-term evolution of neuroendocrine cell hyperplasia of infancy: the FRENCHI findings. Eur J Pediatr 2023; 182:949-956. [PMID: 36449078 DOI: 10.1007/s00431-022-04734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
Only few studies report long-term evolution of patients with neuroendocrine cell hyperplasia of infancy (NEHI). We report data from a 54-patient cohort followed up in the French network for rare respiratory diseases (RespiRare). Demographic characteristics and respiratory and nutritional evolution were collected at the time of the patient's last scheduled visit. The mean duration of follow-up was 68 months (5 months to 18 years). Fifteen patients (27.8%) were considered clinically cured. During follow-up, hospitalizations for wheezy exacerbations were reported in 35 patients (55%), and asthma diagnosed in 20 (37%). Chest CT scan improvement was noted in 25/44 (56.8%). Spirometry showed a persistent obstructive syndrome in 8/27 (29.6%). A sleep disorder was rare (2/36, 5.5%). Oxygen weaning occurred in 28 of the 45 patients initially treated (62.2%) and was age-dependent (35.7% under 2 years, 70.5% between 2 and 6 years, and 100% after 7 years). Oxygen duration was linked to a biopsy-proven diagnosis (p = 0.02) and to the use of a nutritional support (p = 0.003). Corticosteroids were largely prescribed at diagnosis, with no evident respiratory or nutritional effect during follow-up. Among 23 patients with an initial failure to thrive, 12 (52.2%) had no weight recovery. Initial enteral feeding (17/54, 31.5%) was stopped at a mean age of 43 months (3 to 120), with no effect on cure and oxygen liberation at the last visit. Conclusion: Our results show that NEHI has a globally positive, but unequal, improvement over time. Further prospective studies are needed to better clarify the different trajectories of patients with NEHI. What is Known: • Neuroendocrine cell hyperplasia of infancy (NEHI) is an interstitial lung disease whose long-term outcome is considered positive from very few studies including heterogeneous populations. What is New: • The 68-month follow-up of our 54-patient cohort showed respiratory/nutritional symptom persistence in 72.2%, oxygen requiring in 34%, and asthma in 37%. When controlled, radiological or functional improvement was noted in 56.8 and 40.7%. Further prospective studies are needed to better clarify the different trajectories of patients with NEHI.
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Affiliation(s)
- Morgane Dervaux
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Caroline Thumerelle
- Pediatric Pulmonology and Allergy Department, Jeanne de Flandre Hospital, CHU Lille, Univ. Lille, Pole Enfant, Lille, France
| | - Candice Fabre
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Rola Abou-Taam
- Reference Center for Rare Lung Diseases, Pediatric Pulmonology Department, University Hospital of Necker-Enfants Malades, AP-HP, Paris, France
| | - Tiphaine Bihouee
- Chronic Childhood Diseases Unit, Pediatric Department, Nantes University Hospital, Nantes, France
| | - Jacques Brouard
- Service de Pédiatrie Médicale, CHU Caen, Caen, et UMR1311 DYNAMICURE, Normandie Université, UNICAEN, UNIROUEN, Rouen, France
| | - Annick Clement
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), AP‑HP, Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Christophe Delacourt
- Reference Center for Rare Lung Diseases, Pediatric Pulmonology Department, University Hospital of Necker-Enfants Malades, AP-HP, Paris, France
| | - Céline Delestrain
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Ralph Epaud
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Sofiane Ghdifan
- Pediatric Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alice Hadchouel
- Reference Center for Rare Lung Diseases, Pediatric Pulmonology Department, University Hospital of Necker-Enfants Malades, AP-HP, Paris, France
| | - Véronique Houdouin
- Pediatric Pulmonology Department, INSERM UMR S 976 Human Immunology, AP-HP, Paris University Robert Debre Hospital, Paris, France
| | - Géraldine Labouret
- Pediatric Pulmonology Department, University Hospital for Children, Toulouse, France
| | - Caroline Perisson
- Pediatric Unit, University Hospital Sud Reunion, Saint-Pierre, France
| | - Philippe Reix
- Pediatric Pulmonology, Allergology Cystic Fibrosis Department, Hospices Civils of Lyon, Hôpital Femme Mère Enfant, Bron, France.,UMR 5558, CNRS Equipe, EMET University, Claude Bernard Lyon 1, Lyon, France
| | - Marie-Catherine Renoux
- Paediatric Cardiology and Pulmonology Department, Montpellier University Hospital, Montpellier, France
| | | | - Laurence Weiss
- Specialized Pediatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Julie Mazenq
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Nadia Nathan
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), AP‑HP, Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France. .,Aix Marseille University, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France. .,Unité de Pneumopédiatrie, CHU Timone-Enfants, 13385 Cedex 5, Marseille, France.
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Interstitial Lung Disease in Children: “Specific Conditions of Undefined Etiology” Becoming Clearer. CHILDREN 2022; 9:children9111744. [PMID: 36421193 PMCID: PMC9688624 DOI: 10.3390/children9111744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/07/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
Background: Children’s interstitial lung disease (chILD) is a rare group of pediatric lung diseases affecting the lung interstitium diffusely. In this work, we focused our attention on a specific infant group of chILD, also known as “specific conditions of undefined aetiology”, including pulmonary interstitial glycogenosis (PIG) and neuroendocrine cell hyperplasia of infancy (NEHI). Methods: PubMed was searched to conduct this narrative review. We searched for articles in English using the following keywords: (1) neuroendocrine cell hyperplasia of infancy; (2) NEHI; (3) pulmonary interstitial glycogenosis; (4) PIG; (5) chILD. Results: An increasing interest and insight into these two conditions have been reported. The updated literature suggests that it is possible to look at these disorders as a continuum of diseases, rather than two different entities, since they share a pulmonary dysmaturity. Conclusions: NEHI and PIG are featured by dysmaturity of airway development and consequent respiratory distress. Understanding the underlying pathogenic mechanisms would lead to identifying new targeted therapies to ameliorate the mortality and morbidity of these rare conditions.
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11
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Schapiro AH, Baker ML, Rattan MS, Crotty EJ. Childhood interstitial lung disease more prevalent in infancy: a practical review. Pediatr Radiol 2022; 52:2267-2277. [PMID: 35501606 DOI: 10.1007/s00247-022-05375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/24/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
Childhood interstitial lung disease (chILD) is a heterogeneous group of uncommon, mostly chronic pediatric pulmonary disorders characterized by impaired gas exchange and diffuse abnormalities on imaging. A subset of these diseases occurs more frequently in infants and young children than in older children and teenagers. Some of these disorders occur in certain clinical scenarios and/or have typical imaging features that can help the radiologist recognize when to suggest a possible diagnosis and potentially spare a child a lung biopsy. We review the clinical, histopathological and computed tomography features of chILD more prevalent in infancy, including diffuse developmental disorders, growth abnormalities, specific conditions of undefined etiology, and surfactant dysfunction mutations and related disorders, to familiarize the pediatric radiologist with this group of disorders.
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Affiliation(s)
- Andrew H Schapiro
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA. .,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Michael L Baker
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mantosh S Rattan
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eric J Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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12
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A Rare Case Report of NEHI in a Preterm Infant with Review of the Literature. Case Rep Pediatr 2022; 2022:7907338. [PMID: 35992743 PMCID: PMC9391125 DOI: 10.1155/2022/7907338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare respiratory disorder. During infancy, it typically presents with hypoxemia, tachypnea, and respiratory distress, and is commonly misdiagnosed as common childhood illnesses such as pneumonia, reactive airway disease, or bronchiolitis. Lack of awareness about this relatively new and rare disorder in primary care and acute care settings lead to delayed diagnosis and unnecessary use of antibiotics. Case Presentation. We present a case of a 7-month-old girl, born prematurely at 32 weeks with tachypnea and respiratory distress who was initially diagnosed with viral pneumonia, then upper respiratory infection, and finally with community-acquired bacterial pneumonia, while the child never had any fever or upper respiratory symptoms. Failure of outpatient treatment with oral antibiotic and bronchodilator, with the persistence of respiratory symptoms such as retractions, bilateral crackles, and hypoxemia led to hospitalization for intravenous antibiotics. Given persistent symptoms, further evaluation was performed, and she was diagnosed with NEHI based on characteristic chest CT findings. Conclusions Viral respiratory infections are the most frequent cause of respiratory illnesses in the first years of life. Primary care providers should be aware of less frequent causes of persistent respiratory symptoms in infancy like NEHI and other interstitial lung diseases in children. This may prevent unnecessary use of antibiotics and delayed diagnosis.
