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Severe recurrent pneumonia in children: Underlying causes and clinical profile in Vietnam. Ann Med Surg (Lond) 2021; 67:102476. [PMID: 34188906 PMCID: PMC8219639 DOI: 10.1016/j.amsu.2021.102476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/04/2022] Open
Abstract
Background There is still limited data on severe recurrent pneumonia in children, especially in developing countries as Vietnam. This study was conducted to identify the underlying causes and clinical profile of children with severe recurrent pneumonia admitted to the Pediatric Intensive Care Unit (PICU), National Children's Hospital. Methods This was a prospective and descriptive study on 110 children with severe pneumonia admitted to the PICU from November 2019 to August 2020. Data were collected to investigate the clinical profile and underlying diseases. Results Severe recurrent pneumonia accounted for 29.4%. Underlying causes were diagnosed in 91.8% of sRP children, in which the most common causes were abnormalities in respiratory, cardiovascular system and immune disorders. 74.5% of sRP children admitted to ICU had been previously intubated or ventilated, 34.5% had shock, 7.3% had multiple organ failure. Recurrent lesions on chest x-ray in the same lobe accounted for 18.2%. Conclusions The majority of patients with severe recurrent pneumonia had an underlying disease. Comprehensive management is necessary for severe recurrent pneumonia. Highlight: Severe recurrent pneumonia accounted for 29.4% of pneumonia cases and 14.4% of all cases admitted to PICU. Underlying causes were diagnosed in 91.8% of severe recurrent pneumonia children. In Vietnam, most common causes of sRP were abnormalities in respiratory, cardiovascular system and immune disorders.
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Kabra SK, Kumar A. A young child with persistent respiratory symptoms: Think beyond asthma. J Postgrad Med 2019; 63:81-83. [PMID: 28397738 PMCID: PMC5414432 DOI: 10.4103/jpgm.jpgm_92_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - A Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Trivedi M, Denton E. Asthma in Children and Adults-What Are the Differences and What Can They Tell us About Asthma? Front Pediatr 2019; 7:256. [PMID: 31294006 PMCID: PMC6603154 DOI: 10.3389/fped.2019.00256] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/06/2019] [Indexed: 12/30/2022] Open
Abstract
Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.
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Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Eve Denton
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Underlying Diseases and Causative Microorganisms of Recurrent Pneumonia in Children: A 13-Year Study in a University Hospital. J Trop Pediatr 2018; 65:224-230. [PMID: 30011014 PMCID: PMC7107262 DOI: 10.1093/tropej/fmy037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pneumonia is a significant cause of death for children, particularly those in developing countries. The records of children who were hospitalized because of pneumonia between January 2003 and December 2015 were retrospectively reviewed, and patients who met the recurrent pneumonia criteria were included in this study. During this 13-year period, 1395 patients were hospitalized with pneumonia; of these, 129 (9.2%) met the criteria for recurrent pneumonia. Underlying diseases were detected in 95 (73.6%) patients, with aspiration syndrome (21.7%) being the most common. Rhinovirus (30.5%), adenovirus (17.2%) and respiratory syncytial virus (13.9%) were the most frequent infectious agents. These results demonstrate that underlying diseases can cause recurrent pneumonia in children. Viruses are also commonly seen in recurrent pneumonia. Appropriate treatments should be chosen based on an analysis of the underlying disease, the patient's clinical condition and the laboratory and radiological data.
