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Dervaux M, Thumerelle C, Fabre C, Abou-Taam R, Bihouee T, Brouard J, Clement A, Delacourt C, Delestrain C, Epaud R, Ghdifan S, Hadchouel A, Houdouin V, Labouret G, Perisson C, Reix P, Renoux MC, Troussier F, Weiss L, Mazenq J, Nathan N, Dubus JC. Long-term evolution of neuroendocrine cell hyperplasia of infancy: the FRENCHI findings. Eur J Pediatr 2023; 182:949-956. [PMID: 36449078 DOI: 10.1007/s00431-022-04734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
Only few studies report long-term evolution of patients with neuroendocrine cell hyperplasia of infancy (NEHI). We report data from a 54-patient cohort followed up in the French network for rare respiratory diseases (RespiRare). Demographic characteristics and respiratory and nutritional evolution were collected at the time of the patient's last scheduled visit. The mean duration of follow-up was 68 months (5 months to 18 years). Fifteen patients (27.8%) were considered clinically cured. During follow-up, hospitalizations for wheezy exacerbations were reported in 35 patients (55%), and asthma diagnosed in 20 (37%). Chest CT scan improvement was noted in 25/44 (56.8%). Spirometry showed a persistent obstructive syndrome in 8/27 (29.6%). A sleep disorder was rare (2/36, 5.5%). Oxygen weaning occurred in 28 of the 45 patients initially treated (62.2%) and was age-dependent (35.7% under 2 years, 70.5% between 2 and 6 years, and 100% after 7 years). Oxygen duration was linked to a biopsy-proven diagnosis (p = 0.02) and to the use of a nutritional support (p = 0.003). Corticosteroids were largely prescribed at diagnosis, with no evident respiratory or nutritional effect during follow-up. Among 23 patients with an initial failure to thrive, 12 (52.2%) had no weight recovery. Initial enteral feeding (17/54, 31.5%) was stopped at a mean age of 43 months (3 to 120), with no effect on cure and oxygen liberation at the last visit. Conclusion: Our results show that NEHI has a globally positive, but unequal, improvement over time. Further prospective studies are needed to better clarify the different trajectories of patients with NEHI. What is Known: • Neuroendocrine cell hyperplasia of infancy (NEHI) is an interstitial lung disease whose long-term outcome is considered positive from very few studies including heterogeneous populations. What is New: • The 68-month follow-up of our 54-patient cohort showed respiratory/nutritional symptom persistence in 72.2%, oxygen requiring in 34%, and asthma in 37%. When controlled, radiological or functional improvement was noted in 56.8 and 40.7%. Further prospective studies are needed to better clarify the different trajectories of patients with NEHI.
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Affiliation(s)
- Morgane Dervaux
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Caroline Thumerelle
- Pediatric Pulmonology and Allergy Department, Jeanne de Flandre Hospital, CHU Lille, Univ. Lille, Pole Enfant, Lille, France
| | - Candice Fabre
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Rola Abou-Taam
- Reference Center for Rare Lung Diseases, Pediatric Pulmonology Department, University Hospital of Necker-Enfants Malades, AP-HP, Paris, France
| | - Tiphaine Bihouee
- Chronic Childhood Diseases Unit, Pediatric Department, Nantes University Hospital, Nantes, France
| | - Jacques Brouard
- Service de Pédiatrie Médicale, CHU Caen, Caen, et UMR1311 DYNAMICURE, Normandie Université, UNICAEN, UNIROUEN, Rouen, France
| | - Annick Clement
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), AP‑HP, Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Christophe Delacourt
- Reference Center for Rare Lung Diseases, Pediatric Pulmonology Department, University Hospital of Necker-Enfants Malades, AP-HP, Paris, France
| | - Céline Delestrain
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Ralph Epaud
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Sofiane Ghdifan
- Pediatric Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alice Hadchouel
- Reference Center for Rare Lung Diseases, Pediatric Pulmonology Department, University Hospital of Necker-Enfants Malades, AP-HP, Paris, France
| | - Véronique Houdouin
- Pediatric Pulmonology Department, INSERM UMR S 976 Human Immunology, AP-HP, Paris University Robert Debre Hospital, Paris, France
| | - Géraldine Labouret
- Pediatric Pulmonology Department, University Hospital for Children, Toulouse, France
| | - Caroline Perisson
- Pediatric Unit, University Hospital Sud Reunion, Saint-Pierre, France
| | - Philippe Reix
- Pediatric Pulmonology, Allergology Cystic Fibrosis Department, Hospices Civils of Lyon, Hôpital Femme Mère Enfant, Bron, France.,UMR 5558, CNRS Equipe, EMET University, Claude Bernard Lyon 1, Lyon, France
| | - Marie-Catherine Renoux
- Paediatric Cardiology and Pulmonology Department, Montpellier University Hospital, Montpellier, France
| | | | - Laurence Weiss
- Specialized Pediatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Julie Mazenq
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Nadia Nathan
- Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), AP‑HP, Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France. .,Aix Marseille University, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France. .,Unité de Pneumopédiatrie, CHU Timone-Enfants, 13385 Cedex 5, Marseille, France.