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Fabre C, Thumerelle C, Dervaux M, Abou-Taam R, Bihouee T, Brouard J, Clement A, Delacourt C, Delestrain C, Epaud R, Ghdifan S, Hadchouel A, Houdouin V, Labouret G, Perisson C, Reix P, Renoux MC, Troussier F, Weiss L, Mazenq J, Nathan N, Dubus JC. French national cohort of neuroendocrine cell hyperplasia of infancy (FRENCHI) study: diagnosis and initial management. Eur J Pediatr 2022; 181:3067-3073. [PMID: 35678871 DOI: 10.1007/s00431-022-04510-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Early diagnosis of neuroendocrine cell hyperplasia of infancy (NEHI) is crucial as, conversely to the other causes of intersititial lung disease, corticosteroids are not recommended. Diagnosis is historically based on lung biopsy (NEHI), but in current practice, a clinical and radiological approach is more and more preferred (NEHI syndrome). This national study aimed to address diagnosis and initial management of patients followed up for a NEHI pattern in pediatric centers for rare lung diseases (RespiRare, France). Data on neonatal and familial events, symptoms at diagnosis, explorations performed and results, and therapeutic management were collected by questionnaire. Fifty-four children were included (boys 63%). The mean onset of symptoms was 3.8 ± 2.6 months. The most frequent symptoms at diagnosis were tachypnea (100%), retraction (79.6%), crackles (66.7%), and hypoxemia (59.3%). The mean NEHI clinical score, evocative when ≥ 7/10, was 7.9 ± 1.4 (76% with a score ≥ 7). All chest CT-scans showed ground glass opacities evolving at least the middle lobe and the lingula. Lung biopsy was performed in 38.9% of the cases and was typical of NEHI in only 52.4%, even when the clinical presentation was typical. Initial treatments were oxygen (83.6%) and more curiously intravenous pulses of steroids (83.3%) and azithromycin (70.2%). CONCLUSION This national cohort of patients underlines diagnosis difficulties of NEHI. A composite clinical and radiological score should help clinicians for limiting the use of anti-inflammatory drugs. WHAT IS KNOWN •Neuroendocrine cell hyperplasia of infancy (NEHI) is an interstitial lung disease whose diagnosis is essential to limit corticosteroids therapy. WHAT IS NEW •In this national cohort of 54 patients with a NEHI pattern, diagnosis is mainly based on clinical symptoms and chest CT-scan results. The newly proposed clinical score and, when performed, the lung biopsies are faulted in 25 and 50% of the cases, respectively. •Corticosteroids are widely used. Such results plead for a new composite score to formally diagnose NEHI.
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Affiliation(s)
- Candice Fabre
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Caroline Thumerelle
- Pediatric Pulmonology and Allergy Department, Jeanne de Flandre Hospital, CHU Lille, Univ. Lille, Pole Enfant, Lille, France
| | - Morgane Dervaux
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Rola Abou-Taam
- AP-HP, Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases, University Hospital of Necker-Enfants Malades, Paris, France
| | - Tiphaine Bihouee
- Chronic Childhood Diseases Unit, Pediatric Department, Nantes University Hospital, Nantes, France
| | - Jacques Brouard
- Service de Pédiatrie Médicale, CHU Caen, Caen, et UMR1311 DYNAMICURE, Normandie Université, UNICAEN, UNIROUEN, Rouen, France
| | - Annick Clement
- AP-HP, Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Christophe Delacourt
- AP-HP, Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases, University Hospital of Necker-Enfants Malades, Paris, France
| | - Céline Delestrain
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Ralph Epaud
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Sofiane Ghdifan
- Pediatric Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alice Hadchouel
- AP-HP, Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases, University Hospital of Necker-Enfants Malades, Paris, France
| | - Véronique Houdouin
- AP-HP, Pediatric Pulmonology Department, UMR S 976 INSERM Human Immunology, Paris University, Robert Debre Hospital, Paris, France
| | - Géraldine Labouret
- Pediatric Pulmonology Department, University Hospital for Children, Toulouse, France
| | - Caroline Perisson
- Pediatric Unit, University Hospital Sud Reunion, Saint-Pierre, France
| | - Philippe Reix
- Pediatric Pulmonology, Allergology, Cystic Fibrosis Department, Hospices Civils of Lyon, Hôpital Femme Mère Enfant, Bron, France.,UMR 5558, Equipe EMET, CNRS, University Claude Bernard Lyon 1, Lyon, France
| | - Marie-Catherine Renoux
- Paediatric Cardiology and Pulmonology Department, Montpellier University Hospital, Montpellier, France
| | | | - Laurence Weiss
- Specialized Pediatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Julie Mazenq
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Nadia Nathan
- AP-HP, Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France. .,IRD, Aix Marseille University, MEPHI, IHU Méditerranée Infection, Marseille, France. .,Unité de Pneumopédiatrie, CHU Timone-Enfants, 13385, Cedex 5/0491386816, Marseille, France.
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14
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Neuroendocrine cell hyperplasia of infancy: Feasibility of objective evaluation with quantitative CT. Clin Imaging 2022; 89:43-48. [PMID: 35700553 DOI: 10.1016/j.clinimag.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/17/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe quantitative CT parameters of children with a typical pattern for NEHI and compare them to controls. MATERIALS AND METHODS Eleven patients (7 boys) with NEHI and an available chest CT concordant NEHI were identified. Eleven age-, sex-, height-matched, with CT technique-matching were identified for comparison. An open-source software was used to segment the lung parenchyma into lobes using the fissures. Quantitative parameters such as low attenuation areas, mean lung density, kurtosis, skewness, ventilation heterogeneity, lung mass, and volume were calculated for both controls and cases. RESULTS Analysis of the lung parenchyma showed that patients with NEHI had a lower mean lung density (-615 HU vs -556 HU, p = 0.03) with higher ventilation heterogeneity (0.23 vs 0.19, p = 0.04), lung mass (232 g vs 146 g, p = 0.01) and volume (595 mL vs 339 mL, p = 0.008) compared to controls. Most lobes followed this trend, except the middle lobe that showed only a higher lung mass (32.9 g vs 19.6 g, p = 0.02) and volume (77.4 vs 46.9, p = 0.005) in patients with NEHI compared to controls. CONCLUSION Quantitative CT is a feasible technique in children with a typical pattern for NEHI and is associated with differences in attenuation, ventilation heterogeneity, and lung volume.
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Xu J, Xu L, Sui P, Chen J, Moya EA, Hume P, Janssen WJ, Duran JM, Thistlethwaite P, Carlin A, Gulleman P, Banaschewski B, Goldy MK, Yuan JXJ, Malhotra A, Pryhuber G, Crotty-Alexander L, Deutsch G, Young LR, Sun X. Excess neuropeptides in lung signal through endothelial cells to impair gas exchange. Dev Cell 2022; 57:839-853.e6. [PMID: 35303432 PMCID: PMC9137452 DOI: 10.1016/j.devcel.2022.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/02/2022] [Accepted: 02/23/2022] [Indexed: 01/16/2023]
Abstract
Although increased neuropeptides are often detected in lungs that exhibit respiratory distress, whether they contribute to the condition is unknown. Here, we show in a mouse model of neuroendocrine cell hyperplasia of infancy, a pediatric disease with increased pulmonary neuroendocrine cells (PNECs), excess PNEC-derived neuropeptides are responsible for pulmonary manifestations including hypoxemia. In mouse postnatal lung, prolonged signaling from elevated neuropeptides such as calcitonin gene-related peptide (CGRP) activate receptors enriched on endothelial cells, leading to reduced cellular junction gene expression, increased endothelium permeability, excess lung fluid, and hypoxemia. Excess fluid and hypoxemia were effectively attenuated by either prevention of PNEC formation, inactivation of CGRP gene, endothelium-specific inactivation of CGRP receptor gene, or treatment with CGRP receptor antagonist. Neuropeptides were increased in human lung diseases with excess fluid such as acute respiratory distress syndrome. Our findings suggest that restricting neuropeptide function may limit fluid and improve gas exchange in these conditions.
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Affiliation(s)
- Jinhao Xu
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA; Department of Biological Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Le Xu
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Pengfei Sui
- CAS Center for Excellence in Molecular Cell Science, Shanghai Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, 320 Yueyang Road, Shanghai 200031, China
| | - Jiyuan Chen
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92121, USA
| | - Esteban A Moya
- Division of Physiology, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Patrick Hume
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - William J Janssen
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Jason M Duran
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Medical Center, La Jolla, CA 92037, USA
| | - Patricia Thistlethwaite
- Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, CA 92093, USA
| | - Aaron Carlin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Peter Gulleman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Brandon Banaschewski
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 16104, USA
| | - Mary Kate Goldy
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 16104, USA
| | - Jason X-J Yuan
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92121, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92121, USA
| | - Gloria Pryhuber
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Laura Crotty-Alexander
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, University of California San Diego, La Jolla, CA 92121, USA; Veterans Affairs San Diego Healthcare System, La Jolla, CA 92161, USA
| | - Gail Deutsch
- Department of Laboratories, Seattle Children's Hospital, University of Washington, Seattle, WA 98105, USA
| | - Lisa R Young
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 16104, USA
| | - Xin Sun
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA; Department of Biological Sciences, University of California San Diego, La Jolla, CA 92093, USA.
