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Twynam-Perkins J, Fall A, Lefferts JW, Urquhart DS. An innovative strategy for personalised medicine in a CFSPID case that evolved with time. Paediatr Respir Rev 2023; 47:23-26. [PMID: 37407313 DOI: 10.1016/j.prrv.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
We present a challenging case that illustrates how the clinical manifestations in children with CFTR mutations of uncertain significance may change over time. This case highlights the evolution of confirming a diagnosis of CF and emphasises the importance of regular review and monitoring of this patient cohort.
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Affiliation(s)
- J Twynam-Perkins
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK; Department of Child Life and Health, University of Edinburgh, UK
| | - A Fall
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK
| | - J W Lefferts
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Regenerative Medicine Center, Center for Living Technologies, University Medical Center Utrecht, Utrecht, the Netherlands
| | - D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, UK; Department of Child Life and Health, University of Edinburgh, UK.
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Urquhart DS, Hebestreit H, Saynor Z, Radtke T. 'Gold-standard' field test is a non-sequitur. Pulmonology 2023; 29:173. [PMID: 36117100 DOI: 10.1016/j.pulmoe.2022.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children and Young People, Edinburgh, EH16 4TJ, United Kingdom; Department of Child Life and Health, University of Edinburgh, United Kingdom.
| | - H Hebestreit
- Paediatric Department, University Hospitals Würzburg, Germany
| | - Z Saynor
- School of Sport, Health and Exercise Science, Faculty of Science and Health, University of Portsmouth, United Kingdom
| | - T Radtke
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
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Abstract
Annual review exercise testing is recommended by the Cystic Fibrosis (CF) Trust. Testing to date has focused on evaluating aerobic fitness, a key prognostic indicator. Tests available range from simple field tests, to comprehensive evaluations of aerobic exercise (dys)function - cardiopulmonary exercise testing (CPET). 'Field tests', although easy to perform are limited in the information they provide,whereas CPET, the 'gold standard' measure of aerobic fitness, is recommended as the first-choice exercise test by the European CF Society Exercise Working Group. CPET offers a precise cardiovascular, respiratory and metabolic evaluation of exercise capacity, including assessment of mechanism(s) of exercise limitation.
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Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom; Department of Child Life and Health, University of Edinburgh, United Kingdom.
| | - Z L Saynor
- Department of Sport and Exercise Science, University of Portsmouth, United Kingdom; Paediatric and Adult Respiratory Outpatient Departments, University Hospital Southampton, Southampton, United Kingdom
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Abstract
Prader Willi syndrome, resulting from the partial deletion or lack of expression of a region of genes on the paternal chromosome 15, has a number of phenotypic features which predispose affected patients to ventilatory problems. These include generalised hypotonia, abnormal arousal and ventilatory responses to hypoxia and hypercapnia, scoliosis and frequently, obesity. The spectrum of the resulting respiratory complications thus runs from sleep disordered breathing, to aspiration and respiratory functional impairment. While the use of growth hormone, in conjunction with multidisciplinary clinical management, is currently the cornerstone of clinical care of these patients, concerns have been raised following reports of sudden death shortly after growth hormone initiation. This review summarizes the respiratory complications commonly seen and draws together the published literature on the impact of growth hormone in relation to various respiratory parameters, aiming to provide the reader with the necessary information to manage these patients as safely as possible.
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Affiliation(s)
- H-L Tan
- Department of Paediatric Respiratory and Sleep Medicine, Royal Brompton Hospital, London.
