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Burgos MA, Bastir M, Pérez-Ramos A, Sanz-Prieto D, Heuzé Y, Maréchal L, Esteban-Ortega F. Assessing nasal airway resistance and symmetry: An approach to global perspective through computational fluid dynamics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3830. [PMID: 38700070 DOI: 10.1002/cnm.3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
This study aimed to explore the variability in nasal airflow patterns among different sexes and populations using computational fluid dynamics (CFD). We focused on evaluating the universality and applicability of dimensionless parameters R (bilateral nasal resistance) and ϕ (nasal flow asymmetry), initially established in a Caucasian Spanish cohort, across a broader spectrum of human populations to assess normal breathing function in healthy airways. In this retrospective study, CT scans from Cambodia (20 males, 20 females), Russia (20 males, 18 females), and Spain (19 males, 19 females) were analyzed. A standardized CFD workflow was implemented to calculate R-ϕ parameters from these scans. Statistical analyses were conducted to assess and compare these parameters across different sexes and populations, emphasizing their distribution and variances. Our results indicated no significant sex-based differences in the R parameter across the populations. However, moderate sexual dimorphism in the ϕ parameter was observed in the Cambodian group. Notably, no geographical differences were found in either R or ϕ parameters, suggesting consistent nasal airflow characteristics across the diverse human groups studied. The study also emphasized the importance of using dimensionless variables to effectively analyze the relationships between form and function in nasal airflow. The observed consistency of R-ϕ parameters across various populations highlights their potential as reliable indicators in both medical practice and further CFD research, particularly in diverse human populations. Our findings suggest the potential applicability of dimensionless CFD parameters in analyzing nasal airflow, highlighting their utility across diverse demographic and geographic contexts. This research advances our understanding of nasal airflow dynamics and underscores the need for additional studies to validate these parameters in broader population cohorts. The approach of employing dimensionless parameters paves the way for future research that eliminates confounding size effects, enabling more accurate comparisons across different populations and sexes. The implications of this study are significant for the advancement of personalized medicine and the development of diagnostic tools that accommodate individual variations in nasal airflow.
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Affiliation(s)
- Manuel A Burgos
- Department of Thermal and Fluid Engineering, Fluid Mechanics and Thermal Engineering Group, Polytechnic University of Cartagena, Cartagena, Spain
| | - Markus Bastir
- Department of Paleobiology, Paleoanthropology Group, National Museum of Natural Sciences - Spanish National Research Council, Madrid, Spain
| | - Alejandro Pérez-Ramos
- Faculty of Science, Department of Ecology and Geology, Paleobiology, Paleoclimatology and Paleogeography Group, University of Málaga, Málaga, Spain
- Faculty of Science, Department of Surgery, Paleobiology, Paleoclimatology and Paleogeography Group, University of Málaga, Málaga, Spain
| | - Daniel Sanz-Prieto
- Department of Thermal and Fluid Engineering, Fluid Mechanics and Thermal Engineering Group, Polytechnic University of Cartagena, Cartagena, Spain
- Faculty of Sciences, Department of Biology, Autonomous University of Madrid, Madrid, Spain
| | - Yann Heuzé
- PACEA UMR 5199, University of Bordeaux, French National Centre for Scientific Research, Ministère de la Culture, Pessac, France
| | - Laura Maréchal
- PACEA UMR 5199, University of Bordeaux, French National Centre for Scientific Research, Ministère de la Culture, Pessac, France
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Hammond JD, Kielt MJ, Conroy S, Lingappan K, Austin ED, Eldredge LC, Truog WE, Abman SH, Nelin LD, Guaman MC. Exploring the Association of Male Sex With Adverse Outcomes in Severe Bronchopulmonary Dysplasia: A Retrospective, Multicenter Cohort Study. Chest 2024; 165:610-620. [PMID: 37879559 DOI: 10.1016/j.chest.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is a significant contributor to morbidity and death in infants who are born premature. Male sex is an independent risk factor for the development of BPD. However, whether male sex is associated with adverse outcomes that occur after formal diagnosis of severe BPD prior to hospital discharge remains unclear. RESEARCH QUESTION Is male sex associated with a higher risk of adverse outcomes in infants with established severe BPD? STUDY DESIGN AND METHODS A retrospective, multicenter cohort study of infants enrolled in the BPD Collaborative Registry from January 1, 2015, to June 29, 2022, was performed. Demographics, clinical characteristics, and outcomes were stratified by sex (ie, male vs female). Regression modeling was used to estimate the association of sex with the primary composite outcome of death or tracheostomy at hospital discharge. RESULTS We identified 1,156 infants with severe BPD, defined at 36 weeks postmenstrual age by the National Institutes of Health 2001 consensus definition. The cohort was predominantly male (59% male infants, 41% female infants). However, rates of mechanical ventilation at 36 weeks postmenstrual age (ie, type 2 severe BPD) did not differ by sex. Overall mortality rates within the cohort were low (male infants, 5.3%; female infants, 3.6%). The OR of death or tracheostomy for male-to-female infants was 1.0 (95% CI, 0.7-1.5). INTERPRETATION Our results lead us to speculate that, although sex is an important variable that contributes to the development and pathogenesis of severe BPD, it does not appear to be associated with adverse outcomes in this cohort of infants with established disease. The surprising results raise important questions surrounding the temporal role of biological sex in the development of severe BPD and its progression during the neonatal ICU stay. As we explore the phenotypes and endotypes of BPD, it is imperative to consider how sex modulates the disease from birth through hospital discharge.
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Affiliation(s)
| | | | - Sara Conroy
- Nationwide Children's Hospital, Columbus, OH
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Lewis TR, Kielt MJ, Walker VP, Levin JC, Guaman MC, Panitch HB, Nelin LD, Abman SH. Association of Racial Disparities With In-Hospital Outcomes in Severe Bronchopulmonary Dysplasia. JAMA Pediatr 2022; 176:852-859. [PMID: 35913704 PMCID: PMC9344383 DOI: 10.1001/jamapediatrics.2022.2663] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Bronchopulmonary dysplasia (BPD) is the most common serious morbidity of preterm birth. Short-term respiratory outcomes for infants with the most severe forms of BPD are highly variable. The mechanisms that explain this variability remain unknown and may be mediated by racial disparities. OBJECTIVE To determine the association of maternal race with death and length of hospital stay in a multicenter cohort of infants with severe BPD. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study included preterm infants enrolled in the BPD Collaborative registry from January 1, 2015, to July 19, 2021, involving 8 BPD Collaborative centers located in the US. Included patients were born at less than 32 weeks' gestation, had a diagnosis of severe BPD as defined by the 2001 National Institutes of Health Consensus Criteria, and were born to Black or White mothers. EXPOSURES Maternal race: Black vs White. MAIN OUTCOMES AND MEASURES Death and length of hospital stay. RESULTS Among 834 registry infants (median [IQR] gestational age, 25 [24-27] weeks; 492 male infants [59%]) meeting inclusion criteria, the majority were born to White mothers (558 [67%]). Death was observed infrequently in the study cohort (32 [4%]), but Black maternal race was associated with an increased odds of death (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5) after adjusting for center. Black maternal race was also significantly associated with length of hospital stay (adjusted between-group difference, 10 days; 95% CI, 3-17 days). CONCLUSIONS AND RELEVANCE In a multicenter severe BPD cohort, study results suggest that infants born to Black mothers had increased likelihood of death and increased length of hospital stay compared with infants born to White mothers. Prospective studies are needed to define the sociodemographic mechanisms underlying disparate health outcomes for Black infants with severe BPD.
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Affiliation(s)
- Tamorah R. Lewis
- Children’s Mercy Hospital, The University of Missouri—Kansas City, Kansas City
| | - Matthew J. Kielt
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Valencia P. Walker
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Jonathan C. Levin
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Howard B. Panitch
- Children’s Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Leif D. Nelin
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | - Steven H. Abman
- Children's Hospital Colorado, The University of Colorado School of Medicine, Aurora
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Harris C, Zivanovic S, Lunt A, Calvert S, Bisquera A, Marlow N, Peacock JL, Greenough A. Lung function and respiratory outcomes in teenage boys and girls born very prematurely. Pediatr Pulmonol 2020; 55:682-689. [PMID: 31910333 DOI: 10.1002/ppul.24631] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/27/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Male sex in prematurely born infants has been associated with worse respiratory outcomes in early childhood. WORKING HYPOTHESIS Respiratory outcomes at 11 to 14 years of age in children born very prematurely and routinely exposed to antenatal corticosteroids and postnatal surfactant would differ according to sex. STUDY DESIGN Analysis of follow-up data. PATIENT-SUBJECT SELECTION Three hundred and nineteen children born before 29 weeks of gestational age from the United Kingdom Oscillation Study. METHODOLOGY Spirometry was used to assess forced expiratory flow at 75%, 50%, and 25% of expired vital capacity (FEF75 , FEF50 , and FEF25 ), forced expiratory volume in 1 second (FEV1 ), peak expiratory flow (PEF), and forced vital capacity (FVC). Lung volumes were measured using a helium dilution technique (FRCHe ) and by plethysmography (FRCpleth ). Total lung capacity (TLC) and residual volume (RV) were calculated. Mean lung function measurements were compared using linear mixed models and reported as unadjusted and adjusted for neonatal and age 11 to 14 years factors. The participants also completed health questionnaires and provided a urine sample for assessment of passive or active smoking. RESULTS Three (FEF25 , FEF25-75 , FEV1 ) lung function measures showed significant differences in favor of females after adjustment. The percentage of children with abnormal lung function (below 5th centile for normal) had adjusted differences between 10 and 30 percentage points, for example, for FEF25 15% females compared with 26% males. CONCLUSIONS Among extremely prematurely born school children airway function was significantly worse in males.