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16
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Laenger FP, Schwerk N, Dingemann J, Welte T, Auber B, Verleden S, Ackermann M, Mentzer SJ, Griese M, Jonigk D. Interstitial lung disease in infancy and early childhood: a clinicopathological primer. Eur Respir Rev 2022; 31:31/163/210251. [PMID: 35264412 PMCID: PMC9488843 DOI: 10.1183/16000617.0251-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 02/07/2023] Open
Abstract
Children's interstitial lung disease (chILD) encompasses a wide and heterogeneous spectrum of diseases substantially different from that of adults. Established classification systems divide chILD into conditions more prevalent in infancy and other conditions occurring at any age. This categorisation is based on a multidisciplinary approach including clinical, radiological, genetic and histological findings. The diagnostic evaluation may include lung biopsies if other diagnostic approaches failed to identify a precise chILD entity, or if severe or refractory respiratory distress of unknown cause is present. As the majority of children will be evaluated and diagnosed outside of specialist centres, this review summarises relevant clinical, genetic and histological findings of chILD to provide assistance in clinical assessment and rational diagnostics. ILD of childhood is comparable by name only to lung disease in adults. A dedicated interdisciplinary team is required to achieve the best possible outcome. This review summarises the current clinicopathological criteria and associated genetic alterations.https://bit.ly/3mpxI3b
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Affiliation(s)
- Florian Peter Laenger
- Institute of Pathology, Medical School Hannover, Hannover, Germany .,German Center for Lung Research (DZL), Hannover, Germany
| | - Nicolaus Schwerk
- German Center for Lung Research (DZL), Hannover, Germany.,Clinic for Pediatric Pneumology, Allergology and Neonatology, Medical School Hannover, Hannover, Germany
| | - Jens Dingemann
- German Center for Lung Research (DZL), Hannover, Germany.,Dept of Pediatric Surgery, Medical School Hannover, Hannover, Germany
| | - Tobias Welte
- German Center for Lung Research (DZL), Hannover, Germany.,Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Dept of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Stijn Verleden
- Antwerp Surgical Training, Anatomy and Research Center, University of Antwerp, Antwerp, Belgium
| | - Maximilian Ackermann
- Division of Thoracic Surgery, Dept of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Steven J Mentzer
- Division of Thoracic Surgery, Dept of Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthias Griese
- German Center for Lung Research (DZL), Hannover, Germany.,Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Danny Jonigk
- Institute of Pathology, Medical School Hannover, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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17
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Miraftabi P, Kirjavainen T, Föhr A, Lohi J, Martelius L. Pathological role of neuroendocrine cells in infants with persistent tachypnoea - are they only bystanders? Acta Paediatr 2022; 111:636-637. [PMID: 34816482 DOI: 10.1111/apa.16192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Päria Miraftabi
- HUS Medical Imaging Center Radiology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Turkka Kirjavainen
- Department of Pediatrics Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anna Föhr
- HUS Medical Imaging Center Radiology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Jouko Lohi
- Department of Pathology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Laura Martelius
- HUS Medical Imaging Center Radiology University of Helsinki and Helsinki University Hospital Helsinki Finland
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18
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Azadinia B, Khosravinia H, Masouri B, Kavan BP. Effects of early growth rate and fat soluble vitamins on glucose tolerance, feed transit time, certain liver and pancreas related parameters and their share in intra-flock variation in performance indices in broiler chicken. Poult Sci 2022; 101:101783. [PMID: 35339932 PMCID: PMC8957045 DOI: 10.1016/j.psj.2022.101783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Borzou Azadinia
- Department of Animal Sciences, Faculty of Agriculture, Lorestan University, Khorramabad 6813717133, Lorestan, Iran
| | - Heshmatollah Khosravinia
- Department of Animal Sciences, Faculty of Agriculture, Lorestan University, Khorramabad 6813717133, Lorestan, Iran.
| | - Babak Masouri
- Department of Animal Sciences, Faculty of Agriculture, Lorestan University, Khorramabad 6813717133, Lorestan, Iran
| | - Bahman Parizadian Kavan
- Department of Animal Sciences, Faculty of Agriculture, Lorestan University, Khorramabad 6813717133, Lorestan, Iran
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19
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Yang KH, Kulatti A, Sherer K, Rao A, Cernelc-Kohan M. Case report: Rare lung disease of infancy diagnosed with the assistance of a home pulse oximetry baby monitor. Front Pediatr 2022; 10:918764. [PMID: 36147808 PMCID: PMC9488520 DOI: 10.3389/fped.2022.918764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare childhood interstitial lung disease characterized by a gradual onset of tachypnea, hypoxemia, and failure to thrive in the first 2 years of life. NEHI is challenging to diagnose and can masquerade as common respiratory infections and reactive airway disease. Timely diagnosis is essential to optimize management of comorbidities, improve outcomes, and prevent unnecessary interventions. We report a case of a 14-month-old male who was hospitalized multiple times with recurrent episodes of presumed bronchiolitis. However, early on, the parents had detected unexplained nighttime hypoxemia with a wearable home pulse oximetry baby monitor. While recurrent respiratory infections are common in infancy, our patient had numerous persistent symptoms refractory to traditional treatments, which prompted further workup and ultimately led to the diagnosis of NEHI. The home baby monitor provided useful information that accelerated workup for a presentation that did not fit the usual picture of recurrent bronchiolitis, bronchospasm, or pneumonia. These devices that monitor infant cardiopulmonary status and oxygenation are becoming increasingly popular for home use. There is controversy over their clinical utility due to the frequency of false alarms, excessive parental reliance on these devices, and lack of Food and Drug Administration oversight to ensure accuracy and effectiveness of these devices. Our case provides an example of how in certain clinical settings, information from these devices might serve as a complementary tool in the pediatrician's medical decision-making and possibly lead to a rare diagnosis such as NEHI.
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Affiliation(s)
- Kevin H Yang
- Rady Children's Hospital, UC San Diego School of Medicine, San Diego, CA, United States
| | - Art Kulatti
- Rady Children's Hospital, UC San Diego School of Medicine, San Diego, CA, United States
| | - Kimberly Sherer
- Rady Children's Hospital, UC San Diego School of Medicine, San Diego, CA, United States
| | - Aparna Rao
- Division of Respiratory Medicine, Rady Children's Hospital, San Diego, CA, United States
| | - Mateja Cernelc-Kohan
- Division of Respiratory Medicine, Rady Children's Hospital, San Diego, CA, United States
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20
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Marczak H, Peradzyńska J, Seidl E, Griese M, Urbankowski T, Lange J, Bogusławski S, Krenke K. The improved clinical course of persistent tachypnea of infancy with inhaled bronchodilators and corticosteroids. Pediatr Pulmonol 2021; 56:3952-3959. [PMID: 34520130 DOI: 10.1002/ppul.25674] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/31/2021] [Accepted: 09/11/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Persistent tachypnea of infancy (PTI) is the most common interstitial lung disease in young children. As no standardized therapeutic guidelines exist, different pharmaceuticals are used to treat PTI; inhaled corticosteroids (ICS) and bronchodilators being mostly used. This observation assessed the effectiveness of bronchodilators and ICS in children with PTI enrolled in the children's interstitial lung diseases (chILD)-EU Register. METHODS Symptomatic children with PTI were observed according to a predetermined stepwise protocol including bronchodilators as the first choice treatment (6 weeks). In patients with incomplete response, additionally, ICS was given (12 weeks). Signs, symptoms, and pulmonary function were evaluated at three time points: at baseline, 6 (±1) weeks after initiation of bronchodilators, and 12 (±1) weeks after bronchodilators/ICS. RESULTS Thirty-one children (median age: 44 months, interquartile range [IQR]: 15-67) were included. The therapy was associated with a significant reduction of tachypnea (53.3% of patients, p = 0.02), exercise intolerance (52.2% of patients, p < 0.001), chest retractions (43.8% of patients, p = 0.04), and crackles (29.2% of patients, p = 0.02). Also, a significant improvement in forced expiratory volume in 1 s (FEV1 ) (median z score: -2.21 vs. -0.47, p = 0.03), residual volume (RV) (median z score 5.28 vs. 1.07, p = 0.007), RV% total lung capacity (TLC) (median z score: 6.05 vs. 1.48, p = 0.01), sRaw (median z score: 6.6 vs. 4.64, p = 0.01), R5 (median z score: 1.27 vs. 0.31, p = 0.009), and R5-R20 (median: 0.58 vs. 0.26 kPa/(l/s), p = 0.002) was demonstrated. CONCLUSIONS Inhaled bronchodilators and ICS may exert a positive effect on the severity of symptoms and pulmonary function test (PFT) in symptomatic children with PTI. However, a randomized control trial should be conducted to confirm their effectiveness.
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Affiliation(s)
- Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Peradzyńska
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Elias Seidl
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | - Matthias Griese
- Department of Pediatric Pneumology, Hauner Children's Hospital, Ludwig Maximilians University, Munich, Germany
| | | | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Stanisław Bogusławski
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
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Abstract
Childhood interstitial lung disease (ChILD) is an umbrella term encompassing a diverse group of diffuse lung diseases affecting infants and children. Although the timely and accurate diagnosis of ChILD is often challenging, it is optimally achieved through the multidisciplinary integration of imaging findings with clinical data, genetics, and potentially lung biopsy. This article reviews the definition and classification of ChILD; the role of imaging, pathology, and genetics in ChILD diagnosis; treatment options; and future goals. In addition, a practical approach to ChILD imaging based on the latest available research and the characteristic imaging appearance of ChILD entities are presented.
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22
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Abstract
Neonatal lung biopsy guides important medical decisions when the diagnosis is not clear from prior clinical assessment, imaging, or genetic testing. Common scenarios that lead to biopsy include severe acute respiratory distress in a term neonate, pulmonary hypertension disproportionate to that expected for gestational age or known cardiac anomalies, and assessment of suspected genetic disorder based on clinical features or genetic variant of unknown significance. The differential diagnosis includes genetic developmental disorders, genetic surfactant disorders, vascular disorders, acquired infection, and meconium aspiration. This article describes pathologic patterns in the neonatal lung and correlation with molecular abnormalities, where appropriate.
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23
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Wang B, Cardenas M, Bedoya M, Colin AA, Rossi GA. Upregulation of neuropeptides and obstructive airway disorder in infancy: A review with focus on post-RSV wheezing and NEHI. Pediatr Pulmonol 2021; 56:1297-1306. [PMID: 33524244 DOI: 10.1002/ppul.25292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/31/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022]
Abstract
Obstructive airway disorders, common in infancy and early childhood, include some entities that are recognized to have neuro immune mediators as their underlying pathogenetic mechanisms. The best characterized example amongst post-viral wheezing phenotypes is the disorder that follows respiratory syncytial virus (RSV) infection and leads to intermittent, long-term wheezing. The underlying mechanisms of the airway reactivity related to RSV infection have been extensively studies and are associated with dysregulation of the nonadrenergic-noncholinergic (NANC) system, via upregulation of neurotransmitters, typically Substance P. Neuroendocrine hyperplasia of infancy (NEHI), while a less common entity, is a disorder characterized by more severe and long-term obstructive airway disease. NEHI is pathophysiologically characterized by abundance of neuroendocrine cells in the airways containing the neuroimmune mediator bombesin, the release of which is presumed to be the driver of the persistent small airway obstruction and functional air-trapping. Here we review the NANC and neuroendocrine cells, the neurotransmitter systems and their studied roles in pulmonary diseases with a focus on their role in lung development, and subsequent various pediatric lung diseases. We focus on the juxtaposition of the separate neuroimmune mechanisms underlying the pathogenesis of post-RSV recurrent wheezing and NEHI's persistent small airway obstruction. We finally propose a unifying concept of neuropeptides in obstructive disorders that may encompass these two entities and possibly others.