| | - D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh; Department of Child Life and Health, University of Edinburgh
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Nortier MR, Urquhart DS. P87 Repeat survey of vitamin K prescribing patterns and bone health surveillance in UK paediatric CF centres. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Urquhart DS, Gallella S, Gidaris D, Brady E, Blacklock S, Tsirikos AI. Six-year follow-up study on the effect of combined anterior and posterior spinal fusion on lung function and quality of life in young people with adolescent idiopathic scoliosis. Arch Dis Child 2014; 99:922-6. [PMID: 24861049 DOI: 10.1136/archdischild-2013-305739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The effects of spinal surgery on lung function and quality of life (QoL) are important patient outcomes. Long-term follow-up of lung function and QoL in those undergoing combined anterior and posterior spinal fusion (A/PSF) for adolescent idiopathic scoliosis (AIS) is poorly documented with only one study extending beyond 2 years, though available evidence points to a decrement in lung function. Our study evaluated long-term change in lung function and QoL following A/PSF for AIS. DESIGN Prospective cohort study. PATIENTS Patients with AIS. SETTING Tertiary paediatric respiratory centre and national spinal service. DESIGN Spirometry was performed along with QoL (Scoliosis Research Society-22 (SRS-22) questionnaire). Paired t test and one-way analysis of variance were used to compare pre-A/PSF and post-A/PSF data. RESULTS Data were available for 12 patients (9 female) who underwent A/PSF at mean 13.8 (range 11.8-15) years. Mean follow-up was undertaken 5.8 (range 4.1-6.8) years postoperatively. Height increased from mean (SD) 169 (9) cm preoperatively to 175 (5) cm at follow-up (p<0.01). Scoliosis corrected from 100 (15)° to 29 (11)° (p<0.001). Mean (SD) forced expiratory volume in 1 s was -3.4 (1.4) z scores preoperatively versus -3.3 (1) z scores postoperatively (p=0.85); and forced vital capacity was -3.4 (1.7) ) z scores pre-A/PSF and -3.4 (1.1) z scores post-A/PSF (p=0.83). SRS-22 scores improved mean (SD) of 3.6 (0.3) preoperatively to 4.2 (0.3) at 2 years postoperatively, and 4.4 (0.4) at 6 year follow-up (p<0.001, analysis of variance). High patient satisfaction rates (4.8 (0.3)) were recorded. No correlation was noted between changes in forced expiratory volume in 1 s (r=-0.15, p=0.63) or forced vital capacity (r=-0.12, p=0.71) and change in long-term SRS-22 score. CONCLUSIONS Long-term follow-up of patients with AIS suggests no deficit in pulmonary function, while QoL shows incremental improvement and patient satisfaction is high over 6 years after A/PSF.
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Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - S Gallella
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - D Gidaris
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - E Brady
- Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, UK
| | - S Blacklock
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK
| | - A I Tsirikos
- Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, UK
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Hathorn C, Fall A, McGurk S, Tsirikos AI, Urquhart DS. Acquisition bias may have led to acceptance of the false null hypothesis that prevalence of scoliosis is the same in cystic fibrosis as the general population. Pediatr Pulmonol 2014; 49:201. [PMID: 24178919 DOI: 10.1002/ppul.22947] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
- C Hathorn
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Urquhart DS, Gallela S, Brady E, Blacklock S, Tsirikos AT. P81 Long-term effect of combined anterior and posterior spinal fusion on pulmonary function and quality of life in young people with adolescent idiopathic scoliosis. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Urquhart DS, Gulliver T, Williams G, Harris MA, Nyunt O, Suresh S. Central sleep-disordered breathing and the effects of oxygen therapy in infants with Prader-Willi syndrome. Arch Dis Child 2013; 98:592-5. [PMID: 23761691 DOI: 10.1136/archdischild-2012-303441] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe breathing patterns in infants with Prader-Willi Syndrome (PWS), as well as the effects of supplemental oxygen (O2) on breathing patterns. Children with PWS commonly have sleep-disordered breathing, including hypersomnolence and obstructive sleep apnoea, as well as central sleep breathing abnormalities that are present from infancy. DESIGN Retrospective cohort study. PATIENTS Infants with a diagnosis of PWS. SETTING Tertiary children's hospital. INTERVENTIONS Infants with PWS underwent full polysomnography, and in those with frequent desaturations associated with central events, supplemental O2 during sleep was started and followed with regular split-night studies (periods in both air and O2). RESULTS Thirty split-night studies on 10 infants (8 female) aged 0.06-1.79 (median 0.68, IQR 0.45, 1.07) years were undertaken. At baseline (ie, air), children with PWS had a median (IQR) central apnoea index (CAI) of 4.7 (1.9, 10.6) per hour, with accompanying falls in oxygen saturation (SpO2). O2 therapy led to statistically significant reductions in CAI to 2.5/hour (p=0.002), as well as a reduced central event index (CEI) and improved SpO2. No change in the number of obstructive events was noted. Central events were more prevalent in rapid-eye movement/active sleep. CONCLUSIONS It is concluded that infants with PWS may have central sleep-disordered breathing, which, in some children, may cause frequent desaturations. Improvements in CAI and CEI as well as oxygenation were noted with O2 therapy. Longitudinal work with this patient group would help to establish the timing of onset of obstructive symptoms.