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Affiliation(s)
- Christopher Harris
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Sanja Zivanovic
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Alan Lunt
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
| | - Sandy Calvert
- Department of Child Health, St.George's Hospital, London, United Kingdom
| | - Alessandra Bisquera
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Neil Marlow
- Neonatal Medicine, University College, London, United Kingdom
| | - Janet L Peacock
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre based at Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Anne Greenough
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, United Kingdom.,Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre based at Guy's and St. Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
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Kim KT, Knopp J, Dixon B, Chase JG. Mechanically ventilated premature babies have sex differences in specific elastance: A pilot study. Pediatr Pulmonol 2020; 55:177-184. [PMID: 31596060 DOI: 10.1002/ppul.24538] [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: 07/25/2019] [Accepted: 09/18/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES A pilot study to compare pulmonary mechanics in a neonatal intensive care unit (NICU) cohort, specifically, comparing lung elastance between male and female infants in the NICU. HYPOTHESIS Anecdotally, male infants are harder to ventilate than females. We hypothesize that males have higher model-based elastance (converse: lower specific compliance) compared to females, reflecting underlying stiffer lungs. STUDY DESIGN A clinically validated, single-compartment model is used to identify specific elastance (inverse of specific compliance) and resistance for each breath. Specific elastance accounts for weight differences when comparing male and female infants. Relative percent breath-to-breath variability (%ΔE) in specific elastance is also compared. Level of asynchrony was also determined. PATIENT-SUBJECT SELECTION Ten invasively mechanically ventilated patients from Christchurch Women's Hospital. METHODOLOGY Airway pressure and flow data from 10 invasive mechanical ventilation (MV) infants from Christchurch Women's Hospital Neonatal Intensive Care Unit, New Zealand was prospectively recorded under standard MV care. Model-based specific elastance and resistance are identified for each breath, as well as relative percent breath-to-breath variability (%ΔE) in specific elastance. RESULTS Male infants overall had higher specific elastance compared to females infants (P ≤ .01), with median (interquartile range) for males of 1.91 (1.33-2.48) cmH2 O·kg/mL compared to 1.31 (0.86-2.02) cmH2 O·kg/mL in females. Male infants had lower variability with %ΔE of -0.03 (-7.56 to 8.01)% vs female infants of -0.59 (12.56-12.86)%. Males had 14.75% asynchronous breaths whereas females had 17.54%. CONCLUSION Overall, males had higher specific elastance and correspondingly lower breath-to-breath variability. These results indicate male and female infants may require different MV settings, mode, and monitoring.
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Affiliation(s)
- Kyeong Tae Kim
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Knopp
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
| | - Bronwyn Dixon
- Neonatal Intensive Care Unit, Christchurch Women's Hospital, Christchurch, New Zealand
| | - J Geoffrey Chase
- Centre for Bioengineering, University of Canterbury, Christchurch, New Zealand
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Kosma P, Palme-Kilander C, Bottai M, Ljungberg H, Hallberg J. Forced expiratory flows and volumes in a Swedish cohort of healthy term infants. Pediatr Pulmonol 2020; 55:185-189. [PMID: 31682334 DOI: 10.1002/ppul.24562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 09/29/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The use of pulmonary function tests (PFTs) in infants has increased during the last decades, making the need for equipment- and ethnic-specific reference data mandatory for appropriate interpretation of the results. AIM Our aim was to investigate how well the already published reference equations for infant spirometry fit a healthy population of Swedish infants. METHOD We performed forced tidal and raised volume expiratory maneuvers in healthy infants using Jaeger BabyBody equipment. RESULTS PFT data were collected from 91 healthy infants aged between 3 months to 2 years at 143 occasions. Mean (standard deviation) z-scores were 0.68(1.33) for maximal flow at functional residual capacity (V'max FRC), -0.15(0.96) for forced vital capacity (FVC), 0.40(1.33) for the forced expired volume in the initial 0.5 seconds (FEV0.5 ) and 0.52(0.93) for the ratio FEV0.5 /FVC, respectively. Z-scores for all indices but FEV0.5 /FVC were highly dependent on length. CONCLUSIONS We have shown that the use of previously published reference equations may result in an age-related misinterpretation of lung function measure in a Swedish infant population.
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Affiliation(s)
- Paraskevi Kosma
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Matteo Bottai
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Henrik Ljungberg
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Department of Pediatrics, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden
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Dahl MJ, Bowen S, Aoki T, Rebentisch A, Dawson E, Pettet L, Emerson H, Yu B, Wang Z, Yang H, Zhang C, Presson AP, Joss-Moore L, Null DM, Yoder BA, Albertine KH. Former-preterm lambs have persistent alveolar simplification at 2 and 5 months corrected postnatal age. Am J Physiol Lung Cell Mol Physiol 2018; 315:L816-L833. [PMID: 30211655 PMCID: PMC6295507 DOI: 10.1152/ajplung.00249.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/29/2018] [Accepted: 09/02/2018] [Indexed: 12/29/2022] Open
Abstract
Preterm birth and mechanical ventilation (MV) frequently lead to bronchopulmonary dysplasia, the histopathological hallmark of which is alveolar simplification. How developmental immaturity and ongoing injury, repair, and remodeling impact completion of alveolar formation later in life is not known, in part because of lack of suitable animal models. We report a new model, using former-preterm lambs, to test the hypothesis that they will have persistent alveolar simplification later in life. Moderately preterm lambs (~85% gestation) were supported by MV for ~6 days before being transitioned from all respiratory support to become former-preterm lambs. Results are compared with term control lambs that were not ventilated, and between males (M) and females (F). Alveolar simplification was quantified morphometrically and stereologically at 2 mo (4 M, 4 F) or 5 mo (4 M, 6 F) corrected postnatal age (cPNA) compared with unventilated, age-matched term control lambs (4 M, 4 F per control group). These postnatal ages in sheep are equivalent to human postnatal ages of 1-2 yr and ~6 yr, respectively. Multivariable linear regression results showed that former-preterm lambs at 2 or 5 mo cPNA had significantly thicker distal airspace walls ( P < 0.001 and P < 0.009, respectively), lower volume density of secondary septa ( P < 0.007 and P < 0.001, respectively), and lower radial alveolar count ( P < 0.003 and P < 0.020, respectively) compared with term control lambs. Sex-specific differences were not detected. We conclude that moderate preterm birth and MV for ~6 days impedes completion of alveolarization in former-preterm lambs. This new model provides the opportunity to identify underlying pathogenic mechanisms that may reveal treatment approaches.
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Affiliation(s)
- Mar Janna Dahl
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Sydney Bowen
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Toshio Aoki
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Andrew Rebentisch
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Elaine Dawson
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Luke Pettet
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Haleigh Emerson
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Baifeng Yu
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Zhengming Wang
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Haixia Yang
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah , Salt Lake City, Utah
- Division of Critical Care, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Lisa Joss-Moore
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Donald M Null
- Division of Neonatology, University of California , Davis, California
| | - Bradley A Yoder
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Kurt H Albertine
- Division of Neonatology, Department of Pediatrics, University of Utah , Salt Lake City, Utah
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Suaini NHA, Koplin JJ, Peters RL, Sasaki M, Ellis JA, Martino DJ, Lowe AJ, Tang MLK, Ponsonby AL, Gurrin LC, Dharmage SC, Allen KJ. Children with East Asian-Born Parents Have an Increased Risk of Allergy but May Not Have More Asthma in Early Childhood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:539-547.e3. [PMID: 30149095 DOI: 10.1016/j.jaip.2018.07.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND We previously reported that infants with Asian-born parents are 3 times more likely to have IgE-mediated food allergy than those with Australian-born parents. It is unknown whether this translates to the increased risk of other allergic diseases later in childhood and whether ancestry interacts with other risk factors for allergic disease development. OBJECTIVE To compare prevalence and risk factors for allergic rhinitis, asthma, and aeroallergen sensitization at age 6 between children with East Asian-born and Caucasian-born parents. METHODS A total of 5276 1-year-old infants were recruited into a population-based longitudinal study of allergy. A total of 4455 children participated in age 6 follow-up (84.4%), including 3015 with Caucasian-born parents and 415 with East Asian-born parents. Children underwent skin prick tests to aeroallergens and questionnaires captured data on asthma, eczema, and allergic rhinitis. RESULTS Compared with children with Caucasian-born parents, children of East Asian-born parents had more allergic rhinitis (19.9% [95% confidence interval (CI) 14.9-26] vs 9.3% [95% CI 8-10.8], P < .001) and aeroallergen sensitization (64.3% [95% CI 57.5-70.5] vs 34.4% [95% CI 32.2-36.7], P < .001) at age 6. Asthma was similar in both groups (9.1% [95% CI 6.2-13.2] vs 11.7% [95% CI 10.4-13.1]), P = .21. Children with IgE-mediated food allergy and eczema in infancy were 3 times more likely to have asthma and 2 times more likely to have allergic rhinitis at age 6, irrespective of ancestry. CONCLUSIONS Children of East Asian ancestry born in Australia have a higher burden of most allergic diseases in the first 6 years of life, whereas asthma may follow a different pattern. IgE-mediated food allergy and eczema at age 1 increase the risk of asthma and allergic rhinitis irrespective of ancestry.
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Affiliation(s)
- Noor H A Suaini
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rachel L Peters
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mari Sasaki
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justine A Ellis
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia; Genes, Environment & Complex Disease, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - David J Martino
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Adrian J Lowe
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Mimi L K Tang
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Clinical Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Anne-Louise Ponsonby
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Lyle C Gurrin
- The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Shyamali C Dharmage
- The School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katrina J Allen
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Clinical Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
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Kotecha SJ, Lowe J, Kotecha S. Does the sex of the preterm baby affect respiratory outcomes? Breathe (Sheff) 2018; 14:100-107. [PMID: 29875829 PMCID: PMC5980477 DOI: 10.1183/20734735.017218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Being born very preterm is associated with later deficits in lung function and an increased rate of respiratory symptoms compared with term-born children. The rates of early respiratory infections are higher in very preterm-born subjects, which may independently lead to deficits in lung function in later life. As with very preterm-born children, deficits in lung function, increased respiratory symptoms and an increased risk of respiratory infections in early life are observed in late -preterm-born children. However, the rates of respiratory symptoms are lower compared with very preterm-born children. There is some evidence to suggest that respiratory outcomes may be improving over time, although not all the evidence suggests improvements. Male sex appears to increase the risk for later adverse respiratory illness. Although not all studies report that males have worse long-term respiratory outcomes than females. It is essential that preterm-born infants are followed up into childhood and beyond, and that appropriate treatment for any lung function deficits and respiratory symptoms is prescribed if necessary. If these very preterm-born infants progress to develop chronic obstructive airway disease in later life then the impact, not only on the individuals, but also the economic impact on healthcare services, is immense. Educational aims To report the effect of the sex of the preterm baby on respiratory outcomes.To explore the short- and long-term respiratory outcomes of preterm birth.