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Affiliation(s)
- Bin Wang
- Division of Critical Care Medicine, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Monica Cardenas
- Division of Pediatric Pulmonology, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Mariana Bedoya
- Division of Pediatric Pulmonology, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Jackson Memorial Hospital and Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Giovanni A Rossi
- Pulmonary and Allergy Disease Unit, Department of Pediatrics, G. Gaslini University Hospital, Genoa, Italy
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Balinotti JE, Maffey A, Colom A, Roldán O, Díaz W, Medín M, Racimo M, Teper A. Clinical, functional, and computed tomography findings in a cohort of patients with neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2021; 56:1681-1686. [PMID: 33580744 DOI: 10.1002/ppul.25319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Neuroendocrine cell hyperplasia of infancy (NEHI) is one of the most common interstitial lung diseases in children. Both the etiology and pathophysiological mechanisms of the disease are still unknown. Prognosis is usually favorable; however, there are significant morbidities during the early years of life. OBJECTIVE To describe the clinical course, infant pulmonary function tests and computed tomography (CT) findings in a cohort of patients with NEHI in Argentina. METHODS This is a observational multicenter cohort study of children diagnosed with NEHI between 2011 and 2020. RESULTS Twenty patients participated in this study. The median age of onset of symptoms was 3 months and the median age at diagnosis was 6 months. The most common clinical presentation was tachypnea, retractions and hypoxemia. The chest CT findings showed central ground glass opacities and air trapping. Infant pulmonary function tests revealed an obstructive pattern in 75% of the cases (10/12). Most patients (75%) required home oxygen therapy for 17 months (interquartile range 12-25). In 85% of them, tachypnea and hypoxemia spontaneously resolved between the second and third years of life. CONCLUSION In this cohort, the first symptoms appeared during the early months of life. The typical clinical, CT, and functional findings allowed the diagnosis without the need of a lung biopsy. Although most patients required home oxygen therapy, they showed a favorable evolution.
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Affiliation(s)
- Juan E Balinotti
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Alberto Maffey
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Colom
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Oscar Roldán
- Division of Pediatric, Sanatorio del Salvador, Córdoba, Argentina
| | - Walter Díaz
- Division of Pediatric, Alexander Fleming Hospital, Mendoza, Argentina
| | - Martín Medín
- Department of Pathology, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Mariano Racimo
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Teper
- Department of Medicine, Respiratory Center, Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
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Breuer O, Cohen-Cymberknoh M, Picard E, Bentur L, Bar-Yoseph R, Shoseyov D, Tsabari R, Kerem E, Hevroni A. The Use of Infant Pulmonary Function Tests in the Diagnosis of Neuroendocrine Cell Hyperplasia of Infancy. Chest 2021; 160:1397-1405. [PMID: 34029568 DOI: 10.1016/j.chest.2021.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/15/2021] [Accepted: 05/07/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infant pulmonary function tests (iPFTs) in subjects with neuroendocrine cell hyperplasia of infancy (NEHI) have demonstrated significant expiratory airflow obstruction and air trapping. RESEARCH QUESTION Can indexes from iPFTs be used in the diagnosis of NEHI? STUDY DESIGN AND METHODS This is an observational case-control study evaluating iPFT results from a registry of patients assessed at the Hadassah Hebrew University Medical Center between 2008 and 2018. We used the Kruskal-Wallis H test to compare iPFT results in infants with NEHI with those in two infants in a disease control group (infants evaluated for recurrent wheezing and infants evaluated owing to prematurity) and those in a spirometry control group of infants with normal expiratory airflow. Receiver operating characteristic (ROC) curves were used to assess the diagnostic accuracy of the iPFT indexes. RESULTS We evaluated iPFT data in 481 infants (15, NEHI; 292, wheezing; 128, premature; and 46, control group). Infants with NEHI had significantly increased trapped air volumes (median functional residual capacity measured with baby-body plethysmograph [FRCpleth] was 199% predicted; median ratio of residual volume to total lung capacity was 59% predicted) when compared with results in all evaluated groups of infants (P < .001), including multiple pairwise comparisons. Airflow limitation was demonstrated in infants with NEHI when compared with the infants in the spirometry control group but was similar to that in the two infants in the disease control group. FRCpleth had the best discriminatory ability for NEHI diagnosis, with an FRCpleth ≥ 150% predicted demonstrating a ROC of 0.91 (95% CI, 0.82-1.00), sensitivity of 86.7% (95% CI, 59.5%-98.3%), and specificity of 95.5% (95% CI, 93.2%-97.3%). INTERPRETATION Findings on iPFTs of markedly increased air trapping, out of proportion to the degree of airflow limitation, are characteristic of infants with NEHI. iPFT results demonstrating an FRCpleth ≥ 150% predicted are highly specific for NEHI and may aid in early diagnosis. Further research is required to confirm these findings in a prospective cohort and to understand the pathophysiologic explanation for these findings.
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Affiliation(s)
- Oded Breuer
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Malena Cohen-Cymberknoh
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonary Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lea Bentur
- Pediatric Pulmonary Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - David Shoseyov
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Reuven Tsabari
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eitan Kerem
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Avigdor Hevroni
- Pediatric Pulmonology and CF Unit, Department of Pediatrics, Hadassah Medical Center, and Faculty of Medicine, Hebrew University of Jerusalem, Israel; Pediatric Pulmonary Unit, Kaplan Medical Center, Rehovot, Israel
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26
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Brouns I, Verckist L, Pintelon I, Timmermans JP, Adriaensen D. Pulmonary Sensory Receptors. ADVANCES IN ANATOMY EMBRYOLOGY AND CELL BIOLOGY 2021; 233:1-65. [PMID: 33950466 DOI: 10.1007/978-3-030-65817-5_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Inge Brouns
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium.
| | - Line Verckist
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
| | - Isabel Pintelon
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
| | - Jean-Pierre Timmermans
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
| | - Dirk Adriaensen
- Laboratory of Cell Biology and Histology, Department of Veterinary Sciences, University of Antwerp, Antwerpen (Wilrijk), Belgium
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27
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McCravy M, Ingram JL, Que LG. Dysregulated Metabolism in the Pathophysiology of Non-Allergic Obese Asthma. J Asthma Allergy 2021; 14:179-186. [PMID: 33692628 PMCID: PMC7939487 DOI: 10.2147/jaa.s282284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/01/2021] [Indexed: 12/31/2022] Open
Abstract
Asthma is an obstructive airway disease that is characterized by reversible airway obstruction and is classically associated with atopic, TH2 driven inflammation. Landmark studies in the second half of the twentieth century identified eosinophils as a key mediator of inflammation and steroids, both inhaled and systemic, as a cornerstone of therapy. However, more recently other phenotypes of asthma have emerged that do not respond as well to traditional therapies. In particular, obese patients who develop asthma as adults are less likely to have eosinophilic airway inflammation and do not respond to traditional therapies. Obese patients often have metabolic comorbidities such as impaired glucose tolerance and dyslipidemias, also known as metabolic syndrome (MetS). The unified pathophysiology of metabolic syndrome is not known, however, several signaling pathways, such as the neuropeptide glucagon-like peptide-1 (GLP-1) and nitric oxide (NO) signaling have been shown to be dysregulated in MetS. These pathways are targeted by commercially available medications. This review discusses the potential roles that dysregulation of the GLP-1 and NO signaling pathways, along with arginine metabolism, play in the development of asthma in obese patients. GLP-1 receptors are found in high density in the lung and are also detectable in bronchoalveolar lavage fluid. NO has long been associated with asthma. We hypothesize that these derangements in metabolic signaling pathways underpin the asthmatic phenotype seen in obese patients with non-eosinophilic airway inflammation and poor response to established therapies. While still an active area of research, novel interventions are needed for this subset of patient who respond poorly to available asthma therapies.
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Affiliation(s)
- Matthew McCravy
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jennifer L Ingram
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Loretta G Que
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
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Huang HB, Huang JL, Xu XT, Huang KB, Lin YJ, Lin JB, Zhuang XB. Serum neuron-specific enolase: A promising biomarker of silicosis. World J Clin Cases 2021; 9:1016-1025. [PMID: 33644165 PMCID: PMC7896644 DOI: 10.12998/wjcc.v9.i5.1016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Silicosis is a type of chronic pulmonary fibrosis caused by long-term inhalation of silica dust particles. There has been no ideal biomarker for the diagnosis and differential diagnosis of silicosis until now. Studies have found that elevated neuron-specific enolase (NSE) concentration in the serum of silicosis patients is helpful for diagnosis and severity assessment of the disease. However, the number of cases in these studies was not enough to arouse attention.
AIM To investigate the clinical significance of serum NSE in the diagnosis and staging of silicosis.
METHODS From January 2017 to June 2019, 326 cases of silicosis confirmed in Quanzhou First Hospital Affiliated to Fujian Medical University were included in the silicosis group. A total of 328 healthy individuals or medical patients without silicosis were included in the control group. Serum NSE concentrations of all subjects were determined by electrochemical luminescence.
RESULTS There were no significant differences in sex, age, smoking index and complications between the silicosis and control groups. The mean serum NSE concentration was 26.57 ± 20.95 ng/mL in the silicosis group and 12.42 ± 2.68 ng/mL in the control group. The difference between the two groups was significant (U = 15187, P = 0.000). Among the 326 patients with silicosis, 103 had stage I silicosis, and the mean serum NSE concentration was 15.55 ± 6.23 ng/mL. The mean serum NSE concentration was 21.85 ± 12.05 ng/mL in 70 patients with stage II silicosis. The mean serum NSE concentration was 36.14 ± 25.72 ng/mL in 153 patients with stage III silicosis. Kruskal–Wallis H test suggested that the difference in serum NSE concentration in silicosis patients in the three groups was significant (H = 130.196, P = 0.000). Receiver operating characteristic curve analysis indicated that the area under the curve was 0.858 (95% confidence interval: 0.828-0.888; P = 0.000). When the NSE concentration was 15.82 ng/mL, the Jorden index was the largest, the sensitivity was 72%, and the specificity was 90%.