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Coon ER, Srivastava R, Stoddard GJ, Reilly S, Maloney CG, Bratton SL. Infant Videofluoroscopic Swallow Study Testing, Swallowing Interventions, and Future Acute Respiratory Illness. Hosp Pediatr 2017; 6:707-713. [PMID: 27879283 DOI: 10.1542/hpeds.2016-0049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Tube feedings are commonly prescribed to infants with swallowing abnormalities detected by videofluoroscopic swallow study (VFSS), but there are no studies demonstrating efficacy of these interventions to reduce risk of acute respiratory illness (ARI). We sought to measure the association between swallowing interventions and future ARI, among VFSS-tested infants. METHODS Retrospective cohort of all infants (<12 months) tested with VFSS at a children's hospital between January 1, 2010, and January 1, 2012. Hospital ARI encounters (emergency, observation, or inpatient status) in a 22-hospital integrated health care delivery system, between the first VFSS and age 3 years, were measured. VFSS results were grouped by normal, intermediate, and oropharyngeal aspiration (OPA), with OPA further subdivided by silent versus cough and thin versus thick liquid OPA. Cox regression modeled the association between swallowing interventions (thickened or nasal tube feedings) and ARI, accounting for changes in swallowing and interventions over time. RESULTS 576 infants were tested with a VFSS in their first year of life, receiving a total of 1051 VFSSs in their first 3 years of life. More than 60% of infants received a measured feeding intervention. With the exception of infants with silent OPA who received thickened feedings, neither thickening nor nasal tube feedings, compared with no intervention, were associated with a decreased risk of subsequent ARI. CONCLUSIONS Swallowing interventions and repeated testing are common among VFSS-tested infants. However, the importance of diagnosing and intervening on VFSS-detected swallowing abnormalities for the majority of tested infants remains unclear.
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Affiliation(s)
- Eric R Coon
- Divisions of Pediatric Inpatient Medicine, and
| | - Rajendu Srivastava
- Divisions of Pediatric Inpatient Medicine, and.,Institute for Health Care Leadership, Intermountain Healthcare, Salt Lake City, Utah
| | - Gregory J Stoddard
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Susan L Bratton
- Pediatric Critical Care Medicine, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah
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Montella S, Corcione A, Santamaria F. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience. Int J Mol Sci 2017; 18:ijms18020296. [PMID: 28146079 PMCID: PMC5343832 DOI: 10.3390/ijms18020296] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/26/2022] Open
Abstract
Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%–9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Adele Corcione
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Via Pansini 5, 80131 Naples, Italy.
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Zan Y, Liu H, Zhong L, Qiu L, Tao Q, Chen L. Childhood recurrent pneumonia caused by endobronchial sutures: A case report. Medicine (Baltimore) 2017; 96:e5992. [PMID: 28121955 PMCID: PMC5287979 DOI: 10.1097/md.0000000000005992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recurrent pneumonia is defined as more than two episodes of pneumonia in one year or three or more episodes anytime in life. Common clinical scenarios leading to recurrent pneumonia include anatomical abnormalities of respiratory tract, immunodeficiency, congenital heart diseases, primary ciliary dyskinesia, etc. CASE REPORT A school-aged girl suffered from 1-2 episodes of pneumonia each year after trachea connection and lung repair operation resulted from an accident of car crash. Bronchoscopy revealed the sutures twisted with granulation in the left main bronchus and the patient's symptoms relieved after removal of the sutures. Here we report for the first time that surgical suture was the cause of recurrent pneumonia. CONCLUSIONS This case indicates that children with late and recurrent onset of pneumonia should undergo detailed evaluation including bronchoscopy.