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Affiliation(s)
- Sarah J Kotecha
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - John Lowe
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Sailesh Kotecha
- Dept of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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10
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Pulmonary Morbidity in Infancy after Exposure to Chorioamnionitis in Late Preterm Infants. Ann Am Thorac Soc 2018; 13:867-76. [PMID: 27015030 DOI: 10.1513/annalsats.201507-411oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RATIONALE Chorioamnionitis is an important cause of preterm birth, but its impact on postnatal outcomes is understudied. OBJECTIVES To evaluate whether fetal exposure to inflammation is associated with adverse pulmonary outcomes at 6 to 12 months' chronological age in infants born moderate to late preterm. METHODS Infants born between 32 and 36 weeks' gestational age were prospectively recruited (N = 184). Chorioamnionitis was diagnosed by placenta and umbilical cord histology. Select cytokines were measured in samples of cord blood. Validated pulmonary questionnaires were administered (n = 184), and infant pulmonary function testing was performed (n = 69) between 6 and 12 months' chronological age by the raised volume rapid thoracoabdominal compression technique. MEASUREMENTS AND MAIN RESULTS A total of 25% of participants had chorioamnionitis. Although infant pulmonary function testing variables were lower in infants born preterm compared with historical normative data for term infants, there were no differences between infants with chorioamnionitis (n = 20) and those without (n = 49). Boys and black infants had lower infant pulmonary function testing measurements than girls and white infants, respectively. Chorioamnionitis exposure was associated independently with wheeze (odds ratio [OR], 2.08) and respiratory-related physician visits (OR, 3.18) in the first year of life. Infants exposed to severe chorioamnionitis had increased levels of cord blood IL-6 and greater pulmonary morbidity at age 6 to 12 months than those exposed to mild chorioamnionitis. Elevated IL-6 was associated with significantly more respiratory problems (OR, 3.23). CONCLUSIONS In infants born moderate or late preterm, elevated cord blood IL-6 and exposure to histologically identified chorioamnionitis was associated with respiratory morbidity during infancy without significant changes in infant pulmonary function testing measurements. Black compared with white and boy compared with girl infants had lower infant pulmonary function testing measurements and worse pulmonary outcomes.
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11
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Lorente-Pozo S, Parra-Llorca A, Torres B, Torres-Cuevas I, Nuñez-Ramiro A, Cernada M, García-Robles A, Vento M. Influence of Sex on Gestational Complications, Fetal-to-Neonatal Transition, and Postnatal Adaptation. Front Pediatr 2018; 6:63. [PMID: 29740570 PMCID: PMC5924769 DOI: 10.3389/fped.2018.00063] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/02/2018] [Indexed: 12/19/2022] Open
Abstract
Fetal sex is associated with striking differences during in utero development, fetal-to-neonatal transition, and postnatal morbidity and mortality. Male sex fetuses are apparently protected while in utero resulting in a higher secondary sex rate for males than for females. However, during fetal-to-neonatal transition and thereafter in the newborn period, female exhibits a greater degree of maturation that translates into a better capacity to stabilize, less incidence of prematurity and prematurity-associated morbidities, and better long-term outcomes. The present review addresses the influence of sex during gestation and postnatal adaptation that includes the establishment of an adult-type circulation, the initiation of breathing, endurance when confronted with perinatal hypoxia ischemia, and a gender-related different response to drugs. The intrinsic mechanisms explaining these differences in the perinatal period remain elusive and further experimental and clinical research are therefore stringently needed if an individual oriented therapy is to be developed.
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Affiliation(s)
| | - Anna Parra-Llorca
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Begoña Torres
- Neonatal Research Group, Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Antonio Nuñez-Ramiro
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Cernada
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Ana García-Robles
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain
| | - Maximo Vento
- Neonatal Research Group, Health Research Institute La Fe, Valencia, Spain.,Division of Neonatology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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12
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Lai SH, Liao SL, Yao TC, Tsai MH, Hua MC, Chiu CY, Yeh KW, Huang JL. Raised-Volume Forced Expiratory Flow-Volume Curve in Healthy Taiwanese Infants. Sci Rep 2017; 7:6314. [PMID: 28740164 PMCID: PMC5524959 DOI: 10.1038/s41598-017-06815-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/19/2017] [Indexed: 01/15/2023] Open
Abstract
The raised-volume rapid thoracoabdominal compression (RVRTC) manoeuvre has been applied to obtain full forced expiratory flow-volume curves in infants. No reference data are available for Asian populations. This study was conducted to establish predictive reference equations for Taiwanese infants. Full-term infants without any chronic disease or major anomaly were enrolled from this cohort study. Full forced expiratory flow-volume curves were acquired using RVRTC manoeuvres through Jaeger's system. Tidal breath analysis, passive respiratory mechanics, and tidal forced expiratory flow-volume curves were performed and collected at the same measurement. Multiple linear analyses were used to model the variables. We performed 117 tests of RVRTC flow-volume curves in 97 infants. The results revealed that all parameters, except for FEV0.5 /FVC, correlated highly and positively with body length. These parameters correlated significantly with other parameters of passive respiratory mechanics and tidal forced expiratory flow-volume curves. This is the first study to establish equipment-specific reference data of full forced expiration using RVRTC manoeuvres in Asian infants. The results revealed that parameters of RVRTC manoeuvres are moderately related to other parameters of infant lung function. These race-specific reference data can be used to more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Chih-Yung Chiu
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan.,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan. .,Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan.
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13
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Winck AD, Heinzmann-Filho JP, Schumann D, Zatti H, Mattiello R, Jones MH, Stein RT. Growth, lung function, and physical activity in schoolchildren who were very-low-birth-weight preterm infants. J Bras Pneumol 2017; 42:254-260. [PMID: 27832232 PMCID: PMC5063441 DOI: 10.1590/s1806-37562015000000159] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/03/2016] [Indexed: 12/05/2022] Open
Abstract
Objective: To compare somatic growth, lung function, and level of physical activity in schoolchildren who had been very-low-birth-weight preterm infants (VLBWPIs) or normal-birth-weight full-term infants. Methods: We recruited two groups of schoolchildren between 8 and 11 years of age residing in the study catchment area: those who had been VLBWPIs (birth weight < 1,500 g); and those who had been normal-birth-weight full-term infants (controls, birth weight ≥ 2,500 g). Anthropometric and spirometric data were collected from the schoolchildren, who also completed a questionnaire regarding their physical activity. In addition, data regarding the perinatal and neonatal period were collected from the medical records of the VLBWPIs. Results: Of the 93 schoolchildren screened, 48 and 45 were in the VLBWPI and control groups, respectively. No significant differences were found between the groups regarding anthropometric characteristics, nutritional status, or pulmonary function. No associations were found between perinatal/neonatal variables and lung function parameters in the VLBWPI group. Although the difference was not significant, the level of physical activity was slightly higher in the VLBWPI group than in the control group. Conclusions: Among the schoolchildren evaluated here, neither growth nor lung function appear to have been affected by prematurity birth weight, or level of physical activity.
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Affiliation(s)
- Aline Dill Winck
- Universidade de Caxias do Sul, Caxias do Sul (RS) Brasil.,Rede Metodista de Educação do Sul - IPA - Porto Alegre (RS) Brasil
| | - João Paulo Heinzmann-Filho
- Programa de Pós-Graduação em Pediatria e Saúde da Criança, Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Deise Schumann
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Helen Zatti
- Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Rita Mattiello
- Programa de Pós-Graduação em Pediatria e Saúde da Criança, Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Marcus Herbert Jones
- Programa de Pós-Graduação em Pediatria e Saúde da Criança, Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - Renato Tetelbom Stein
- Programa de Pós-Graduação em Pediatria e Saúde da Criança, Centro Infant, Instituto de Pesquisas Biomédicas, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil.,Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
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14
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Gray D, Willemse L, Visagie A, Czövek D, Nduru P, Vanker A, Stein DJ, Koen N, Sly PD, Hantos Z, Hall GL, Zar HJ. Determinants of early-life lung function in African infants. Thorax 2017; 72:445-450. [PMID: 27856821 PMCID: PMC5520243 DOI: 10.1136/thoraxjnl-2015-207401] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/13/2016] [Accepted: 10/17/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Low lung function in early life is associated with later respiratory illness. There is limited data on lung function in African infants despite a high prevalence of respiratory disease. AIM To assess the determinants of early lung function in African infants. METHOD Infants enrolled in a South African birth cohort, the Drakenstein child health study, had lung function measured at 6-10 weeks of age. Measurements, made with the infant breathing via a facemask during natural sleep, included tidal breathing, sulfur hexafluoride multiple breath washout and the forced oscillation technique. Information on antenatal and early postnatal exposures was collected using questionnaires and urine cotinine. Household benzene exposure was measured antenatally. RESULTS Successful tests were obtained in 645/675 (95%) infants, median (IQR) age of 51 (46-58) days. Infant size, age and male gender were associated with larger tidal volume. Infants whose mothers smoked had lower tidal volumes (-1.6 mL (95% CI -3.0 to -0.1), p=0.04) and higher lung clearance index (0.1 turnovers (95% CI 0.01 to 0.3), p=0.03) compared with infants unexposed to tobacco smoke. Infants exposed to alcohol in utero or household benzene had lower time to peak tidal expiratory flow over total expiratory time ratios, 10% (95% CI -15.4% to -3.7%), p=0.002) and 3.0% (95% CI -5.2% to -0.7%, p=0.01) lower respectively compared with unexposed infants. HIV-exposed infants had higher tidal volumes (1.7 mL (95% CI 0.06 to 3.3) p=0.04) compared with infants whose mothers were HIV negative. CONCLUSION We identified several factors including infant size, sex, maternal smoking, maternal alcohol, maternal HIV and household benzene associated with altered early lung function, many of which are factors amenable to public health interventions. Long-term study of lung function and respiratory disease in these children is a priority to develop strategies to strengthen child health.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dorottya Czövek
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Polite Nduru
- Division of Epidemiology and Biostatistics, Department of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorder, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorder, University of Cape Town, Cape Town, South Africa
| | - Peter D Sly
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Zoltán Hantos
- Children's Lung, Environment and Asthma Research, Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Graham L Hall
- Telethon Kids Institute, Australia Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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15
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Lingappan K, Jiang W, Wang L, Moorthy B. Sex-specific differences in neonatal hyperoxic lung injury. Am J Physiol Lung Cell Mol Physiol 2016; 311:L481-93. [PMID: 27343189 DOI: 10.1152/ajplung.00047.2016] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/24/2016] [Indexed: 11/22/2022] Open
Abstract
Male sex is considered an independent predictor for the development of bronchopulmonary dysplasia (BPD) after adjusting for other confounders. BPD is characterized by an arrest in lung development with marked impairment of alveolar septation and vascular development. The reasons underlying sexually dimorphic outcomes in premature neonates are not known. In this investigation, we tested the hypothesis that male neonatal mice will be more susceptible to hyperoxic lung injury and will display larger arrest in lung alveolarization. Neonatal male and female mice (C57BL/6) were exposed to hyperoxia [95% FiO2, postnatal day (PND) 1-5] and euthanized on PND 7 and 21. Extent of alveolarization, pulmonary vascularization, inflammation, and modulation of the NF-κB pathway were determined and compared with room air controls. Macrophage and neutrophil infiltration was significantly increased in hyperoxia-exposed animals but was increased to a larger extent in males compared with females. Lung morphometry showed a higher mean linear intercept (MLI) and a lower radial alveolar count (RAC) and therefore greater arrest in lung development in male mice. This was accompanied by a significant decrease in the expression of markers of angiogenesis (PECAM1 and VEGFR2) in males after hyperoxia exposure compared with females. Interestingly, female mice showed increased activation of the NF-κB pathway in the lungs compared with males. These results support the hypothesis that sex plays a crucial role in hyperoxia-mediated lung injury in this model. Elucidation of the sex-specific molecular mechanisms may aid in the development of novel individualized therapies to prevent/treat BPD.