CONCLUSION Serum NSE concentration may be a promising biomarker for the diagnosis and assessment of severity of silicosis.
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Affiliation(s)
- Hong-Bo Huang
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jun-Ling Huang
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Xiao-Ting Xu
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Kun-Bo Huang
- Department of Clinical Laboratory, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yi-Jian Lin
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jie-Bin Lin
- Department of Internal Medicine, Infectious Disease Hospital of Quanzhou, Quanzhou 362000, Fujian Province, China
| | - Xi-Bin Zhuang
- Department of Pulmonary and Critical Care Medicine, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Abstract
Diffuse interstitial lung disease of infancy (chILD) shows a spectrum of disease substantially different from that of adults. Established classification systems divide chILD into conditions that are more prevalent in infancy and conditions that occur at any age. The classification is based on a multidisciplinary approach including clinical, radiological, genetic, and histological findings. Lung biopsies become necessary if other diagnostic investigations have not identified a precise chILD or if severe or refractory respiratory distress of unknown cause is present. As the majority of pediatric lung biopsies will be received first by pathologists outside of specialist centers this review summarizes relevant clinical and histological findings of chILD.
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30
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Noguchi M, Furukawa KT, Morimoto M. Pulmonary neuroendocrine cells: physiology, tissue homeostasis and disease. Dis Model Mech 2020; 13:13/12/dmm046920. [PMID: 33355253 PMCID: PMC7774893 DOI: 10.1242/dmm.046920] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Mammalian lungs have the ability to recognize external environments by sensing different compounds in inhaled air. Pulmonary neuroendocrine cells (PNECs) are rare, multi-functional epithelial cells currently garnering attention as intrapulmonary sensors; PNECs can detect hypoxic conditions through chemoreception. Because PNEC overactivation has been reported in patients suffering from respiratory diseases – such as asthma, chronic obstructive pulmonary disease, bronchopulmonary dysplasia and other congenital diseases – an improved understanding of the fundamental characteristics of PNECs is becoming crucial in pulmonary biology and pathology. During the past decade, murine genetics and disease models revealed the involvement of PNECs in lung ventilation dynamics, mechanosensing and the type 2 immune responses. Single-cell RNA sequencing further unveiled heterogeneous gene expression profiles in the PNEC population and revealed that a small number of PNECs undergo reprogramming during regeneration. Aberrant large clusters of PNECs have been observed in neuroendocrine tumors, including small-cell lung cancer (SCLC). Modern innovation of imaging analyses has enabled the discovery of dynamic migratory behaviors of PNECs during airway development, perhaps relating to SCLC malignancy. This Review summarizes the findings from research on PNECs, along with novel knowledge about their function. In addition, it thoroughly addresses the relevant questions concerning the molecular pathology of pulmonary diseases and related therapeutic approaches. Summary: This Review highlights the physiological relevance of pulmonary neuroendocrine cells, rare airway epithelial cells that form intrapulmonary sensory organs, abnormalities of which are associated with several pulmonary disorders, such as asthma and lung cancer.
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Affiliation(s)
- Masafumi Noguchi
- Laboratory for Lung Development and Regeneration, RIKEN Centre for Biosystems Dynamics Research, Kobe 650-0047, Japan.,Department of Biology, University of Padova, Via U. Bassi 58B, 35121 Padova, Italy; Veneto Institute of Molecular Medicine, Via Orus 2, 35129 Padova, Italy
| | - Kana T Furukawa
- Laboratory for Lung Development and Regeneration, RIKEN Centre for Biosystems Dynamics Research, Kobe 650-0047, Japan
| | - Mitsuru Morimoto
- Laboratory for Lung Development and Regeneration, RIKEN Centre for Biosystems Dynamics Research, Kobe 650-0047, Japan
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31
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Abstract
There is a wide differential diagnosis of early onset respiratory distress especially in term babies, and interstitial lung disease (chILD) is a rare but important consideration in this context. chILD manifesting immediately after birth is usually related to mutations in surfactant protein genes, or conditions related to the Congenital Acinar Dysplasia -Alveolar capillary dysplasia - Congenital Alveolar Dysplasia (CAD-ACD) spectrum. There is currently no specific treatment for these conditions, and management is supportive. Prognosis is very poor in most of these babies if onset is early, with relentless respiratory deterioration unless transplanted. Ideally, the diagnosis is made on genetic analysis, but this may be time-consuming and complex in CAD-ACD spectrum, so lung biopsy may be needed to avoid prolonged and futile treatment being instituted. Milder forms with prolonged survival have been reported. Early onset, less severe chILD is usually related to neuroendocrine cell hyperplasia of infancy (NEHI), pulmonary interstitial glycogenosis (PIG) and less severe disorders of surfactant proteins. PIG and NEHI are not specific entities, but are pulmonary dysmaturity syndromes, and there may be a number of underlying genetic and other cause. If the child is stable and thriving, many will not be subject to lung biopsy, and slow improvement and weaning of supplemental oxygen can be anticipated. Where possible, a precise genetic diagnosis should be made in early onset cHILD allow for genetic counselling. chILD survivors and their families have complex respiratory and other needs, and co-ordinated, multi-disciplinary support in the community is essential.
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Affiliation(s)
- Andrew Bush
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK.
| | | | - Jo Gregory
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Andrew Gordon Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College, UK
| | - Thomas Semple
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Rishi Pabary
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
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32
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Seidl E, Carlens J, Schwerk N, Wetzke M, Marczak H, Lange J, Krenke K, Mayell SJ, Escribano A, Seidenberg J, Ahrens F, Hebestreit H, Nährlich L, Sismanlar T, Aslan AT, Snijders D, Ullmann N, Kappler M, Griese M. Persistent tachypnea of infancy: Follow up at school age. Pediatr Pulmonol 2020; 55:3119-3125. [PMID: 32761949 DOI: 10.1002/ppul.25004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Persistent tachypnea of infancy (PTI) is a rare pediatric lung disease of unknown origin. The diagnosis can be made by clinical presentation and chest high resolution computed tomography after exclusion of other causes. Clinical courses beyond infancy have rarely been assessed. METHODS Patients included in the Kids Lung Register diagnosed with PTI as infants and now older than 5 years were identified. Initial presentation, extrapulmonary comorbidities, spirometry and clinical outcome were analyzed. RESULTS Thirty-five children older than 5 years with PTI diagnosed as infants were analyzed. At the age of 5 years, 74% of the patients were reported as asymptomatic and did not develope new symptoms during the observational period at school-age (mean, 3.9 years; range, 0.3-6.3). At the age of about 10 years, none of the symptomatic children had abnormal oxygen saturation during sleep or exercise anymore. Lung function tests and breathing frequency were within normal values throughout the entire observational period. CONCLUSIONS PTI is a pulmonary disease that can lead to respiratory insufficiency in infancy. As at school age most of the previously chronically affected children became asymptomatic and did not develop new symptoms. We conclude that the overall clinical course is favorable.
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Affiliation(s)
- Elias Seidl
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, German Center for Lung Research, Munich, Germany
| | - Julia Carlens
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Martin Wetzke
- Clinic for Pediatric Pneumology, Allergology, and Neonatology, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | - Honorata Marczak
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Sarah J Mayell
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Amparo Escribano
- Hospital Clínico Universitario, Unidad Neumología Infantil, Universidad de Valencia, Valencia, Spain
| | - Jürgen Seidenberg
- Neonatologie und Intensivmedizin, Klinikum Oldenburg, Oldenburg, Germany
| | | | | | - Lutz Nährlich
- Universities of Giessen and Marburg Lung Center, German Center of Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - Tugba Sismanlar
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse T Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deborah Snijders
- Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Nicola Ullmann
- Pediatric Pulmonology and Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics (DPUO), Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, German Center for Lung Research, Munich, Germany
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University, German Center for Lung Research, Munich, Germany
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Xu J, Yu H, Sun X. Less Is More: Rare Pulmonary Neuroendocrine Cells Function as Critical Sensors in Lung. Dev Cell 2020; 55:123-132. [PMID: 33108755 DOI: 10.1016/j.devcel.2020.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
Pulmonary neuroendocrine cells (PNECs) are rare airway epithelial cells that also uniquely harbor neuronal and endocrine characteristics. In vitro data indicate that these cells respond to chemical or mechanical stimuli by releasing neuropeptides and neurotransmitters, implicating them as airway sensors. Emerging in vivo data corroborate this role and demonstrate that PNECs are important for lung response to signals, such as allergens. With close proximity to steady-state immune cells and innervating nerves, PNECs, as prototype tissue-resident neuroendocrine cells, are at the center of a neuro-immune module that enables the fundamental ability of an organ to sense and respond to the environment.
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Affiliation(s)
- Jinhao Xu
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA; Department of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Haoze Yu
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Xin Sun
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA; Department of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA.