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Affiliation(s)
- Yiheng Zan
- West China Medical School of Sichuan University
| | - Hanmin Liu
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lin Zhong
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University
| | - Li Qiu
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University
| | - Qingfen Tao
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University
| | - Lina Chen
- Department of Pediatric Pulmonology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Abu-Hasan M, Elmallah M, Neal D, Brookes J. Salivary Amylase Level in Bronchoalveolar Fluid as a Marker of Chronic Pulmonary Aspiration in Children. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2014; 27:115-119. [PMID: 26697264 DOI: 10.1089/ped.2014.0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Chronic pulmonary aspiration is a common cause of chronic respiratory symptoms in children. However, there is no gold standard diagnostic test for aspiration. In this study, we explore the diagnostic value of measuring salivary amylase in bronchoalveolar lavage (BAL) fluid as a marker of chronic aspiration in children with different chronic respiratory illnesses. Methods: Measurements of salivary amylase in BAL fluid were routinely done in patients undergoing flexible bronchoscopy. Patients' demographic and clinical data were extracted from records and reviewed by one of the investigators. Patients were classified into three different groups based on the reviewer's assessment of risk for aspiration. BAL amylase measurements were masked from the reviewer. Multiple regression analysis was used to determine the effect of the patients' clinical variables on BAL amylase. Results: Sixty-four patients (median age 2 years; range 0-14 years) were included. Indications for bronchoscopy included chronic cough (n=20), chronic wheezing (n=27), Cystic Fibrosis (n=6), recurrent pneumonia (n=5), and lung infiltrate in immunocompromised patients (n=6). Young age, history of excessive drooling, and wet cough were predictive of high BAL amylase. Thirteen patients were considered at no risk of aspiration, 41 patients were at low risk, and 10 patients were at high risk based on clinical symptoms and other diagnostic tests. No significant differences in BAL amylase levels were found between the three groups. However, when high and low risk groups were combined and compared to the no risk group, there was a significantly higher BAL amylase level in the combined at risk groups (1,722 vs. 307 U/L; p=0.03). Receiver operator curve analysis demonstrated that amylase cutoff value of 250 U/L differentiates between the two risk groups with sensitivity of 66.7% and specificity of 69.2%. Conclusion: Salivary amylase level in BAL can help identify children at risk for chronic pulmonary aspiration.
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Affiliation(s)
- Mutasim Abu-Hasan
- Division of Pediatric Pulmonary and Allergy, University of Florida , Gainesville, Florida
| | - Mai Elmallah
- Division of Pediatric Pulmonary and Allergy, University of Florida , Gainesville, Florida
| | - Dan Neal
- Department of Neurosurgery, College of Medicine, University of Florida , Gainesville, Florida
| | - James Brookes
- Pediatric Otolaryngology-Head and Neck Surgery, Alberta Children's Hospital , Calgary, Alberta, Canada
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Hughes D. Recurrent pneumonia . . . Not! Paediatr Child Health 2014; 18:459-60. [PMID: 24426804 DOI: 10.1093/pch/18.9.459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 11/13/2022] Open
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Clinical profile of recurrent community-acquired pneumonia in children. BMC Pulm Med 2013; 13:60. [PMID: 24106756 PMCID: PMC3852007 DOI: 10.1186/1471-2466-13-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this case-control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients. METHODS The study involved 146 children with ≥2 episodes of radiographically confirmed CAP in DLA in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences, and 145 age- and gender-matched controls enrolled in Milan, Italy, between January 2009 and December 2012. The demographic and clinical characteristics of the cases and controls were compared, and a comparison was also made between the cases with rCAP (i.e. ≤3 episodes) and those with highly recurrent CAP (hrCAP: i.e. >3 episodes). RESULTS Gestational age at birth (p = 0.003), birth weight (p = 0.006), respiratory distress at birth (p < 0.001), and age when starting day care attendance (p < 0.001) were significantly different between the cases and controls, and recurrent infectious wheezing (p < 0.001), chronic rhinosinusitis with post-nasal drip (p < 0.001), recurrent upper respiratory tract infections (p < 0.001), atopy/allergy (p < 0.001) and asthma (p < 0.001) were significantly more frequent. Significant risk factors for hrCAP were gastroesophageal reflux disease (GERD; p = 0.04), a history of atopy and/or allergy (p = 0.005), and a diagnosis of asthma (p = 0.0001) or middle lobe syndrome (p = 0.001). Multivariate logistic regression analysis, adjusted for age and gender, showed that all of the risk factors other than GERD and wheezing were associated with hrCAP. CONCLUSIONS The diagnostic approach to children with rCAP in DLAs is relatively easy in the developed world, where the severe chronic underlying diseases favouring rCAP are usually identified early, and patients with chronic underlying disease are diagnosed before the occurrence of rCAP in DLAs. When rCAP in DLAs does occur, an evaluation of the patients' history and clinical findings make it possible to limit diagnostic investigations.