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Affiliation(s)
- Krithika Lingappan
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Weiwu Jiang
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lihua Wang
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Bhagavatula Moorthy
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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16
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Guthrie S, Bienkowska-Gibbs T, Manville C, Pollitt A, Kirtley A, Wooding S. The impact of the National Institute for Health Research Health Technology Assessment programme, 2003-13: a multimethod evaluation. Health Technol Assess 2016; 19:1-291. [PMID: 26307643 DOI: 10.3310/hta19670] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. METHODS Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. RESULTS We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.
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17
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Namba F, Ogawa R, Ito M, Watanabe T, Dennery PA, Tamura M. Sex-related differences in long-term pulmonary outcomes of neonatal hyperoxia in mice. Exp Lung Res 2016; 42:57-65. [DOI: 10.3109/01902148.2016.1141264] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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18
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Lai SH, Liao SL, Yao TC, Tsai MH, Hua MC, Yeh KW, Huang JL. Respiratory Function in Healthy Taiwanese Infants: Tidal Breathing Analysis, Passive Mechanics, and Tidal Forced Expiration. PLoS One 2015; 10:e0142797. [PMID: 26559673 PMCID: PMC4641614 DOI: 10.1371/journal.pone.0142797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023] Open
Abstract
Background Although infant lung function (ILF) testing is widely practiced in developed Western countries it is not typically performed in Eastern countries, and lung measurements are scarce for Asian infants. Therefore, this study aimed to establish normal reference values for Taiwanese infants. Materials and Methods Full-term infants without any chronic diseases and major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children (PATCH) cohort study. Detailed medical data, such as body weight and length, birth history, and histories of previous illness and hospitalization were recorded. Lung function measurements such as analysis of tidal breathing, passive respiratory mechanics, and forced tidal expiratory flow-volume curves were obtained through Jaeger Masterscreen BabyBody Paediatrics System. Multiple linear analyses were performed to determine various parameters of the lung function tests. Results ILF test parameters were collected from 126 infants, and 189 tests were performed. The results revealed that the ratio of time to peak expiratory flow to total expiratory time, the ratio of volume to peak expiratory flow to total expiratory volume, and the ratio of inspiratory time to total respiratory time remained relatively constant despite differences in age. However, body length is the strongest independent variable influencing tidal volume, respiratory rate, resistance, compliance, and maximal expiratory flow at functional residual capacity. Conclusion According to our review of relevant literature, this is the first study to establish a reference data of ILF tests in the Asian population. This study provided reference values and regression equations for several variables of lung function measurements in healthy infants aged less than 2 years. With these race-specific reference data, ILF can more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.
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Affiliation(s)
- Shen-Hao Lai
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Tsung-Chieh Yao
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung Memorial Hospital and Chang Gung University, Keelung, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
| | - Jing-Long Huang
- Department of Pediatrics, Chang Gung Memorial Hospital Chang Gung University, Taoyuan, Taiwan
- Department of Pediatrics, Chang Gung University, Taoyuan, Taiwan
- Prediction of Allergies in Taiwanese Children (PATCH) cohort study, Keelung, Taiwan
- * E-mail:
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19
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Usemann J, Korten I, Latzin P. A big step forward in understanding global differences in respiratory health: first lung function data in African infants. Respirology 2015; 20:1006-7. [PMID: 26305779 DOI: 10.1111/resp.12617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jakob Usemann
- University Children's Hospital Basel, Basel, Switzerland.,Division of Respiratory Medicine Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Insa Korten
- University Children's Hospital Basel, Basel, Switzerland.,Division of Respiratory Medicine Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- University Children's Hospital Basel, Basel, Switzerland
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20
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Gray D, Willemse L, Visagie A, Smith E, Czövek D, Sly PD, Hantos Z, Hall GL, Zar HJ. Lung function and exhaled nitric oxide in healthy unsedated African infants. Respirology 2015; 20:1108-14. [PMID: 26134556 PMCID: PMC4623783 DOI: 10.1111/resp.12579] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/24/2015] [Accepted: 03/31/2015] [Indexed: 12/30/2022]
Abstract
Background and objective Population-appropriate lung function reference data are essential to accurately identify respiratory disease and measure response to interventions. There are currently no reference data in African infants. The aim was to describe normal lung function in healthy African infants. Methods Lung function was performed on healthy South African infants enrolled in a birth cohort study, the Drakenstein child health study. Infants were excluded if they were born preterm or had a history of neonatal respiratory distress or prior respiratory tract infection. Measurements, made during natural sleep, included the forced oscillation technique, tidal breathing, exhaled nitric oxide and multiple breath washout measures. Results Three hundred sixty-three infants were tested. Acceptable and repeatable measurements were obtained in 356 (98%) and 352 (97%) infants for tidal breathing analysis and exhaled nitric oxide outcomes, 345 (95%) infants for multiple breath washout and 293 of the 333 (88%) infants for the forced oscillation technique. Age, sex and weight-for-age z score were significantly associated with lung function measures. Conclusions This study provides reference data for unsedated infant lung function in African infants and highlights the importance of using population-specific data.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
| | - Lauren Willemse
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
| | - Ane Visagie
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
| | - Emilee Smith
- Division of Epidemiology and Biostatistics, School of Public Health and Family, University of Cape Town, Cape Town, South Africa
| | - Dorottya Czövek
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Queensland Children's Medical Research Institute, University of Queensland, Perth, Western Australia, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, University of Queensland, Perth, Western Australia, Australia
| | - Zoltán Hantos
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.,Queensland Children's Medical Research Institute, University of Queensland, Perth, Western Australia, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,MRC Unit, Child and Adolescent Lung Health, Cape Town, South Africa
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Gray D, Czövek D, Smith E, Willemse L, Alberts A, Gingl Z, Hall GL, Zar HJ, Sly PD, Hantos Z. Respiratory impedance in healthy unsedated South African infants: effects of maternal smoking. Respirology 2015; 20:467-73. [PMID: 25581268 PMCID: PMC4670479 DOI: 10.1111/resp.12463] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/17/2014] [Accepted: 11/04/2014] [Indexed: 01/16/2023]
Abstract
Background and objective Non-invasive techniques for measuring lung mechanics in infants are needed for a better understanding of lung growth and function, and to study the effects of prenatal factors on subsequent lung growth in healthy infants. The forced oscillation technique requires minimal cooperation from the individual but has rarely been used in infants. The study aims to assess the use of the forced oscillation technique to measure the influence of antenatal exposures on respiratory mechanics in unsedated infants enrolled in a birth cohort study in Cape Town, South Africa. Methods Healthy term infants were studied at 6–10 weeks of age using the forced oscillation technique. Respiratory impedance was measured in the frequency range 8–48 Hz via a face mask during natural sleep. Respiratory system resistance, compliance and inertance were calculated from the impedance spectra. Results Of 177 infants tested, successful measurements were obtained in 164 (93%). Median (25–75%) values for resistance, compliance and inertance were 50.2 (39.5–60.6) cmH2O.s.L−1, 0.78 (0.61–0.99) mL.cmH2O−1 and 0.062 (0.050–0.086) cmH2O.s2.L−1, respectively. As a group, male infants had 16% higher resistance (P = 0.006) and 18% lower compliance (P = 0.02) than females. Infants whose mothers smoked during pregnancy had a 19% lower compliance than infants not exposed to tobacco smoke during pregnancy (P = 0.005). Neither maternal HIV infection nor ethnicity had a significant effect on respiratory mechanics. Conclusions The forced oscillation technique is sensitive enough to demonstrate the effects of tobacco smoke exposure and sex in respiratory mechanics in healthy infants. This technique will facilitate assessing perinatal influences of lung function in infancy.