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Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia
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Urquhart DS, Orme J, Suresh S. P27 Undergraduate sleep medicine teaching in UK medical schools: A questionnaire survey. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Urquhart DS, Kilner D. P26 The UK paediatric sleep videoconferencing circuit: from idea to reality! Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fall AJ, Mallinson A, Mill A, Urquhart DS. P241 Accuchek (TM) measurement of blood glucose correlates with true lab glucose measurement in children screened for cystic fibrosis related diabetes. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.
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Urquhart DS, Wales P, Parsley C, Suresh S. P198 Effects of oxygen therapy on central sleep-disordered breathing in infants with Prader-Willi syndrome. Thorax 2010. [DOI: 10.1136/thx.2010.151043.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Oliver SJ, Ingram E, Fynn D, Urquhart DS. P130 Limits of agreement for peak expiratory flow measured by mini-Wright's meter and a pneumotachograph. Thorax 2010. [DOI: 10.1136/thx.2010.150987.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thuerey J, Urquhart DS, Wilkinson G. A baby with noisy breathing. BMJ 2010; 341:c4402. [PMID: 20926489 DOI: 10.1136/bmj.c4402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J Thuerey
- Royal Hospital Sick Children Edinburgh, Edinburgh EH 9 1LF.
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Gupta A, Urquhart DS, Devaraj A, Balfour-Lynn IM. A 2 year old with fever and cough. BMJ 2009; 339:b2150. [PMID: 19586972 DOI: 10.1136/bmj.b2150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A Gupta
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP.
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Urquhart DS, Iqbal SM, Bowman J, Suresh S. A 20 month old girl with respiratory distress. BMJ 2009; 338:b1216. [PMID: 19357188 DOI: 10.1136/bmj.b1216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory and Sleep Medicine, Mater Children's Hospital, South Brisbane, QLD 4101, Australia.
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Urquhart DS, Anderson AK, McKenzie SA. Fewer colds, less asthma? A hypothesis to explain the fall in childhood asthma in the UK. J Epidemiol Community Health 2009; 62:921-5. [PMID: 18791051 DOI: 10.1136/jech.2007.068965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
UK asthma prevalence fell significantly between 1993 and 2000. In children aged <5 years hospital admissions for asthma fell by 52% and primary care presentations in children under 14 years by over 40%. From 1994 to 2000, primary care consultations for acute respiratory infections in all age groups fell by 36%, and for the common cold by 46%. Isolates for respiratory syncytial virus notified to the Health Protection Agency voluntary reporting scheme fell by 56% between 1993 and 2003. Falls in UK birth rate and improvements in living conditions were reported by the Office of National Statistics over this time. The authors hypothesise that the fall in asthma reflects a fall in respiratory infections, the most important proximal trigger for asthma exacerbations, and that this in turn may be related to a fall in household members to a number too low for effective virus transmission. Future research into the prevalence of asthma must consider the effect of changing respiratory virus burden on populations.
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Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory Medicine, Level 2, Fielden House, Royal London Hospital, Whitechapel, London E11BB, UK
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Gupta A, Pauliah S, Urquhart DS, Rosenthal M. Endobronchial polyp secondary to pulmonary tuberculosis. Arch Dis Child 2009; 94:230. [PMID: 19234040 DOI: 10.1136/adc.2008.145763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A Gupta
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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Hodgkinson R, Urquhart DS, Thia L, Padley S, Bush A, Gupta A. An 11 month old girl with bilateral wrist swelling. BMJ 2008; 337:a2149. [PMID: 18987032 DOI: 10.1136/bmj.a2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Hodgkinson
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP
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Urquhart DS, Perry L, Gupta A, Rosenthal M. Sleep disordered breathing in a 4 year old child with Down's syndrome. BMJ 2008; 337:a1229. [PMID: 18829651 DOI: 10.1136/bmj.a1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D S Urquhart
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP.