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34
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Emiralioğlu N, Orhan D, Cinel G, Tuğcu GD, Yalçın E, Doğru D, Özçelik U, Griese M, Kiper N. Variation in the bombesin staining of pulmonary neuroendocrine cells in pediatric pulmonary disorders-A useful marker for airway maturity. Pediatr Pulmonol 2020; 55:2383-2388. [PMID: 32558323 DOI: 10.1002/ppul.24910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Pulmonary neuroendocrine cells (NEC) increase with age due to pulmonary maturity. The aim of this study was to determine whether open lung biopsies from patients with interstitial lung diseases have increased pulmonary NEC compared with neuroendocrine cell hyperplasia of infancy (NEHI). Our second aim was to assess pulmonary NECs in the lung autopsy of children without lung disease who died from different causes. METHODS Lung tissue of 5 infants with NEHI; 21 patients with pediatric interstitial lung disease (chILD); 17 lung autopsies of infants at varying age without lung disease were included. The percentage of the airways containing neuroendocrine cells, the average percentage of neuroendocrine cells (NECs) per airway, and the number of neuroendocrine bodies (NEBs) in each case were analyzed. RESULTS The mean percentage of the airways containing neuroendocrine cells were 95% in the NEHI group, 30% in the chILD group, 89% under Intrauterine 37 weeks, 70% between intrauterine 37 to 40 weeks, 52% at postnatal 4 days to 6 months of autopsy ages. In the NEHI group, diffuse NE cell distribution and large NEBs were noticed in the lung biopsy. In the chILD group, neuroendocrine cells were dispersed, did not form clusters and NE cells showed solitary distribution. In the lung autopsy group, linear NE cells were detected at younger aged fetuses and solitary distribution of NE cells was detected with the older increasing age. CONCLUSIONS Our findings confirm that NECs are seen in many other childhood interstitial lung diseases; NE cell hyperplasia may be a marker of decreased pulmonary development and NE cells decrease with the increasing age of the fetus during Intrauterine life.
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Affiliation(s)
- Nagehan Emiralioğlu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Güzin Cinel
- Department of Pediatric Pulmonology, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Gökçen Dilşa Tuğcu
- Department of Pediatric Pulmonology, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Uğur Özçelik
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Matthias Griese
- Division of Pediatric Pneumology, University Hospital Munich & German Center for Lung Research (DZL), Dr. von Hauner Children's Hospital, Munich, Germany
| | - Nural Kiper
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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35
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Casey AM, Deterding RR, Young LR, Fishman MP, Fiorino EK, Liptzin DR. Overview of the ChILD Research Network: A roadmap for progress and success in defining rare diseases. Pediatr Pulmonol 2020; 55:1819-1827. [PMID: 32533913 DOI: 10.1002/ppul.24808] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 04/21/2020] [Indexed: 11/08/2022]
Abstract
Children's interstitial and diffuse lung diseases are a diverse group of rare lung disorders that present in childhood with diffuse pulmonary infiltrates and respiratory signs and symptoms. Children with these disorders face high morbidity and mortality and their families must cope with overwhelming uncertainty. Physicians caring for these patients are challenged by a paucity of directed therapies, or even understanding of natural history. Through the establishment of the Children's Interstitial Lung Disease Foundation Research Network and the Children's Interstitial Lung Disease Foundation significant progress has been made through collaboration and research. This review outlines the past and current successes in the new and rapidly growing field of Children's Interstitial and Diffuse Lung Disease.
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Affiliation(s)
- Alicia M Casey
- Division of Pulmonary Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Robin R Deterding
- Section of Pediatric Pulmonology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Lisa R Young
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Martha P Fishman
- Division of Pulmonary Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Elizabeth K Fiorino
- Division of Pediatric Pulmonology, Weill Cornell Medicine and NewYork-Presbyterian Phyllis and David Komansky Children's Hospital, New York, New York
| | - Deborah R Liptzin
- Section of Pediatric Pulmonology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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Liptzin DR, Pickett K, Brinton JT, Agarwal A, Fishman MP, Casey A, Towe CT, Taylor JB, Kurland G, Hagood JS, Wambach J, Srivastava R, Al-Saleh H, Dell SD, Young LR, Deterding RR. Neuroendocrine Cell Hyperplasia of Infancy. Clinical Score and Comorbidities. Ann Am Thorac Soc 2020; 17:724-728. [PMID: 32109152 PMCID: PMC7258416 DOI: 10.1513/annalsats.201908-617oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/28/2020] [Indexed: 11/20/2022] Open
Abstract
Rationale: Neuroendocrine cell hyperplasia of infancy (NEHI) is an important form of children's interstitial and diffuse lung disease for which the diagnostic strategy has evolved. The prevalence of comorbidities in NEHI that may influence treatment has not been previously assessed.Objectives: To evaluate a previously unpublished NEHI clinical score for assistance in diagnosis of NEHI and to assess comorbidities in NEHI.Methods: We performed a retrospective chart review of 199 deidentified patients with NEHI from 11 centers. Data were collected in a centralized Research Electronic Data Capture registry and we performed descriptive statistics.Results: The majority of patients with NEHI were male (66%). The sensitivity of the NEHI Clinical Score was 87% (95% confidence interval [CI], 0.82-0.91) for all patients from included centers and 93% (95% CI, 0.86-0.97) for those with complete scores (e.g., no missing data). Findings were similar when we limited the population to the 75 patients diagnosed by lung biopsy (87%; 95% CI, 0.77-0.93). Of those patients evaluated for comorbidities, 51% had gastroesophageal reflux, 35% had aspiration or were at risk for aspiration, and 17% had evidence of immune system abnormalities.Conclusions: The NEHI Clinical Score is a sensitive tool for clinically evaluating NEHI; however, its specificity has not yet been addressed. Clinicians should consider evaluating patients with NEHI for comorbidities, including gastroesophageal reflux, aspiration, and immune system abnormalities, because these can contribute to the child's clinical picture and may influence clinical course and treatment.
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Affiliation(s)
- Deborah R. Liptzin
- Section of Pulmonology, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Kaci Pickett
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - John T. Brinton
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Amit Agarwal
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas
| | - Martha P. Fishman
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alicia Casey
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher T. Towe
- Pulmonary Medicine, Cincinnati Children’s Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jane B. Taylor
- Division of Pulmonology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Geoffrey Kurland
- Division of Pulmonology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - James S. Hagood
- Division of Pulmonology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Wambach
- Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Ruma Srivastava
- Department of Pediatrics, Pulmonary Medicine, Wayne State University and Children’s Hospital of Michigan, Detroit, Michigan
| | | | - Sharon D. Dell
- Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and
| | - Lisa R. Young
- Division of Pulmonary Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robin R. Deterding
- Section of Pulmonology, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
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Verma N, Altmayer S, Hochhegger B, Barros MC, Rajderkar D, Mohammed TL. ChILD: A Pictorial Review of Pulmonary Imaging Findings in Childhood Interstitial Lung Diseases. Curr Probl Diagn Radiol 2020; 50:95-103. [PMID: 32317133 DOI: 10.1067/j.cpradiol.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/18/2020] [Indexed: 11/22/2022]
Abstract
Childhood interstitial lung disease (chILD) is a group of lung disorders characterized by lung remodeling leading to abnormal gas exchange. ChILD is classified differently from adult interstitial lung disease and encompasses 2 broad categories: "disorders more prevalent in infancy" (<2 years) and "disorders not specific to infancy" (>2 years). High-resolution computed tomography can play an important role in the evaluation of chILD by narrowing the differential diagnosis and preventing unnecessary invasive procedures if typical imaging patterns are recognized. Thus, the pediatric radiologist should consider chILD in children with respiratory distress and identify the imaging patterns to suggest the diagnosis.
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Affiliation(s)
- Nupur Verma
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Stephan Altmayer
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dhanashree Rajderkar
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Tan-Lucien Mohammed
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
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Abstract
Interstitial (diffuse) lung diseases in infants and children comprise a rare heterogeneous group of parenchymal lung disorders, with clinical syndromes characterized by dyspnea, tachypnea, crackles, and hypoxemia. They arise from a wide spectrum of developmental, genetic, inflammatory, infectious, and reactive disorders. In the past, there has been a paucity of information and limited understanding regarding their pathogenesis, natural history, imaging findings, and histopathologic features, which often resulted in enormous diagnostic challenges and confusion. In recent years, there has been a substantial improvement in the understanding of interstitial lung disease in pediatric patients due to the development of a structured classification system based on the etiology of the lung disease, established pathologic criteria for consistent diagnosis, and the improvement of thoracoscopic techniques for lung biopsy. Imaging plays an important role in evaluating interstitial lung diseases in infants and children by confirming and characterizing the disorder, generating differential diagnoses, and providing localization for lung biopsy for pathological diagnosis. In this chapter, the authors present the epidemiology, challenges, and uncertainties of diagnosis and amplify a recently developed classification system for interstitial lung disease in infants and children with clinical, imaging, and pathological correlation.
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Affiliation(s)
- Robert H. Cleveland
- Department of Radiology, Harvard Medical School Boston Children’s Hospital, Boston, MA USA
| | - Edward Y. Lee
- Department of Radiology, Harvard Medical School Boston Children’s Hospital, Boston, MA USA
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Vece TJ, Esther CR. Identifying Biomarkers in Pediatric Rare Lung Disease. chILD Grows Up. Am J Respir Crit Care Med 2019; 200:1458-1459. [PMID: 31454262 PMCID: PMC6909836 DOI: 10.1164/rccm.201908-1594ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Timothy J Vece
- Department of PediatricsUniversity of North Carolina-Chapel HillChapel Hill, North Carolina
| | - Charles R Esther
- Department of PediatricsUniversity of North Carolina-Chapel HillChapel Hill, North Carolina
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Deterding RR, Wagner BD, Harris JK, DeBoer EM. Pulmonary Aptamer Signatures in Children's Interstitial and Diffuse Lung Disease. Am J Respir Crit Care Med 2019; 200:1496-1504. [PMID: 31409098 PMCID: PMC6909841 DOI: 10.1164/rccm.201903-0547oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023] Open
Abstract
Rationale: Biomarker signatures are needed in children with children's interstitial and diffuse lung disease (chILD) to improve diagnostic approaches, increase our understanding of disease pathogenesis, monitor disease progression, and develop new treatment strategies. Proteomic technology using SOMAmer (Slow Off-rate Modified Aptamer) nucleic acid-based protein-binding reagents allows for biomarker discovery.Objectives: We hypothesized that proteins and protein pathways in BAL fluid (BALF) would distinguish children with neuroendocrine cell hyperplasia of infancy (NEHI), surfactant dysfunction mutations, and other chILD diagnoses and control subjects.Methods: BALF was collected for clinical indications and banked in patients with chILD and disease control subjects using standardized protocols over 10 years. BALF supernatant was analyzed using an aptamer assay to measure 1,129 protein levels. Protein levels were compared between groups using an ANOVA and adjusted for multiple comparisons using false discovery rate. Proteins were classified into pathways. Hierarchical clustering was used to define endotypes in the group of children with NEHI.Measurements and Main Results: After correcting for multiple testing, children with NEHI (n = 22) had 202 aptamers that were significantly different (P < 0.05) in BALF compared with control subjects (n = 9). Children with surfactant mutation (n = 8) had 51 aptamers significantly different (P < 0.05) in BALF compared with control subjects (n = 9). Proteins associated with pulmonary fibrosis and inflammation were associated with the surfactant dysfunction group but not the NEHI group. Using hierarchical clustering analysis, two distinct NEHI endotypes were identified.Conclusions: Distinct proteins and protein pathways can be determined from BALF of children with chILD, and these hold promise to further our understanding of chILD.