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Affiliation(s)
- Diane Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Hutchison AA, Leclerc F, Nève V, Pillow JJ, Robinson PD. The Respiratory System. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193717 DOI: 10.1007/978-3-642-01219-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This chapter addresses upper airway physiology for the pediatric intensivist, focusing on functions that affect ventilation, with an emphasis on laryngeal physiology and control in breathing. Effective control of breathing ensures that the airway is protected, maintains volume homeostasis, and provides ventilation. Upper airway structures are effectors for all of these functions that affect the entire airway. Nasal functions include air conditioning and protective reflexes that can be exaggerated and involve circulatory changes. Oral cavity and pharyngeal patency enable airflow and feeding, but during sleep pharyngeal closure can result in apnea. Coordination of breathing with sucking and nutritive swallowing alters during development, while nonnutritive swallowing at all ages limits aspiration. Laryngeal functions in breathing include protection of the subglottic airway, active maintenance of its absolute volume, and control of tidal flow patterns. These are vital functions for normal lung growth in fetal life and during rapid adaptations to breathing challenges from birth through adulthood. Active central control of breathing focuses on the coordination of laryngeal and diaphragmatic activities, which adapts according to the integration of central and peripheral inputs. For the intensivist, knowledge of upper airway physiology can be applied to improve respiratory support. In a second part the mechanical properties of the respiratory system as a critical component of the chain of events that result in translation of the output of the respiratory rhythm generator to ventilation are described. A comprehensive understanding of respiratory mechanics is essential to the delivery of optimized and individualized mechanical ventilation. The basic elements of respiratory mechanics will be described and developmental changes in the airways, lungs, and chest wall that impact on measurement of respiratory mechanics with advancing postnatal age are reviewed. This will be follwowed by two sections, the first on respiratory mechanics in various neonatal pathologies and the second in pediatric pathologies. The latter can be classified in three categories. First, restrictive diseases may be of pulmonary origin, such as chronic interstitial lung diseases or acute lung injury/acute respiratory distress syndrome, which are usually associated with reduced lung compliance. Restrictive diseases may also be due to chest wall abnormalities such as obesity or scoliosis (idiopathic or secondary to neuromuscular diseases), which are associated with a reduction in chest wall compliance. Second, obstructive diseases are represented by asthma and wheezing disorders, cystic fibrosis, long term sequelae of neonatal lung disease and bronchiolitis obliterans following hematopoietic stem cell transplantation. Obstructive diseases are defined by a reduced FEV1/VC ratio. Third, neuromuscular diseases, mainly represented by DMD and SMA, are associated with a decrease in vital capacity linked to respiratory muscle weakness that is better detected by PImax, PEmax and SNIP measurements.
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Hoo AF, Gupta A, Lum S, Costeloe KL, Huertas-Ceballos A, Marlow N, Stocks J. Impact of ethnicity and extreme prematurity on infant pulmonary function. Pediatr Pulmonol 2014; 49:679-87. [PMID: 24123888 PMCID: PMC4285893 DOI: 10.1002/ppul.22882] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 07/06/2013] [Indexed: 11/11/2022]
Abstract
The impact of birth before 27 completed weeks of gestation on infant pulmonary function (PF) was explored in a multi-ethnic population in comparison to more mature preterm controls (PTC) and healthy fullterm infants. Plethysmographic lung volume (FRCpleth ) and forced expired volume (FEV0.5 ) were obtained at ∼12 months post-term age in 52 extremely preterm (EP) infants (median [range] gestational age [GA]: 26 [23-27] weeks; 40% White mothers; 79% with BPD), 41 PTC (GA:35 [30-36] weeks; 37% White mothers) and 95 fullterm infants (GA:40 [37-42] weeks; 86% White mothers). Using reference equations based on identical equipment and techniques, results were expressed as z-scores to adjust for age, sex and body size. FEV0.5 was significantly lower in EP infants when compared with PTC (mean difference [95% CI]: -1.02[-1.60; -0.44] z-scores, P < 0.001), as was forced vital capacity (FVC) but there were no significant differences in FRCpleth or FEV0.5 /FVC ratio. FEV0.5 , FVC, and FEV0.5 /FVC were significantly lower in both preterm groups when compared with fullterm controls. On multivariable analyses of the combined preterm dataset: FEV0.5 at ∼1 year was 0.11 [0.05; 0.17] z-scores higher/week GA, and 1.28 (0.49; 2.08) z-scores lower in EP infants with prior BPD. Among non-white preterm infants, FEV0.5 was 0.70 (0.17; 1.24) z-scores lower, with similar reductions in FVC, such that there were no ethnic differences in FEV0.5 /FVC. Similar ethnic differences were observed among fullterm infants. These results confirm the negative impact of preterm birth on subsequent lung development, especially following a diagnosis of BPD, and emphasize the importance of taking ethnic background into account when interpreting results during infancy as in older subjects.
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Affiliation(s)
- Ah-Fong Hoo
- Portex Respiratory Unit, UCL Institute of Child Health, London, WC1N 1EH, UK; Paediatric Respiratory Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
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Lum S, Aurora P. Does ethnicity influence lung function in preschool children? Expert Rev Respir Med 2014; 4:267-9. [DOI: 10.1586/ers.10.34] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lingappan K, Jiang W, Wang L, Couroucli XI, Barrios R, Moorthy B. Sex-specific differences in hyperoxic lung injury in mice: implications for acute and chronic lung disease in humans. Toxicol Appl Pharmacol 2013; 272:281-90. [PMID: 23792423 DOI: 10.1016/j.taap.2013.06.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 01/12/2023]
Abstract
Sex-specific differences in pulmonary morbidity in humans are well documented. Hyperoxia contributes to lung injury in experimental animals and humans. The mechanisms responsible for sex differences in the susceptibility towards hyperoxic lung injury remain largely unknown. In this investigation, we tested the hypothesis that mice will display sex-specific differences in hyperoxic lung injury. Eight week-old male and female mice (C57BL/6J) were exposed to 72 h of hyperoxia (FiO2>0.95). After exposure to hyperoxia, lung injury, levels of 8-iso-prostaglandin F2 alpha (8-iso-PGF 2α) (LC-MS/MS), apoptosis (TUNEL) and inflammatory markers (suspension bead array) were determined. Cytochrome P450 (CYP)1A expression in the lung was assessed using immunohistochemistry and western blotting. After exposure to hyperoxia, males showed greater lung injury, neutrophil infiltration and apoptosis, compared to air-breathing controls than females. Pulmonary 8-iso-PGF 2α levels were higher in males than females after hyperoxia exposure. Sexually dimorphic increases in levels of IL-6 (F>M) and VEGF (M>F) in the lungs were also observed. CYP1A1 expression in the lung was higher in female mice compared to males under hyperoxic conditions. Overall, our results support the hypothesis that male mice are more susceptible than females to hyperoxic lung injury and that differences in inflammatory and oxidative stress markers contribute to these sex-specific dimorphic effects. In conclusion, this paper describes the establishment of an animal model that shows sex differences in hyperoxic lung injury in a temporal manner and thus has important implications for lung diseases mediated by hyperoxia in humans.
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Affiliation(s)
- Krithika Lingappan
- Department of Pediatrics, Section of Neonatology, Texas Children's Hospital, Baylor College of Medicine, 1102 Bates Avenue, MC: FC530.01, Houston, TX 77030, USA.
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Huq S, Moussavi Z. Acoustic breath-phase detection using tracheal breath sounds. Med Biol Eng Comput 2012; 50:297-308. [PMID: 22362023 DOI: 10.1007/s11517-012-0869-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 12/05/2011] [Indexed: 11/28/2022]
Abstract
Current breathing flow estimation methods use tracheal breath sounds, but one step of the process, 'breath phase (inspiration/expiration) detection', is done by either assuming alternating breath phases or using a second acoustic channel of lung sounds. The alternating assumption is unreliable for long recordings, non-breathing events, such as apnea, swallow or cough change the alternating nature of the phases. Using lung sounds intensity requires the addition of a secondary channel and the associated labor. Hence, an automatic and accurate method for breath-phase detection using only tracheal sounds would be of great benefit. We present a method using several breath sound parameters to differentiate between the two respiratory phases. The proposed method is novel and independent of flow level; it requires only one prior- and one post-breath sound segment to identify the phase. The proposed method was tested on data from 93 healthy individuals, without any history of pulmonary diseases breathing at 4 different flow levels. The most prominent features were from the duration, volume and shape of the sound envelope. This method has shown an accuracy of 95.6% with 95.5% sensitivity and 95.6% specificity for breath-phase identification without assuming breath-phase-alteration and/or using any other information.
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Affiliation(s)
- Saiful Huq
- Department of Electrical and Computer Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada
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Kontakiotis T, Boutou AK, Ioannidis D, Papakosta D, Argyropoulou P. Spirometry values in a Greek population: is there an appropriate reference equation? Respirology 2011; 16:947-52. [PMID: 21624003 DOI: 10.1111/j.1440-1843.2011.02002.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Most published reference values for lung function test (LFT) parameters introduce systematic bias. The aim of this study was to compare measured values of FEV(1) and FVC with the corresponding normal predicted values in a Greek population, and to produce reference equations for LFT parameters in this population. METHODS In a cross-sectional study conducted in Macedonia, Greece, 1080 adult healthy, non-smokers (432 men, 648 women, aged 18-80 years), underwent spirometry. Measured values of FVC and FEV(1) were compared with predicted values determined using three existing sets of reference equations: one recently derived from a European population and two others widely used in Europe (European Coal and Steel Community; ECSC) and the USA (National Health and Nutrition Examination Survey; NHANES III). Height and age were entered into the multivariate regression analysis to produce reference equations for LFT parameters. RESULTS All three published sets of equations underpredicted FEV(1) in men. FVC was accurately predicted by all equations except NHANES III. The discrepancy was even greater among women; the ECSC equation underpredicted both FEV(1) and FVC, the NHANES III equation overpredicted both FEV(1) and FVC, while the third set of equations accurately predicted FEV(1) but overpredicted FVC. The derived reference equation for FEV(1) in men was -0.28 × age + 0.057 × height - 4.91, and in women -0.021 × age + 0.039 × height - 2.58. The derived reference equation for FVC in men was -0.28 × age + 0.071 × height - 6.763, and in women -0.019 × age + 0.056 × height - 5.018. CONCLUSIONS Measured FEV(1) and FVC values in a Greek population differed significantly from those predicted using previously published reference equations. The new locally derived spirometry reference equations may be more suitable for evaluation of lung function in everyday practice.