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Saad K, Mohamed SA, Metwalley KA. Recurrent/Persistent Pneumonia among Children in Upper Egypt. Mediterr J Hematol Infect Dis 2013; 5:e2013028. [PMID: 23667726 PMCID: PMC3647710 DOI: 10.4084/mjhid.2013.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 04/10/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Recurrent/persistent pneumonia in children continues to be a major challenge for the pediatricians. The aim of our study was to establish the prevalence and underlying causes of recurrent/persistent pneumonia in children in Upper Egypt. SETTINGS Assiut University Children Hospital, Assiut, Egypt. PATIENTS AND METHODS Patients, admitted for pneumonia to the hospital during 2 years, were investigated with microbiological, biochemical, immunological and radiological tests in order to establish the prevalence of recurrent/persistent pneumonia and to find out its underlying causes. RESULTS 113 out of 1228 patients (9.2%) met the diagnosis of recurrent/persistent pneumonia. Identified causes were; aspiration syndrome (17.7%), pulmonary TB (14.0%), congenital heart disease (11.5%), bronchial asthma (9.7%), immune deficiency disorders (8.8%) and vitamin D deficiency rickets (7.0%). Other causes included; congenital anomalies of the respiratory tract, interstitial lung diseases, bronchiectasis, and sickle cell anemia. No predisposing factors could be identified in 15% of cases. CONCLUSION Approximately 1 out of 10 children with diagnosis of pneumonia in Assiut University Children Hospital had recurrent/persistent pneumonia. The most frequent underlying cause for recurrent/persistent pneumonia was aspiration syndrome, followed by pulmonary TB.
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Affiliation(s)
- Khaled Saad
- Department of Pediatrics, Assiut University, Assiut 71516, Egypt
- Correspondence to: Khaled Saad, Department of Pediatrics, Faculty of medicine, University of Assiut, Assiut 71516, Egypt, Tel +20-106-080-182*, Fax +20-88-236-8371. E-mail:
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Østergaard MS, Nantanda R, Tumwine JK, Aabenhus R. Childhood asthma in low income countries: an invisible killer? PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:214-9. [PMID: 22623048 DOI: 10.4104/pcrj.2012.00038] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bacterial pneumonia has hitherto been considered the key cause of the high respiratory morbidity and mortality in children under five years of age (under-5s) in low-income countries, while asthma has not been stated as a significant reason. This paper explores the definitions and concepts of pneumonia and asthma/wheezing/bronchiolitis and examines whether asthma in under-5s may be confused with pneumonia. Over-diagnosing of bacterial pneumonia can be suspected from the limited association between clinical pneumonia and confirmatory test results such as chest x-ray and microbiological findings and poor treatment results using antibiotics. Moreover, children diagnosed with recurrent pneumonia in infancy were often later diagnosed with asthma. Recent studies showed a 10-15% prevalence of preschool asthma in low-income countries, although under-5s with long-term cough and difficulty breathing remain undiagnosed. New studies demonstrate that approximately 50% of acutely admitted under-5s diagnosed with pneumonia according to Integrated Management of Childhood Illnesses could be re-diagnosed with asthma or wheezing when using re-defined diagnostic criteria and treatment. It is hypothesised that untreated asthma may contribute to respiratory mortality since respiratory syncytial virus (RSV) is an important cause of respiratory death in childhood, and asthma in under-5s is often exacerbated by viral infections, including RSV. Furthermore, acute respiratory treatment failures were predominantly seen in under-5s without fever, which suggests the diagnosis of asthma/wheezing rather than bacterial pneumonia. Ultimately, underlying asthma may have contributed to malnutrition and fatal bacterial pneumonia. In conclusion, preschool asthma in low-income countries may be significantly under-diagnosed and misdiagnosed as pneumonia, and may be the cause of much morbidity and mortality.
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Affiliation(s)
- Marianne Stubbe Østergaard
- Department of General Practice and Research Unit of General Practice, University of Copenhagen, Copenhagen, Denmark.