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Fabre C, Thumerelle C, Dervaux M, Abou-Taam R, Bihouee T, Brouard J, Clement A, Delacourt C, Delestrain C, Epaud R, Ghdifan S, Hadchouel A, Houdouin V, Labouret G, Perisson C, Reix P, Renoux MC, Troussier F, Weiss L, Mazenq J, Nathan N, Dubus JC. French national cohort of neuroendocrine cell hyperplasia of infancy (FRENCHI) study: diagnosis and initial management. Eur J Pediatr 2022; 181:3067-3073. [PMID: 35678871 DOI: 10.1007/s00431-022-04510-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Early diagnosis of neuroendocrine cell hyperplasia of infancy (NEHI) is crucial as, conversely to the other causes of intersititial lung disease, corticosteroids are not recommended. Diagnosis is historically based on lung biopsy (NEHI), but in current practice, a clinical and radiological approach is more and more preferred (NEHI syndrome). This national study aimed to address diagnosis and initial management of patients followed up for a NEHI pattern in pediatric centers for rare lung diseases (RespiRare, France). Data on neonatal and familial events, symptoms at diagnosis, explorations performed and results, and therapeutic management were collected by questionnaire. Fifty-four children were included (boys 63%). The mean onset of symptoms was 3.8 ± 2.6 months. The most frequent symptoms at diagnosis were tachypnea (100%), retraction (79.6%), crackles (66.7%), and hypoxemia (59.3%). The mean NEHI clinical score, evocative when ≥ 7/10, was 7.9 ± 1.4 (76% with a score ≥ 7). All chest CT-scans showed ground glass opacities evolving at least the middle lobe and the lingula. Lung biopsy was performed in 38.9% of the cases and was typical of NEHI in only 52.4%, even when the clinical presentation was typical. Initial treatments were oxygen (83.6%) and more curiously intravenous pulses of steroids (83.3%) and azithromycin (70.2%). CONCLUSION This national cohort of patients underlines diagnosis difficulties of NEHI. A composite clinical and radiological score should help clinicians for limiting the use of anti-inflammatory drugs. WHAT IS KNOWN •Neuroendocrine cell hyperplasia of infancy (NEHI) is an interstitial lung disease whose diagnosis is essential to limit corticosteroids therapy. WHAT IS NEW •In this national cohort of 54 patients with a NEHI pattern, diagnosis is mainly based on clinical symptoms and chest CT-scan results. The newly proposed clinical score and, when performed, the lung biopsies are faulted in 25 and 50% of the cases, respectively. •Corticosteroids are widely used. Such results plead for a new composite score to formally diagnose NEHI.