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Affiliation(s)
- Robin R. Deterding
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Brandie D. Wagner
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado
| | - J. Kirk Harris
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Emily M. DeBoer
- Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado; and
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Gower WA, Birnkrant DJ, Black JB, Noah TL. Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing. Pediatr Pulmonol 2019; 54:1655-1662. [PMID: 31402599 DOI: 10.1002/ppul.24461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/11/2019] [Indexed: 12/31/2022]
Abstract
Pediatric Pulmonology publishes original research, case reports, and review articles on topics related to a wide range of children's respiratory disorders. In this article, we highlight the past year's publications in the topic areas of rare lung diseases, respiratory complications of neuromuscular disorders, and diagnostic testing, as well as selected literature in these areas from other journals.
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Affiliation(s)
- William A Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David J Birnkrant
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio.,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jane B Black
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Terry L Noah
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Elgabaly EA, Dsouza AP, Mathew A, Anwar M. Infrequent and Potentially Missed Cause of Hypoxemia in an Infant. Cureus 2019; 11:e5766. [PMID: 31723525 PMCID: PMC6825484 DOI: 10.7759/cureus.5766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neuroendocrine cell hyperplasia of infancy (NEHI) is a recently reported condition and commonly missed. A general pediatrician who encounters an infant with an insidious onset of breathlessness, hypoxemia, and failure to thrive should think through a diagnosis of NEHI when common respiratory diseases are excluded. Lung biopsy is regarded as the diagnostic gold standard for NEHI and typically demonstrates increased numbers of neuroendocrine cells (NECs) in otherwise near-normal lung tissues. However, classic high-resolution computed tomography (HRCT) findings can enable to establish the diagnosis without the need for a biopsy. This case shows typical chest imaging findings of NEHI with a brief review of the literature.
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Affiliation(s)
- Elham A Elgabaly
- Pediatric Radiology, Al Jalila Children Specialty Hospital, Dubai, ARE
| | - Ajay P Dsouza
- Radiology, Al Jalila Children Specialty Hospital, Dubai, ARE
| | - Aji Mathew
- Pediatric Pulmonology, Al Jalila Children Specialty Hospital, Dubai, ARE
| | - Muhammad Anwar
- Pediatric Radiology, Al Jalila Children Specialty Hospital, Dubai, ARE
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Chen J, Nong G, Liu X, Ji W, Zhao D, Ma H, Wang H, Zheng Y, Shen K. Genetic basis of surfactant dysfunction in Chinese children: A retrospective study. Pediatr Pulmonol 2019; 54:1173-1181. [PMID: 31081264 DOI: 10.1002/ppul.24334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the prevalence of surfactant dysfunction (SD) and the genotype distribution in Chinese childhood interstitial lung disease (chILD). METHODS From December 2013 to December 2016, whole exons and splicing regions of surfactant protein (SP)-B, SP-C, and adenosine triphosphate (ATP)-binding cassette subfamily A member 3 (ABCA3) were sequenced in chILD with unknown etiology in five children's medical centers of China. The sequencing was performed by Next-generation sequencing technique in a molecular genetics laboratory. The clinical and genetic data were reviewed retrospectively. RESULTS In total, 136 patients of age 3 months to 13 years (mean 12.5 ± 9.4 months) were recruited, among which 76 were males. Of the 136 cases of chILD, 13.2% (18 of 136) were diagnosed with SD. In these 18 SD cases, 15 had heterozygous SP-C deficiencies, two cases had compound heterozygous ABCA3 deficiencies, and no SP-B deficiency was identified. In SP-C deficiencies, there were six cases with p.I73T, 2 with p.I73N, 5 with p.V39L, 1 with c.417delA, and 1 case with IVS4, +1G>C. Two cases of ABCA3 mutation were heterozygous with c.1755delC and c.2890G>A; c.3913T>C (R1305W) and exon 13 to 18 deletion. One was negative by sequencing while diagnosed positive by pathology. CONCLUSION The proportion of genetic mutation of SD in chILD is 13.2% in China, of which SP-C deficiency is predominant. The mutation, SP-C p.V39L, was found to be relatively prevalent in China and warrants further investigation.
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Affiliation(s)
- Jiehua Chen
- National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, and the National Center for Children's Health, Beijing, China.,Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Province, China
| | - Xiuyun Liu
- National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, and the National Center for Children's Health, Beijing, China
| | - Wei Ji
- Department of Respiratory Medicine, The Affiliated Children's Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Deyu Zhao
- Department of Respiratory Medicine, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongling Ma
- Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Heping Wang
- Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Yuejie Zheng
- Department of Respiratory Medicine, Shenzhen Children's Hospital, Shenzhen, Guangdong, China
| | - Kunling Shen
- National Clinical Research Center for Respiratory Diseases, Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, and the National Center for Children's Health, Beijing, China
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Spielberg DR, Brody AS, Baker ML, Woods JC, Towe CT. Ground-glass burden as a biomarker in neuroendocrine cell hyperplasia of infancy. Pediatr Pulmonol 2019; 54:822-827. [PMID: 30843378 DOI: 10.1002/ppul.24301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/17/2019] [Accepted: 02/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare pediatric interstitial lung disease (ILD). Distinct chest computed tomography (CT) define its radiographic appearance-specifically, ground-glass (GG) opacities most prominent in the right middle lobe (RML) and lingula. We sought to quantitatively validate this description and correlate radiologic findings with clinical presentation. METHODS Twenty-one children with NEHI were identified retrospectively, alongside 10 age-matched controls without lung disease. Clinical histories were reviewed for NEHI subjects. Semiautomated image analysis was used to measure lung volume and density. A patient-specific Hounsfield unit threshold defining GG was developed to quantify GG and assess its distribution in each subject. RESULTS NEHI subjects had more GG than controls (37.9 ± 11.3% vs 14.0 ± 2.7%, P < 0.0001). The proportion of GG in the RML and lingula was greater in NEHI patients compared to controls (1.43 ± 0.37 vs 0.45 ± 0.21, P < 0.0001). GG preferentially involved the RML and lingula in 20/21 NEHI subjects. There was more GG distribution in NEHI subjects who were prescribed continuous oxygen compared with those using only nocturnal oxygen (45.7 ± 8.9% vs 29.3 ± 6.1%, P = 0.003). CONCLUSIONS We confirm the previously reported finding that most patients with childhood ILD and a distinctive pattern of GG distribution on CT scan are likely to have NEHI. The amount of GG may be a biomarker for severity of respiratory disease.
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Affiliation(s)
- David R Spielberg
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, Section of Pulmonary Medicine, Baylor College of Medicine, Houston, Texas
| | - Alan S Brody
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael L Baker
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jason C Woods
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher T Towe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Bush A, Griese M, Seidl E, Kerem E, Reu S, Nicholson AG. Early onset children's interstitial lung diseases: Discrete entities or manifestations of pulmonary dysmaturity? Paediatr Respir Rev 2019; 30:65-71. [PMID: 30552058 DOI: 10.1016/j.prrv.2018.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/05/2018] [Indexed: 12/18/2022]
Abstract
Interstitial lung diseases in children (chILD) are rare and diverse. The current classifications include a group of early onset chILD specific to infancy, namely neuro-endocrine cell hyperplasia of infancy (NEHI), pulmonary interstitial glycogenosis (PIG) and the alveolar capillary-congenital acinar dysplasia (ACD-CAD) spectrum, as well as alveolar growth disorders. NEHI and PIG cells are seen in the normal developing foetal lung. We hypothesise that these conditions are in fact overlapping manifestations of pulmonary dysmaturity, respectively of airway, mesenchymal and vascular elements, rather than discrete clinical conditions in their own right. Clinically, these present as respiratory distress in early life. Mild cases rightly never undergo lung biopsy, and for these the clinical description 'persistent tachypnoea of infancy' has been proposed. In terms of pathology, we reviewed current literature, which showed that NEHI cells decline with age, and are not specific to NEHI, which we confirmed by unpublished re-analysis of a second dataset. Furthermore, specific genetic disorders which affect pulmonary maturation lead to a histological picture indistinguishable from NEHI. PIG and ACD-CAD are also associated with pulmonary growth disorders, and manifestations of PIG and NEHI may be present in the same child. We conclude that, contrary to current classifications, NEHI, PIG, and ACD-CAD should be considered as overlapping manifestations of pulmonary dysmaturation, frequently associated with disorders of alveolar growth, rather than as separate conditions. Identification of one of these patterns should be the start, not the end of the diagnostic journey, and underlying in particular genetic causes should be sought.