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Bell KL, Boyd RN, Tweedy SM, Weir KA, Stevenson RD, Davies PSW. A prospective, longitudinal study of growth, nutrition and sedentary behaviour in young children with cerebral palsy. BMC Public Health 2010; 10:179. [PMID: 20370929 PMCID: PMC2867996 DOI: 10.1186/1471-2458-10-179] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 04/06/2010] [Indexed: 12/02/2022] Open
Abstract
Background Cerebral palsy is the most common cause of physical disability in childhood, occurring in one in 500 children. It is caused by a static brain lesion in the neonatal period leading to a range of activity limitations. Oral motor and swallowing dysfunction, poor nutritional status and poor growth are reported frequently in young children with cerebral palsy and may impact detrimentally on physical and cognitive development, health care utilisation, participation and quality of life in later childhood. The impact of modifiable factors (dietary intake and physical activity) on growth, nutritional status, and body composition (taking into account motor severity) in this population is poorly understood. This study aims to investigate the relationship between a range of factors - linear growth, body composition, oral motor and feeding dysfunction, dietary intake, and time spent sedentary (adjusting for motor severity) - and health outcomes, health care utilisation, participation and quality of life in young children with cerebral palsy (from corrected age of 18 months to 5 years). Design/Methods This prospective, longitudinal, population-based study aims to recruit a total of 240 young children with cerebral palsy born in Queensland, Australia between 1st September 2006 and 31st December 2009 (80 from each birth year). Data collection will occur at three time points for each child: 17 - 25 months corrected age, 36 ± 1 months and 60 ± 1 months. Outcomes to be assessed include linear growth, body weight, body composition, dietary intake, oral motor function and feeding ability, time spent sedentary, participation, medical resource use and quality of life. Discussion This protocol describes a study that will provide the first longitudinal description of the relationship between functional attainment and modifiable lifestyle factors (dietary intake and habitual time spent sedentary) and their impact on the growth, body composition and nutritional status of young children with cerebral palsy across all levels of functional ability.
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Affiliation(s)
- Kristie L Bell
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Discipline of Paediatrics and Child Health, School of Medicine, The University of Queensland, Brisbane, Australia.
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Abstract
This study assessed the clinical value of routine follow-up chest radiographs in hospitalized children with community-acquired pneumonia. The study population consisted of 196 children hospitalized for community-acquired pneumonia diagnosed between 1993-1995. Seventeen infective agents (10 viruses and 7 bacteria) were sought. Chest radiographs were taken on admission and 3-7 weeks later. All children were treated with antibiotics. Data on the course of illness over the following 8-10 years were obtained from patient files and questionnaires sent to parents. A potential causative agent was found in 165 (84%) of 196 cases. On follow-up chest radiographs, residual or new changes were seen in 30% of cases. The residual changes tended to be more common after mixed viral-bacterial infection (43%) than after sole viral (25%) or sole bacterial (20%) infection. Interstitial infiltrates (66%), atelectasis (46%), and enlarged lymph nodes were the most common sequelae seen on follow-up. Residual findings on follow-up radiographs did not affect the treatment of the children. No further chest radiographs were taken. During the 8-10-year follow-up of 194 children, no illnesses appeared that were associated with previous pneumonia. Twenty-six children had a new episode of pneumonia, 7 of them had asthma, and 6 had different underlying illnesses. In conclusion, routine follow-up chest radiographs are not needed in childhood community-acquired pneumonia if the child has a clinically uneventful recovery.
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Affiliation(s)
- R. Virkki
- Departments of Diagnostic Imaging and Pediatrics, Turku University Hospital, Turku, Finland
| | - T. Juven
- Departments of Diagnostic Imaging and Pediatrics, Turku University Hospital, Turku, Finland
| | - J. Mertsola
- Departments of Diagnostic Imaging and Pediatrics, Turku University Hospital, Turku, Finland
| | - O. Ruuskanen
- Departments of Diagnostic Imaging and Pediatrics, Turku University Hospital, Turku, Finland
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