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Affiliation(s)
- Theodore Kontakiotis
- Department of Pulmonology, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece
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Pramana IA, Latzin P, Schlapbach LJ, Hafen G, Kuehni CE, Nelle M, Riedel T, Frey U. Respiratory symptoms in preterm infants: burden of disease in the first year of life. Eur J Med Res 2011; 16:223-30. [PMID: 21719396 PMCID: PMC3352195 DOI: 10.1186/2047-783x-16-5-223] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective While respiratory symptoms in the first year of life are relatively well described for term infants, data for preterm infants are scarce. We aimed to describe the burden of respiratory disease in a group of preterm infants with and without bronchopulmonary dysplasia (BPD) and to assess the association of respiratory symptoms with perinatal, genetic and environmental risk factors. Methods Single centre birth cohort study: prospective recording of perinatal risk factors and retrospective assessment of respiratory symptoms during the first year of life by standardised questionnaires. Main outcome measures: Cough and wheeze (common symptoms), re-hospitalisation and need for inhalation therapy (severe outcomes). Patients: 126 preterms (median gestational age 28.7 weeks; 78 with, 48 without BPD) hospitalised at the University Children's Hospital of Bern, Switzerland 1999-2006. Results Cough occurred in 80%, wheeze in 44%, rehospitalisation in 25% and long term inhalation therapy in wheezers in 13% of the preterm infants. Using logistic regression, the main risk factor for common symptoms was frequent contact with other children. Severe outcomes were associated with maximal peak inspiratory pressure, arterial cord blood pH, APGAR and CRIB-Score. Conclusions Cough in preterm infants is as common as in term infants, whereas wheeze, inhalation therapy and re-hospitalisations occur more often. Severe outcomes are associated with perinatal risk factors. Preterm infants who did not qualify for BPD according to latest guidelines also showed a significant burden of respiratory disease in the first year of life.
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Affiliation(s)
- Isabelle A Pramana
- Devision of paediatric pneumology, Children's Hospital of the University of Bern, 3010 Bern, Switzerland.
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Pillarisetti N, Williamson E, Linnane B, Skoric B, Robertson CF, Robinson P, Massie J, Hall GL, Sly P, Stick S, Ranganathan S. Infection, Inflammation, and Lung Function Decline in Infants with Cystic Fibrosis. Am J Respir Crit Care Med 2011; 184:75-81. [DOI: 10.1164/rccm.201011-1892oc] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Clougherty JE. A growing role for gender analysis in air pollution epidemiology. CIENCIA & SAUDE COLETIVA 2011; 16:2221-38. [DOI: 10.1590/s1413-81232011000400021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 10/16/2009] [Indexed: 01/22/2023] Open
Abstract
Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.
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Sojo L, Garcia-Patterson A, María MA, Martín E, Ubeda J, Adelantado JM, de Leiva A, Corcoy R. Are birth weight predictors in diabetic pregnancy the same in boys and girls? Eur J Obstet Gynecol Reprod Biol 2010; 153:32-7. [DOI: 10.1016/j.ejogrb.2010.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 05/26/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
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Zhang Y, McConnell R, Gilliland F, Berhane K. Ethnic differences in the effect of asthma on pulmonary function in children. Am J Respir Crit Care Med 2010; 183:596-603. [PMID: 20889910 DOI: 10.1164/rccm.200912-1863oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The impact of asthma on chronic lung function deficits is well known. However, there has been little study of ethnic differences in these asthma-associated deficits. OBJECTIVES To examine whether there are ethnic differences in the effects of asthma on children's lung function. METHODS We evaluated the impact of asthma on lung function in 3,245 Hispanic and non-Hispanic white school children (age 10-18 yr) in a longitudinal analysis of the Southern California Children's Health Study. Sex-specific mixed-effects regression spline models were fitted separately for each ethnic group. MEASUREMENTS AND MAIN RESULTS Large deficits in flows were observed among children with asthma diagnosed before age 4 years regardless of ethnicity. Hispanic girls with asthma had greater deficits in flows than non-Hispanic girls and were largest for maximal midexpiratory flow (-5.13% compared with -0.58%, respectively). A bigger impact of asthma in Hispanic girls was also found for FEV(1), FEF(75), and PEF (P value 0.04, 0.07, and 0.005, respectively). These ethnic differences were limited to girls diagnosed after age 4 years. In boys, asthma was also associated with greater deficits in flows among Hispanic than in non-Hispanic white children (differences that were not statistically significant). Ethnic differences in prevalence of pets and pests in the home, health insurance coverage, parental education, and smoking did not explain the pattern of lung function differences. CONCLUSIONS Larger asthma-associated lung function deficits in Hispanics, especially among girls, merit further investigation to determine public health implications and to identify causes amenable to intervention.
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Affiliation(s)
- Yue Zhang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
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Clougherty JE. A growing role for gender analysis in air pollution epidemiology. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:167-76. [PMID: 20123621 PMCID: PMC2831913 DOI: 10.1289/ehp.0900994] [Citation(s) in RCA: 350] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 10/16/2009] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. DATA SOURCES AND DATA EXTRACTION A PubMed literature search was performed in July 2009, using the terms "respiratory" and any of "sex" or "gender" or "men and women" or "boys and girls" and either "PM2.5" (particulate matter <or= 2.5 microm in aerodynamic diameter) or "NO2" (nitrogen dioxide). I reviewed the identified studies, and others cited therein, to summarize current evidence of effect modification, with attention to authors' interpretation of observed differences. Owing to broad differences in exposure mixes, outcomes, and analytic techniques, with few studies examining any given combination thereof, meta-analysis was not deemed appropriate at this time. DATA SYNTHESIS More studies of adults report stronger effects among women, particularly for older persons or where using residential exposure assessment. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. CONCLUSIONS The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.
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Affiliation(s)
- Jane E Clougherty
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Minocchieri S, Burren JM, Bachmann MA, Stern G, Wildhaber J, Buob S, Schindel R, Kraemer R, Frey UP, Nelle M. Development of the premature infant nose throat-model (PrINT-Model): an upper airway replica of a premature neonate for the study of aerosol delivery. Pediatr Res 2008; 64:141-6. [PMID: 18391845 DOI: 10.1203/pdr.0b013e318175dcfa] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinical efficacy of aerosol therapy in premature newborns depends on the efficiency of delivery of aerosolized drug to the bronchial tree. To study the influence of various anatomical, physical, and physiological factors on aerosol delivery in preterm newborns, it is crucial to have appropriate in vitro models, which are currently not available. We therefore constructed the premature infant nose throat-model (PrINT-Model), an upper airway model corresponding to a premature infant of 32-wk gestational age by three-dimensional (3D) reconstruction of a three-planar magnetic resonance imaging scan and subsequent 3D-printing. Validation was realized by visual comparison and comparison of total airway volume. To study the feasibility of measuring aerosol deposition, budesonide was aerosolized through the cast and lung dose was expressed as percentage of nominal dose. The airway volumes of the initial magnetic resonance imaging and validation computed tomography scan showed a relative deviation of 0.94%. Lung dose at low flow (1 L/min) was 61.84% and 9.00% at high flow (10 L/min), p < 0.0001. 3D-reconstruction provided an anatomically accurate surrogate of the upper airways of a 32-wk-old premature infant, making the model suitable for future in vitro testing.
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Affiliation(s)
- Stefan Minocchieri
- Department of Paediatrics, Division of Neonatology, University of Bern, Inselspital, Bern, BE, Switzerland.
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Abstract
Among ventilated children, the incidence of acute lung injury (ALI) was 9%; of that latter group 80% developed the acute respiratory distress syndrome (ARDS). The population-based prevalence of pediatric ARDS was 5.5 cases/100.000 inhabitants. Underlying diseases in children were septic shock (34%), respiratory syncytial virus infections (16%), bacterial pneumonia (15%), near-drowning 9%, and others. Mortality ranged from 18% to 27% for ALI (including ALI-non ARDS and ARDS) and from 29% to 50% for ARDS. Mortality was only 3%-11% in children with ALI-non ARDS. As risk factors, oxygenation indices and multi-organ failure have been identified. New insights into the pathophysiology (for example the interplay between intraalveolar coagulation/fibrinolysis and inflammation and the genetic polymorphism for the angiotensin-converting enzyme) offer new therapeutic options. Lung protective mechanical ventilation with optimal lung recruitment is the mainstay of supportive therapy. New therapeutic modalities refer to corticosteroid and surfactant treatment. Well-designed follow up studies are needed.
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Van Putte-Katier N, Uiterwaal CSPM, De Jong BM, Kimpen JLL, Verheij TJM, Van Der Ent CK. The influence of maternal respiratory infections during pregnancy on infant lung function. Pediatr Pulmonol 2007; 42:945-51. [PMID: 17726702 DOI: 10.1002/ppul.20688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION We studied whether maternal respiratory infections during pregnancy adversely influence lung growth and development of the offspring, resulting in poor early life lung function. METHODS Infants were participants of the Wheezing Illnesses Study Leidsche Rijn (WHISTLER). Lung function measurements (single occlusion technique) were performed during natural sleep. Questionnaire data were used to obtain information on maternal respiratory infections during pregnancy. Multivariate analysis was conducted to assess the relationship between maternal respiratory infections during pregnancy and resistance and compliance of the respiratory system, adjusting for potential confounding variables. RESULTS Lower values of compliance (Crs) were found in infants of mothers with respiratory infections during pregnancy; Crs fell by 5.5% (P = 0.031). The difference in Crs between infants of mothers with and without respiratory infections during pregnancy remained unchanged and statistically significant after adjusting for potential confounding variables. The more respiratory infections the mother experienced during pregnancy, the lower the value of Crs was in her offspring (P for trend = 0.016). Using Crs corrected for body weight the relationship with maternal infections was non-significant, however still showing a trend. CONCLUSIONS The results of this study may indicate that mothers who experience respiratory infections during pregnancy have newborns with lower compliance of the respiratory system.