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Affiliation(s)
- Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital and Imperial College, London UK.
| | - Matthias Griese
- Dr. von Hauner Children's Hospital, Division of Pediatric Pneumology, University Hospital Munich & Geerman Center for Lung Research (DZL), Lindwurmstr. 4, 80337 München, Germany
| | - Elias Seidl
- Department of Pediatric Pneumology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, German Center for Lung Research, Munich, Germany
| | - Eitan Kerem
- Department of Paediatrics and Paediatric Pulmonology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Simone Reu
- Institute of Pathology, Faculty of Medicine, LMU Munich, Germany
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton & Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, UK
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46
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Sisman Y, Buchvald FF, Ring AM, Wassilew K, Nielsen KG. Long-Term Lung Function and Exercise Capacity in Postinfectious chILD. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:4-11. [PMID: 31032143 PMCID: PMC6484343 DOI: 10.1089/ped.2018.0973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/10/2019] [Indexed: 11/12/2022]
Abstract
Background: Severe postinfectious diffuse pulmonary disease may clinically mimic other entities of children's interstitial lung disease and is clinically challenging comprising various disease severities despite treatment. Long-term lung function trend and physical capacity in children with postinfectious diffuse pulmonary disease are rarely reported. We investigated trends in pulmonary function by long-term follow-up and assessed physical capacity in such patients. Methods: We performed a descriptive, single-center follow-up study in children with biopsy-verified postinfectious diffuse pulmonary disease. Patients with completed primary treatment course were eligible for follow-up, including pulmonary function and exercise (VO2peak) testing. Results: Thirty patients with postinfectious diffuse pulmonary disease were identified and included. Median (range) age at diagnose was 27.5 (2–172) months after a mean lag time of 23 months. H. influenzae and rhinovirus were the most frequent pathogens. Fifteen patients were available for follow-up after mean (range) 7.6 (2–15) years of treatment completion. Lung clearance index (LCI2.5), forced expiratory volume in 1 second (FEV1), and bronchodilator responsiveness were abnormal in 80%, 53%, and 44%, respectively. Diffusion capacity for monoxide was abnormal in 7% and total lung capacity in 33%. Only 8% demonstrated low VO2peak, while 40% reported difficulties during physical exertion. Longitudinal data on spirometry (n = 14) remained unchanged from end of treatment throughout follow-up. A significant association was found between zLCI2.5 and zFEV1 (multiple linear regression; r2 = 0.61; P = 0.0003). Conclusion: Postinfectious diffuse pulmonary disease in children carries a varying degree of chronic pulmonary impairment with onset of symptoms in the first months of life and a typical considerable lag time before diagnosis. Follow-up several years after the initial injury demonstrated moderate-to-severe peripheral airway impairment although no further lung function decline was found years after completion of treatment. Despite acceptable VO2peak, a considerable proportion struggled during heavy exercise.
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Affiliation(s)
- Yagmur Sisman
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik F Buchvald
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Astrid Madsen Ring
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katharina Wassilew
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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47
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Garg A, Sui P, Verheyden JM, Young LR, Sun X. Consider the lung as a sensory organ: A tip from pulmonary neuroendocrine cells. Curr Top Dev Biol 2019; 132:67-89. [PMID: 30797518 DOI: 10.1016/bs.ctdb.2018.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
While the lung is commonly known for its gas exchange function, it is exposed to signals in the inhaled air and responds to them by collaborating with other systems including immune cells and the neural circuit. This important aspect of lung physiology led us to consider the lung as a sensory organ. Among different cell types within the lung that mediate this role, several recent studies have renewed attention on pulmonary neuroendocrine cells (PNECs). PNECs are a rare, innervated airway epithelial cell type that accounts for <1% of the lung epithelium population. They are enriched at airway branch points. Classical in vitro studies have shown that PNECs can respond to an array of aerosol stimuli such as hypoxia, hypercapnia and nicotine. Recent in vivo evidence suggests an essential role of PNECs at neuroimmunomodulatory sites of action, releasing neuropeptides, neurotransmitters and facilitating asthmatic responses to allergen. In addition, evidence supports that PNECs can function both as progenitor cells and progenitor niches following airway epithelial injury. Increases in PNECs have been documented in a large array of chronic lung diseases. They are also the cells-of-origin for small cell lung cancer. A better understanding of the specificity of their responses to distinct insults, their impact on normal lung function and their roles in the pathogenesis of pulmonary ailments will be the next challenge toward designing therapeutics targeting the neuroendocrine system in lung.
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Affiliation(s)
- Ankur Garg
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Pengfei Sui
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Jamie M Verheyden
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Lisa R Young
- Division of Pulmonary Medicine, Center for Childhood Lung Research, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Xin Sun
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States; Department of Biological Sciences, University of California, San Diego, La Jolla, CA, United States.
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48
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Yonker LM, Kinane TB. Diagnostic and clinical course of pulmonary interstitial glycogenosis: The tip of the iceberg. Pediatr Pulmonol 2018; 53:1659-1661. [PMID: 30259700 DOI: 10.1002/ppul.24167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/10/2018] [Indexed: 01/22/2023]
Abstract
"Pulmonary Interstitial Glycogenosis: Diagnostic Evaluation and Clinical Course," written by Liptzin et al is a timely and insightful phenotypic summary of a rare pediatric interstitial lung disease. Twenty-four infants with biopsy-proven pulmonary interstitial glycogenosis (PIG) were reviewed at their center. Genetic analysis, bronchoscopy results, imaging, biopsy, and cardiology findings were described, and treatment decision and clinical outcomes were discussed.
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Affiliation(s)
- Lael M Yonker
- Division of Pediatric Pulmonary, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - T Bernard Kinane
- Division of Pediatric Pulmonary, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts
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Liptzin DR, Baker CD, Darst JR, Weinman JP, Dishop MK, Galambos C, Brinton JT, Deterding RR. Pulmonary interstitial glycogenosis: Diagnostic evaluation and clinical course. Pediatr Pulmonol 2018; 53:1651-1658. [PMID: 30019520 PMCID: PMC6456905 DOI: 10.1002/ppul.24123] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/21/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to describe the phenotype for patients with P.I.G. including presentation, evaluation, cardiac co-morbidities, high resolution computed tomography findings, and outcomes. METHODS With institutional review board approval, we performed a retrospective review of patients with biopsy-proven P.I.G. Biopsies, high resolution chest computed tomography, and cardiac evaluations were reviewed and characterized by experts in each field. RESULTS Sixty-two percent of the patients were male. The median gestational age was 37 weeks (range 27-40). The median age at biopsy was 1.6 months (range 0.3-6 months). Structural heart disease was present in 63% of patients. Pulmonary hypertension (diagnosed by echocardiogram and/or cardiac catheterization) was noted in 38% of patients. Alveolar simplification was present in 79% of patients. Fifty percent of available biopsies revealed patchy disease. An increase in age at biopsy was associated with patchy (vs diffuse) disease. Ninety-two percent of patients were treated with systemic corticosteroids. Median age at last follow-up was 1234 days with a range of 37 days to 15 years. At the time of last follow-up, 12 patients were off all support, eight were on supplemental oxygen, two were mechanically ventilated, one underwent lung transplantation, and one died. CT findings commonly included ground glass opacities (86%) and cystic change (50%). CONCLUSIONS The P.I.G. phenotype has not been comprehensively described, and poor recognition and misconceptions about P.I.G. persist. P.I.G. is a disease that presents in early infancy, requires significant medical intervention, and frequently is seen in association with alveolar simplification and/or cardiovascular disease. CT findings include ground glass opacities and cysts. Patients should be monitored for pulmonary hypertension. Without life-threatening comorbidities, many patients do well over time, although respiratory symptoms may persist into adolescence.
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Affiliation(s)
- Deborah R Liptzin
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Christopher D Baker
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Jeffrey R Darst
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Jason P Weinman
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan K Dishop
- Division Chief of Pathology and Laboratory Medicine at Phoenix Children's Medical Group, Phoenix, Arizona
| | - Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - John T Brinton
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Robin R Deterding
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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Mastej EJ, DeBoer EM, Humphries SM, Cook MC, Hunter KS, Liptzin DR, Weinman JP, Deterding RR. Lung and airway shape in neuroendocrine cell hyperplasia of infancy. Pediatr Radiol 2018; 48:1745-1754. [PMID: 29955904 DOI: 10.1007/s00247-018-4189-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare lung disease associated with significant air trapping. Although chest CT is crucial in establishing a diagnosis, CT and biopsy findings do not reveal airway abnormalities to explain the air trapping. OBJECTIVE We compared lung and airway morphology obtained from chest CT scans in children with NEHI and control children. In the children with NEHI, we explored relationships between lung and airway shape and lung function. MATERIALS AND METHODS We performed a retrospective review of children with NEHI who underwent clinical chest CT. We identified control children of similar size and age. We created lung masks and airway skeletons using semi-automated software and compared them using statistical shape modeling methods. Then we calculated a logistic regression model using lung and airway shape to differentiate NEHI from controls, and we compared shape model parameters to lung function measurements. RESULTS Airway and lung shapes were statistically different between children with NEHI and controls. We noted a broad lung apex in the children with NEHI and a significantly increased apical anterior-posterior lung diameter. A logistic regression model including lung shape was 90% accurate in differentiating children with NEHI from controls. Correlation coefficients were significant between lung function values and lung and airway shape. CONCLUSION Lung and airway shapes were different between children with NEHI and control children in this cohort. Children with NEHI had an increased anteroposterior diameter of their lungs that might be useful in the diagnostic criteria.
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Affiliation(s)
- Emily J Mastej
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
| | - Emily M DeBoer
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA.
| | | | - Marlijne C Cook
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kendall S Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah R Liptzin
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
| | - Jason P Weinman
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robin R Deterding
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
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