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Affiliation(s)
- Candice Fabre
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Caroline Thumerelle
- Pediatric Pulmonology and Allergy Department, Jeanne de Flandre Hospital, CHU Lille, Univ. Lille, Pole Enfant, Lille, France
| | - Morgane Dervaux
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Rola Abou-Taam
- AP-HP, Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases, University Hospital of Necker-Enfants Malades, Paris, France
| | - Tiphaine Bihouee
- Chronic Childhood Diseases Unit, Pediatric Department, Nantes University Hospital, Nantes, France
| | - Jacques Brouard
- Service de Pédiatrie Médicale, CHU Caen, Caen, et UMR1311 DYNAMICURE, Normandie Université, UNICAEN, UNIROUEN, Rouen, France
| | - Annick Clement
- AP-HP, Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Christophe Delacourt
- AP-HP, Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases, University Hospital of Necker-Enfants Malades, Paris, France
| | - Céline Delestrain
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Ralph Epaud
- Center for Rare Lung Diseases (RespiRare), Centre Hospitalier Intercommunal of Créteil, University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Sofiane Ghdifan
- Pediatric Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alice Hadchouel
- AP-HP, Pediatric Pulmonology Department, Reference Center for Rare Lung Diseases, University Hospital of Necker-Enfants Malades, Paris, France
| | - Véronique Houdouin
- AP-HP, Pediatric Pulmonology Department, UMR S 976 INSERM Human Immunology, Paris University, Robert Debre Hospital, Paris, France
| | - Géraldine Labouret
- Pediatric Pulmonology Department, University Hospital for Children, Toulouse, France
| | - Caroline Perisson
- Pediatric Unit, University Hospital Sud Reunion, Saint-Pierre, France
| | - Philippe Reix
- Pediatric Pulmonology, Allergology, Cystic Fibrosis Department, Hospices Civils of Lyon, Hôpital Femme Mère Enfant, Bron, France.,UMR 5558, Equipe EMET, CNRS, University Claude Bernard Lyon 1, Lyon, France
| | - Marie-Catherine Renoux
- Paediatric Cardiology and Pulmonology Department, Montpellier University Hospital, Montpellier, France
| | | | - Laurence Weiss
- Specialized Pediatric Department, University Hospital of Strasbourg, Strasbourg, France
| | - Julie Mazenq
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France
| | - Nadia Nathan
- AP-HP, Pediatric Pulmonology Department and Reference Center for Rare Lung Diseases (RespiRare), Sorbonne University, Inserm UMR S-933 Childhood Genetic Disorders, Armand Trousseau Hospital, Paris, France
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department, University Timone Hospital for Children, AP-HM, Marseille, France. .,IRD, Aix Marseille University, MEPHI, IHU Méditerranée Infection, Marseille, France. .,Unité de Pneumopédiatrie, CHU Timone-Enfants, 13385, Cedex 5/0491386816, Marseille, France.
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Abstract
There is a wide differential diagnosis of early onset respiratory distress especially in term babies, and interstitial lung disease (chILD) is a rare but important consideration in this context. chILD manifesting immediately after birth is usually related to mutations in surfactant protein genes, or conditions related to the Congenital Acinar Dysplasia -Alveolar capillary dysplasia - Congenital Alveolar Dysplasia (CAD-ACD) spectrum. There is currently no specific treatment for these conditions, and management is supportive. Prognosis is very poor in most of these babies if onset is early, with relentless respiratory deterioration unless transplanted. Ideally, the diagnosis is made on genetic analysis, but this may be time-consuming and complex in CAD-ACD spectrum, so lung biopsy may be needed to avoid prolonged and futile treatment being instituted. Milder forms with prolonged survival have been reported. Early onset, less severe chILD is usually related to neuroendocrine cell hyperplasia of infancy (NEHI), pulmonary interstitial glycogenosis (PIG) and less severe disorders of surfactant proteins. PIG and NEHI are not specific entities, but are pulmonary dysmaturity syndromes, and there may be a number of underlying genetic and other cause. If the child is stable and thriving, many will not be subject to lung biopsy, and slow improvement and weaning of supplemental oxygen can be anticipated. Where possible, a precise genetic diagnosis should be made in early onset cHILD allow for genetic counselling. chILD survivors and their families have complex respiratory and other needs, and co-ordinated, multi-disciplinary support in the community is essential.
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Affiliation(s)
- Andrew Bush
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK.
| | | | - Jo Gregory
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Andrew Gordon Nicholson
- Royal Brompton and Harefield NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College, UK
| | - Thomas Semple
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Rishi Pabary
- Imperial College, UK; Royal Brompton and Harefield NHS Foundation Trust, UK
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Mastej EJ, DeBoer EM, Humphries SM, Cook MC, Hunter KS, Liptzin DR, Weinman JP, Deterding RR. Lung and airway shape in neuroendocrine cell hyperplasia of infancy. Pediatr Radiol 2018; 48:1745-1754. [PMID: 29955904 DOI: 10.1007/s00247-018-4189-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare lung disease associated with significant air trapping. Although chest CT is crucial in establishing a diagnosis, CT and biopsy findings do not reveal airway abnormalities to explain the air trapping. OBJECTIVE We compared lung and airway morphology obtained from chest CT scans in children with NEHI and control children. In the children with NEHI, we explored relationships between lung and airway shape and lung function. MATERIALS AND METHODS We performed a retrospective review of children with NEHI who underwent clinical chest CT. We identified control children of similar size and age. We created lung masks and airway skeletons using semi-automated software and compared them using statistical shape modeling methods. Then we calculated a logistic regression model using lung and airway shape to differentiate NEHI from controls, and we compared shape model parameters to lung function measurements. RESULTS Airway and lung shapes were statistically different between children with NEHI and controls. We noted a broad lung apex in the children with NEHI and a significantly increased apical anterior-posterior lung diameter. A logistic regression model including lung shape was 90% accurate in differentiating children with NEHI from controls. Correlation coefficients were significant between lung function values and lung and airway shape. CONCLUSION Lung and airway shapes were different between children with NEHI and control children in this cohort. Children with NEHI had an increased anteroposterior diameter of their lungs that might be useful in the diagnostic criteria.