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Affiliation(s)
- Nienke Van Putte-Katier
- Department of Pediatric Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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Katier N, Uiterwaal CSPM, de Jong BM, Verheij TJM, van der Ent CK. Passive respiratory mechanics measured during natural sleep in healthy term neonates and infants up to 8 weeks of life. Pediatr Pulmonol 2006; 41:1058-64. [PMID: 16998930 DOI: 10.1002/ppul.20492] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The single occlusion technique (SOT) is a simple and noninvasive technique for measurement of passive respiratory mechanics in infants. Reference values based on measurements of a large population of healthy infants performed outside specialized research laboratories are lacking. The aim of this study was to present reference values for passive respiratory mechanics based on a large population of healthy term neonates and infants measured during natural sleep in routine care. As part of the ongoing Wheezing Illnesses Study Leidsche Rijn (WHISTLER), the compliance (C(rs)) and resistance (R(rs)) of the respiratory system were measured in 450 healthy unsedated neonates and infants with a mean age of 4.6 +/- 1.3 weeks. Multivariable regression analysis, with gestational age, age at measurement, body size, sex, and ethnicity as possible predictors, was carried out to estimate prediction equations for mean C(rs) and R(rs) values. Technically acceptable lung function measurements could be performed in 328 (73%) neonates and infants. Median C(rs) was 39.5 (range 14.8-79.1) ml/kPa and median R(rs) was 7.4 (range 3.8-19.5) kPa/L/sec. The following regression equations for C(rs) and R(rs) were obtained: ln C(rs) = 1.677 + 1.3 x 10(-4) x birth weight (g) + 0.030 x birth length (cm) and ln R(rs) = 2.496-3.1 x 10(-6) x birth length(3) (cm(3)) - 0.114 x sex. We provided reference values for passive respiratory mechanics using the SOT in a large population of healthy term neonates and infants measured during natural sleep. These data provide a frame of reference for assessing the normality of SOT measurements performed in routine care.
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Affiliation(s)
- N Katier
- Departments of Pediatric Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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Thomas MR, Marston L, Rafferty GF, Calvert S, Marlow N, Peacock JL, Greenough A. Respiratory function of very prematurely born infants at follow up: influence of sex. Arch Dis Child Fetal Neonatal Ed 2006; 91:F197-201. [PMID: 16418306 PMCID: PMC2672701 DOI: 10.1136/adc.2005.081927] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To test the hypothesis that male compared with female prematurely born infants would have worse lung function at follow up. DESIGN Prospective follow up study. SETTING Tertiary neonatal intensive care units PATIENTS Seventy six infants, mean (SD) gestational age 26.4 (1.5) weeks, from the United Kingdom oscillation study. INTERVENTIONS Lung function measurements at a corrected age of 1 year. MAIN OUTCOME MEASURES Airways resistance (Raw) and functional residual capacity (FRC(pleth)) measured by whole body plethysmography, specific conductance (sGaw) calculated from Raw and FRC(pleth), and FRC measured by a helium gas dilution technique (FRC(He)). RESULTS The 42 male infants differed significantly from the 34 female infants in having a lower birth weight for gestation, requiring more days of ventilation, and a greater proportion being oxygen dependent at 36 weeks postmenstrual age and discharge. Furthermore, mean Raw and FRC(pleth) were significantly higher and mean sGaw significantly lower. After adjustment for birth and current size differences, the sex differences in FRC(pleth) and sGaw were 15% and 26% respectively and remained significant. CONCLUSION Lung function at follow up of prematurely born infants is influenced by sex.
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Affiliation(s)
- M R Thomas
- Department of Child Health, 4th Floor Golden Jubilee Wing, King's College Hospital, London SE5 9RS, UK
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Baldwin DN, Pillow JJ, Stocks J, Frey U. Lung-function tests in neonates and infants with chronic lung disease: tidal breathing and respiratory control. Pediatr Pulmonol 2006; 41:391-419. [PMID: 16555264 DOI: 10.1002/ppul.20400] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper is the fourth in a series of reviews that will summarize available data and critically discuss the potential role of lung-function testing in infants with acute neonatal respiratory disorders and chronic lung disease of infancy. The current paper addresses information derived from tidal breathing measurements within the framework outlined in the introductory paper of this series, with particular reference to how these measurements inform on control of breathing. Infants with acute and chronic respiratory illness demonstrate differences in tidal breathing and its control that are of clinical consequence and can be measured objectively. The increased incidence of significant apnea in preterm infants and infants with chronic lung disease, together with the reportedly increased risk of sudden unexplained death within the latter group, suggests that control of breathing is affected by both maturation and disease. Clinical observations are supported by formal comparison of tidal breathing parameters and control of breathing indices in the research setting.
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Affiliation(s)
- David N Baldwin
- Centre for Child Health Research and Telethon Institute for Child Health Research, University of Western Australia, Perth, Western Australia, Australia.
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Gappa M, Pillow JJ, Allen J, Mayer O, Stocks J. Lung function tests in neonates and infants with chronic lung disease: lung and chest-wall mechanics. Pediatr Pulmonol 2006; 41:291-317. [PMID: 16493664 DOI: 10.1002/ppul.20380] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This is the fifth paper in a review series that summarizes available data and critically discusses the potential role of lung function testing in infants and young children with acute neonatal respiratory disorders and chronic lung disease of infancy (CLDI). This review focuses on respiratory mechanics, including chest-wall and tissue mechanics, obtained in the intensive care setting and in infants during unassisted breathing. Following orientation of the reader to the subject area, we focused comments on areas of enquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically with respect to relevant methods, equipment and study design, limitations and strengths of different techniques, and availability and appropriateness of reference data. Recommendations to guide future investigations in this field are provided. Numerous different methods have been used to assess respiratory mechanics with the aims of describing pulmonary status in preterm infants and assessing the effect of therapeutic interventions such as surfactant treatment, antenatal or postnatal steroids, or bronchodilator treatment. Interpretation of many of these studies is limited because lung volume was not measured simultaneously. In addition, populations are not comparable, and the number of infants studied has generally been small. Nevertheless, results appear to support the pathophysiological concept that immaturity of the lung leads to impaired lung function, which may improve with growth and development, irrespective of the diagnosis of chronic lung disease. To fully understand the impact of immaturity on the developing lung, it is unlikely that a single parameter such as respiratory compliance or resistance will accurately describe underlying changes. Assessment of respiratory mechanics will have to be supplemented by assessment of lung volume and airway function. New methods such as the low-frequency forced oscillation technique, which differentiate the tissue and airway components of respiratory mechanics, are likely to require further development before they can be of clinical significance.
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Affiliation(s)
- Monika Gappa
- Department of Pediatric Pulmonology and Neonatology, Medizinische Hochschule Hannover, Hannover, Germany.
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Lum S, Hülskamp G, Merkus P, Baraldi E, Hofhuis W, Stocks J. Lung function tests in neonates and infants with chronic lung disease: forced expiratory maneuvers. Pediatr Pulmonol 2006; 41:199-214. [PMID: 16288484 DOI: 10.1002/ppul.20320] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This fourth paper in a review series on the role of lung function testing in infants and young children with acute neonatal disorders and chronic lung disease of infancy (CLDI) addresses measurements of forced expiration using rapid thoraco-abdominal compression (RTC) techniques and the forced deflation technique. Following orientation of the reader to the subject area, we focus our comments on the areas of inquiry proposed in the introductory paper to this series. The quality of the published literature is reviewed critically, and recommendations are provided to guide future investigation in this field. All studies on infants and young children with CLDI using forced expiratory or deflation maneuvers demonstrated that forced flows at low lung volume remain persistently low through the first 3 years of life. Measurement of maximal flow at functional residual capacity (V'maxFRC) is the most commonly used method for assessing airway function in infants, but is highly dependent on lung volume and airway tone. Recent studies suggested that the raised volume RTC technique, which assesses lung function over an extended volume range as in older children, may be a more sensitive means of discriminating changes in airway function in infants with respiratory disease. The forced deflation technique allows investigation of pulmonary function during the early development of CLDI in intubated subjects, but its invasive nature precludes its use in the routine setting. For all techniques, there is an urgent need to establish suitable reference data and evaluate within- and between-occasion repeatability, prior to establishing the clinical usefulness of these techniques in assessing baseline airway function and/or response to interventions in subjects with CLDI.
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Affiliation(s)
- Sooky Lum
- Portex Respiratory Unit, Institute Institute of Child Health, London, UK.
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Abstract
BACKGROUND Neonatal mortality and morbidity are sex biased in low birth weight infants. The "Y chromosome effect" has been suggested to be responsible for these maturational differences. OBJECTIVE To examine the association of sex and neonatal outcomes. DESIGN AND METHODS A retrospective observational study. Data on all low birth weight infants who survived for >48 hrs were analyzed. Neonatal outcomes were compared between male and female infants. A regression model was used to detect the influence of sex on outcomes after controlling for confounders. Analysis was repeated after stratification of infants into three groups: group A (<1000 g), group B (1000-1499 g), and group C (1500-2499 g). RESULTS A total of 833 infants were included in this study; 419 female infants and 414 male infants. Male infants had an increased rate of overall intraventricular hemorrhage (IVH) (12.2% vs. 7.2%, p = .02) and IVH grades 3-4 (4.8% vs. 2.3%, p = .04). In addition, male infants had higher bilirubin levels (10.19 +/- 3.1 mg/dL vs. 9.32 +/- 2.94 mg/dL, p = .001). In a regression model, male sex continued to have significant influence on IVH, IVH grades 3-4, death, and bilirubin. In group A, male infants had a significantly increased prevalence of death (regression coefficient, 1.82 +/- 0.65; p = .005) that could not be explained by the increased prevalence of IVH (p = .18) in regression analysis. In group B, male sex was significantly associated with a higher bilirubin level (regression coefficient, 0.94 + 0.3; p = .002). In bivariate analyses, IVH and IVH grades 3-4 were significantly higher in male compared with female infants (19.8% vs. 3.9%, p < .0001) and (8.5% vs. 0.97%, p = .02), respectively, but these differences lost significance in multiple-regression analysis. In group C, male sex positively influenced the prevalence of IVH (regression coefficient, 1.7 +/- 0.57; p = .003). Bilirubin measured higher in male infants (11.38 +/- 2.87 mg/dL vs. 10.19 +/- 3.22 mg/dL, p = .0004), but the difference lost significance in regression analysis (regression coefficient, 0.21 +/- 0.31; p = .5). CONCLUSIONS Bilirubin, IVH, and death were significantly higher in male infants. In subgroup analysis, significance was retained in group A (<1000 g). Whether a single biological factor is responsible for these differences or perhaps a multi-causal process involving a complex interaction of physiologic, environmental, and pathologic responses needs to be further addressed in future research.