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Urquhart DS, Fitzpatrick M, Cope J, Jaffe A. Vitamin K prescribing patterns and bone health surveillance in UK children with cystic fibrosis. J Hum Nutr Diet 2007; 20:605-10. [DOI: 10.1111/j.1365-277x.2007.00830.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nicholl RM, Balasubramaniam VP, Urquhart DS, Sellathurai N, Rutherford MA. Postmortem brain MRI with selective tissue biopsy as an adjunct to autopsy following neonatal encephalopathy. Eur J Paediatr Neurol 2007; 11:167-74. [PMID: 17270474 DOI: 10.1016/j.ejpn.2006.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 12/04/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022]
Abstract
Following the death of a neonate it is essential that parents are given full and accurate information about the probable cause of death. Perinatal autopsy often adds new information or may even change the presumed diagnosis [Cartlidge PH, Dawson AT, Stewart JH, Vujanic GM. Value and quality of perinatal and infant postmortem examinations: cohort analysis of 400 consecutive deaths. Br Med J 1995;310(6973):155-8; Khong TY. Falling neonatal autopsy rates. Br Med J 2002;324(7340):749-50] informing decisions regarding the management of any future pregnancy. Autopsy can be considered the "gold standard" for the identification of antecedent events leading to a neonatal death. However, recent events in the UK have added to an already declining rate in neonatal autopsies [Brodlie M, Laing IA. Ten years of neonatal autopsies in tertiary referral centre: retrospective study. Br Med J 2002;324(7340):761-3]. To try and redress this balance the Chief Medical Officer has recommended that research should be commissioned into the use of non-invasive imaging to provide a similar standard of information [The Chief Medical Officer. The removal, retention and use of human organs and tissues from post mortem examination. London, England: The Stationary Office, Department of Health; 2001]. Previous publications on postmortem MRI have focused largely on investigation of the foetus and of still birth [Griffiths PD, Variend D, Evans M, Jones A, Wilkinson ID, Paley MNJ, et al. Postmortem MR imaging of the fetal and stillborn central nervous system. Am J Neuroradiol 2003;24(1):22-7; Whitby EH, Paley MN, Cohen M, GriffithsPD. Postmortem MR imaging of the fetus: an adjunct or a replacement for conventional autopsy? Semin Fetal Neonatal Med 2005;10(5):475-83]. We report our experience on the use of postmortem brain MRI combined with selective tissue biopsy, in six neonatal deaths in the setting of a large district general hospital.
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Affiliation(s)
- R M Nicholl
- Neonatal Unit, Northwick Park Hospital, North West London Hospitals NHS Trust, London, UK.
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Balasubramaniam VP, Isaac AT, Crawford MJ, Urquhart DS. Once bitten, twice shy! A mother's reluctance to put BLS training into use ever again. Arch Dis Child 2007; 92:106. [PMID: 17264283 PMCID: PMC2083304 DOI: 10.1136/adc.2006.099275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Hypoxia during sleep and exercise may occur in an important number of patients with cystic fibrosis (CF). Despite its recognition, no clear definition for hypoxia in CF exists, and nor do guidelines for commencing oxygen therapy. CF patients with hypoxia may have increased pulmonary artery pressure, reduced exercise ability, and skeletal muscle strength, and most importantly of all worse sleep quality, and a worse quality of life. Laboratory and rodent evidence exists to suggest that hypoxia may contribute to the decline in lung function in CF by upregulating lung inflammation, and encouraging growth of Pseudomonas aeruginosa, the most important pathogen associated with CF lung disease. The effects of hypoxia in childhood CF need to be fully studied, and a potential expanded role for oxygen as therapy in CF may be worthy of exploration.
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Affiliation(s)
- D S Urquhart
- Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, and Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Urquhart DS, McKenzie SA. What is the economic impact of preschool viral upper respiratory infection? Eur Respir J 2004; 23:961. [PMID: 15219014 DOI: 10.1183/09031936.04.00001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Urquhart DS, Balasubramaniam VP. Stethoscope head to body weight ratios in the extremely preterm infant. Arch Dis Child Fetal Neonatal Ed 2003; 88:F345. [PMID: 12819173 PMCID: PMC1721591 DOI: 10.1136/fn.88.4.f345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D S Urquhart
- Neonatal Unit, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
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Affiliation(s)
- D S Urquhart
- Northwick Park Hospital, Watford Road, Harrow, Middlesex, UK
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