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Affiliation(s)
- Emily J Mastej
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
| | - Emily M DeBoer
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA.
| | | | - Marlijne C Cook
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kendall S Hunter
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Deborah R Liptzin
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
| | - Jason P Weinman
- Department of Radiology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robin R Deterding
- Department of Pediatrics and Breathing Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave. B-395, Aurora, CO, 80045, USA
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Abstract
The term 'interstitial lung disease' (ILD) refers to a group of disorders involving both the airspaces and tissue compartments of the lung, and these disorders are more accurately termed diffuse lung diseases. Although rare, they are associated with significant morbidity and mortality, with the prognosis depending upon the specific diagnosis. The major categories of ILD in children that present in the neonatal period include developmental disorders, growth disorders, surfactant dysfunction disorders, and specific conditions of unknown etiology unique to infancy. Whereas lung histopathology has been the gold standard for the diagnosis of ILD, as many of the disorders have a genetic basis, non-invasive diagnosis is feasible, and characteristic clinical and imaging features may allow for specific diagnosis in some circumstances. The underlying mechanisms, clinical, imaging, and lung pathology features and outcomes of ILD presenting in newborns are reviewed with an emphasis on genetic mechanisms and diagnosis.
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Affiliation(s)
- Lawrence M. Nogee
- Address: CMSC 6-104A, 600 N. Wolfe Street, Baltimore, MD 21287, USA. Tel.: +1 410 614-3355; fax: +1 410 614-8388.
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Lee J, Sanchez TR, Zhang Y, Jhawar S. The role of high-resolution chest CT in the diagnosis of neuroendocrine cell hyperplasia of infancy - A rare form of pediatric interstitial lung disease. Respir Med Case Rep 2015; 16:101-3. [PMID: 26744669 PMCID: PMC4681975 DOI: 10.1016/j.rmcr.2015.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 12/27/2022] Open
Abstract
Interstitial lung disease (ILD) is rare in infancy or early childhood. Differentiating between the different types of ILD is important for reasons of treatment, monitoring of clinical course and prognosis. We present a case of a 5-month old female with tachypnea and hypoxemia. The clinical suspicion of neuroendocrine cell hyperplasia of infancy (NEHI) was confirmed by high-resolution chest CT and subsequent lung biopsy. We conclude that high-resolution chest CT has characteristics findings that can be used as a non-invasive test to support the clinical diagnosis of neuroendocrine cell hyperplasia of infancy.
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Affiliation(s)
- Julia Lee
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Thomas Ray Sanchez
- Department of Radiology, From the Division of Pediatric Radiology, University of California, Davis Medical Center Children's Hospital, 4860 Y St., Suite 3100 ACC, Sacramento, CA, 95817, USA
- Corresponding author.
| | - Yanhong Zhang
- Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Sanjay Jhawar
- Department of Pediatric Pulmonology, University of California, Davis Medical Center and Children's Hospital, Sacramento, CA, USA
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Abstract
The differential diagnosis of diffuse lung disease in children differs considerably from adults, and analysis of pediatric lung biopsies may prove challenging for pathologists with more extensive exposure to adult lung biopsies. Biopsy diagnosis of pediatric lung disease continues to evolve as new pathologic entities are recognized and new genetic determinants of disease are discovered. This article describes the clinical characteristics, pathologic features, and differential diagnosis of challenging and recently described entities in pediatric lung disease. The specific entities discussed include alveolar capillary dysplasia, genetic disorders of surfactant metabolism, pulmonary interstitial glycogenosis, and neuroendocrine cell hyperplasia of infancy.
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Affiliation(s)
- Megan K Dishop
- Department of Pathology, B120, The Children's Hospital, University of Colorado-Denver School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA.
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