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Affiliation(s)
- Jennifer A Tioseco
- Department of Neonatology, The Children's National Medical Center, Washington, DC, USA
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Friedrich L, Stein RT, Pitrez PMC, Corso AL, Jones MH. Reduced lung function in healthy preterm infants in the first months of life. Am J Respir Crit Care Med 2005; 173:442-7. [PMID: 16322648 DOI: 10.1164/rccm.200503-444oc] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Preterm delivery has been associated with a higher incidence of respiratory morbidity even in infants that do not have significant respiratory disease during the neonatal period. Reduced flows have been reported in children and adolescents born prematurely. OBJECTIVE The aim of this study was to assess lung function in healthy preterm infants in the first months of life. METHODS Preterm infants with less than 48 h of supplemental oxygen were recruited. Lung function was assessed by the raised-volume rapid thoracic compression in the first months of life. The control group consisted of full-term infants without a history of respiratory diseases. MEASUREMENTS AND MAIN RESULTS Sixty-two preterm (29 male) and 27 full-term (10 male) infants were tested. Adjusting for length, age, and sex, we found a mean significant reduction of 92 ml/s (22%) in FEF(50), 73 ml/s (21%) in FEF(25-75), and 19 ml (28%) in FEV(0.5) in the preterm group. These differences in expiratory flows remained significant using another model that adjusts for lung volume (p < 0.01 for FEF(50), FEF(25-75), and FEV(0.5), and p < 0.05 for FEF(75)). In the preterm group, after adjusting for length, male sex, lower gestational age, and increased weight were significantly and independently associated with reduced flows. CONCLUSIONS Our findings confirm that prematurity is independently associated with reduced lung function and that this is detectable in the first months of life. Male sex, lower gestational age, and weight are important predictors for reduced expiratory flows in this group.
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Affiliation(s)
- Luciana Friedrich
- Department of Pediatrics, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Whittaker AL, Sutton AJ, Beardsmore CS. Are ethnic differences in lung function explained by chest size? Arch Dis Child Fetal Neonatal Ed 2005; 90:F423-8. [PMID: 15871993 PMCID: PMC1721951 DOI: 10.1136/adc.2004.062497] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ethnic differences in lung function (LF) are recognised in adults and children. Most prediction equations for LF are derived from whites, so non-whites are at risk of erroneous assessment. It was hypothesised that differences in chest dimensions would explain differences in LF between Asian (Indian) and white schoolchildren. AIMS To quantify the impact of chest dimensions on LF, which would inform our understanding of ethnic differences that have implications for health care. METHODS Children aged 6-11 were studied in school. A questionnaire provided information on ethnicity and respiratory health. Spirometry was used to record FVC, FEV1, FEF25-75, and PEF. Weight, height, sitting height, and chest dimensions (chest height, circumference, antero-posterior and transverse diameters) were measured. RESULTS Data were obtained from 294 healthy children. Standing height was the most important predictor of LF. Ethnicity was an independent predictor for all LF measures except PEF, where the effect was marginal. FVC in whites was 13.4% bigger than in Asians of the same height, and the FEV1 was 10.6% greater in whites. The influence of chest dimensions on lung function was trivial. Body mass index was smaller in Asians but did not explain differences in LF. CONCLUSIONS Differences in chest dimensions did not explain the substantial effect of ethnicity on LF. Mechanisms whereby ethnicity exerts its influence may include differences in inspiratory muscle strength or lung compliance but remain speculative. Nevertheless it remains imperative that ethnic differences are recognised when interpreting LF tests.
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Affiliation(s)
- A L Whittaker
- Department of Child Health, Leicester Warwick Medical School, UK
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Abstract
Bronchopulmonary dysplasia (BPD) has classically been described as including inflammation, architectural disruption, fibrosis, and disordered/delayed development of the infant lung. As infants born at progressively earlier gestations have begun to survive the neonatal period, a 'new' BPD, consisting primarily of disordered/delayed development, has emerged. BPD causes not only significant complications in the newborn period, but is associated with continuing mortality, cardiopulmonary dysfunction, re-hospitalization, growth failure, and poor neurodevelopmental outcome after hospital discharge. Four major risk factors for BPD include premature birth, respiratory failure, oxygen supplementation, and mechanical ventilation, although it is unclear whether any of these factors is absolutely necessary for development of the condition. Genetic susceptibility, infection, and patent ductus arteriosus have also been implicated in the pathogenesis of the disease. The strategies with the strongest evidence for effectiveness in preventing or lessening the severity of BPD include prevention of prematurity and closure of a clinically significant patent ductus arteriosus. Some evidence of effectiveness also exists for single-course therapy with antenatal glucocorticoids in women at risk for delivering premature infants, surfactant replacement therapy in intubated infants with respiratory distress syndrome, retinol (vitamin A) therapy, and modes of respiratory support designed to minimize 'volutrauma' and oxygen toxicity. The most effective treatments for ameliorating symptoms or preventing exacerbation in established BPD include oxygen therapy, inhaled glucocorticoid therapy, and vaccination against respiratory pathogens.Many other strategies for the prevention or treatment of BPD have been proposed, but have weaker or conflicting evidence of effectiveness. In addition, many therapies have significant side effects, including the possibility of worsening the disease despite symptom improvement. For instance, supraphysiologic systemic doses of glucocorticoids lessen the incidence of BPD in infants at risk for the disease, and promote weaning of oxygen and mechanical ventilation in infants with established BPD. However, the side effects of systemic glucocorticoid therapy, most notably the recently recognized adverse effects on neurodevelopment, preclude their routine use for the prevention or treatment of BPD. Future research in BPD will most probably focus on continued incremental improvements in outcome, which are likely to be achieved through the combined effects of many therapeutic modalities.
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Affiliation(s)
- Carl T D'Angio
- Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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Stocks J, Dezateux C. The effect of parental smoking on lung function and development during infancy. Respirology 2004; 8:266-85. [PMID: 14528876 DOI: 10.1046/j.1440-1843.2003.00478.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
While the adverse effects of parental smoking on respiratory health during childhood are well recognized, its potential impact on early lung development is less clear. This review summarizes current evidence on the effect of parental smoking on lung function during infancy. It is difficult to separate the effects of pre- and postnatal exposure, since the majority of mothers who smoke in pregnancy (currently around 30% worldwide) continue to do so thereafter. Nevertheless, measurements undertaken prior to any postnatal exposure have consistently demonstrated significant changes in tidal flow patterns in infants whose mothers smoked in pregnancy. While there is, as yet, no convincing evidence from studies in human infants that smoking during pregnancy is associated with increased airway responsiveness at birth, many studies have demonstrated a reduction in forced expiratory flows (on average by 20%) in infants exposed to parental smoking. While maternal smoking during pregnancy remains the most significant source of such exposure and is likely to be responsible for diminished airway function in early life, continuing postnatal tobacco smoke exposure will increase the risk of respiratory infections, the combination of both being responsible for the two- to fourfold increased risk of wheezing illnesses observed during the first year of life in infants whose parents smoke. These findings emphasize the need to keep infants in a smoke-free environment both before and after birth, not least because of growing awareness that airway function in later life is largely determined by that during foetal development and early infancy.
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Affiliation(s)
- Janet Stocks
- Portex Anesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, London, United Kingdom.
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Abstract
UNLABELLED Female infants have a significantly greater chance of surviving than male infants at similar birthweights and gestational ages, and have an advantage over males for a better outcome with less morbidity. CONCLUSION The exact mechanisms responsible for the gender differences, with a better chance of survival of female infants, remain to be determined. The paper by Elsmén et al. provides an important contribution to this most important area of clinical research.
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Affiliation(s)
- A Pollak
- Department of Neonatology and Paediatric Intensive Care, University Children's Hospital, Vienna, Austria.
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50
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Hoo AF, Dezateux C, Henschen M, Costeloe K, Stocks J. Development of airway function in infancy after preterm delivery. J Pediatr 2002; 141:652-8. [PMID: 12410193 DOI: 10.1067/mpd.2002.128114] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess airway function at 1 year and compare this with similar measurements made shortly after birth in preterm infants without clinical neonatal respiratory disease. STUDY DESIGN Infants born at </=36 weeks' gestational age were eligible if they required no neonatal ventilatory support and were otherwise healthy. Paired measurements of maximal expiratory flow at functional residual capacity (V'(maxFRC)) were obtained ~3 weeks after birth in 24 preterm infants (gestational age [mean +/- SD], 33.2 +/- 2.2 weeks) and repeated at a corrected postnatal age (mean +/- SD) of 57.0 +/- 12.2 weeks. V'(maxFRC) values were expressed as Z scores by means of sex-specific prediction equations. RESULTS V'(maxFRC) was within normal range for all infants shortly after birth (mean +/- SD Z score: -0.06 +/- 0.92). By 1 year, Z scores had reduced significantly [mean (95% CI) 2nd-1st test: -1.94 (-2.27, -1.60)]. V'(maxFRC )Z scores at 3 weeks were highly correlated with those at 1 year of age (Spearman correlation coefficient 0.64). CONCLUSIONS Airway function during the first year shows considerable tracking. Even in the absence of neonatal respiratory disease, preterm delivery is associated with altered airway development during early infancy.
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Affiliation(s)
- Ah-Fong Hoo
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health and Great Ormond Street Hospital NHS Trust, London, United Kingdom
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