痰液炎性细胞在儿童呼吸道感染后咳嗽与咳嗽变异性哮喘的比较及意义

目的　探讨反映气道炎症状况的痰液炎性细胞测定在慢性咳嗽儿童中的临床应用价值。方法　应用Pin等的诱导痰技术 ,对 70例慢性咳嗽 (感染后咳嗽组 39例 ,咳嗽变异性哮喘组 31例 )和 38例缓解期哮喘儿童的新鲜痰涂片 ,进行迈 格氏加姬姆萨 (May Gr櫣ｎｗａｌｄ’ｓ Gimsa)复染法和巴氏 (Papanicolaou)染色法染色 ,做细胞学分类计数 ,测定痰液炎性细胞百分比 ,同步检测变应原皮肤试验和肺通气功能。结果　感染后咳嗽组中痰液嗜酸细胞和中性粒细胞的中位数分别为 0 8%、5 8 0 % ,与咳嗽变异性哮喘组 (分别为 2 4 0 %、2 3.8% )比较 ,两种细胞的组间差异均有显著性 (均 P <0 0 1)。感染后咳嗽持续或反复发作的迁延时间较咳嗽变异性哮喘组更长 ,差异具统计学意义 (P <0 0 5 )。咳嗽变异性哮喘组痰液嗜酸细胞、肥大细胞水平与咳嗽持续时间呈显著正相关 (r=0 4 13,0 80 5 ,均P <0 0 5 )。两组慢性咳嗽儿童的痰液嗜酸细胞均与肺呼气峰流速占预计值的百分比 (PEF %pred)以及最大呼气中段流速 (MMEF) 75 / 2 5呈显著负相关 (r =- 0 2 71,- 0 32 4 ,均P <0 0 5 )。结论　痰液炎性细胞可能成为反映气道炎症类型、鉴别感染后咳嗽与咳嗽变异性哮喘的一项参考指标。     

诱导痰液与哮喘患儿气道炎症的关系探讨

目的探讨简便有效的诱导痰液及细胞分析方法,了解儿童哮喘发作期气道炎症的特点。方法运用高渗盐水雾化吸入诱导痰液的方法,收集３７例哮喘发作期患儿、４８例正常儿童（对照组）痰液。一部分痰液经二硫苏糖醇（ＤＴＴ）液化后,在血球计数板上行细胞总计数;另一部分痰液涂片经瑞氏、甲苯胺蓝染色行细胞分类计数。结果哮喘组８４％取痰成功,诱导过程中呼气峰流速（ＰＥＦ）未见下降（Ｐ＞００５）。痰液细胞总计数哮喘组为（１１２±８９）×１０９／Ｌ,对照组为（７１±６２）×１０９／Ｌ（Ｐ＜００５）。嗜酸性粒细胞、肥大细胞在哮喘发作期气道中明显升高（Ｐ＜００１）。结论诱导痰液分析、评判哮喘患儿气道炎症是一种安全、可靠的新研究方法;嗜酸性细胞、肥大细胞为哮喘发作的主要效应细胞。     

痰液炎性细胞在婴幼儿哮喘诊断中的价值

目的　 探讨反映气道炎症情况的痰液炎性细胞检测在婴幼儿哮喘早期临床诊断中的价值。 方法 　患儿每次喘息发作时均进行诱导痰液炎性细胞检测 ,共对 3 17例患儿进行了 690例次痰液涂片检测。于患儿 4至 5岁间进行随访调查 ,凡符合儿童哮喘诊断标准者为哮喘组 ( 10 8例 ) ,否则为非哮喘组 ( 2 0 9例 )。 结果 　哮喘组痰液嗜酸性粒细胞中位数为 18 1% ,与非哮喘组 (中位数为 1 3 % )比较 ,两组间差异有非常显著性意义 (u =14 3 6,P <0 0 0 1) ,两组间其他炎性细胞的差异均无统计学意义 ;哮喘组痰液嗜酸粒细胞具有明显随病情进展和发作次数增加而增加之趋势 ( χ2 =10 676,P <0 0 0 5 ) ,但非哮喘组炎性细胞均无明显的随病情进展和发作次数的增加而增加之趋势。 结论 　痰液炎性细胞可能为早期诊断婴幼儿哮喘的一项重要参考指标。     

哮喘患儿支气管诱导痰液中炎细胞变化的临床研究

目的研究支气管哮喘患儿急性发作期及其缓解期支气管诱导痰液中炎细胞变化及临床意义。方法选择2002-02—2002-12在中国医大二院儿童哮喘门诊就诊的哮喘患儿,其中哮喘急性发作期34例;哮喘缓解期30例;健康对照组22例。比较哮喘不同病程之间以及不同病程与正常儿童之间支气管诱导痰液细胞成分的差异。结果哮喘患儿急性发作期支气管诱导痰液中,中性粒细胞占细胞总数的百分比明显高于缓解期及正常对照组(均P<0.01)。哮喘急性发作期、缓解期诱导痰液中嗜酸细胞占总数的百分比均明显高于正常对照组,差异显著(P<0.01)。结论支气管哮喘是一种慢性气道炎症性疾病,在不同发病时期气道内的炎细胞变化不同。     

姜黄素对哮喘小鼠气道炎症和气道高反应性的影响

目的 了解姜黄素对哮喘小鼠气道高反应性及气道炎症的影响.方法 对30只Balb/c小鼠随机分为正常对照组、哮喘组及姜黄素干预哮喘小鼠.应用OVA溶液建立哮喘小鼠模型;对各组小鼠进行肺功能的检测;应用Giemsa染色测定各组小鼠支气管肺泡灌洗液的炎症细胞计数;HE染色及PAS染色对各组小鼠行肺组织病理学检测;ELISA方法检测各组小鼠支气管肺泡灌洗液中的IgE含量.结果 哮喘组小鼠在吸入乙酰甲胆碱(Mch)6.25 g/L浓度后,Penh值显著高于正常对照组,两组比较差异有统计学意义(P＜0.01),而姜黄素干预哮喘组较哮喘组明显降低,两组比较差异有统计学意义(P＜0.01).哮喘组小鼠气道盥洗液白细胞总数及嗜酸细胞数显著高于正常对照组,两者比较差异统计学意义(P＜0.01),而姜黄素干预哮喘组白细胞及嗜酸细胞数量明显较哮喘组减少,两者比较有差异有统计学意义(P＜0.01).哮喘组小鼠中BALF的IgE含量较对照组明显升高,两组比较差异有统计学意义(P＜0.01);而姜黄素干预哮喘组中BALF的IgE含量较哮喘组明显降低(P＜0.01).哮喘小鼠肺组织HE染色中可见支气管和血管壁周围有大量的炎性细胞浸润,以嗜酸细胞和淋巴细胞浸润为主,姜黄素干预哮喘组较其减少.PAS染色哮喘组小鼠杯状细胞、黏液分泌明显增多,姜黄素干预哮喘组较其减少.结论 姜黄素可以减轻哮喘小鼠的气道炎症,减轻气道黏液分泌、降低气道高反应性、降低肺泡灌洗液中的IgE含量.     

5～14岁哮喘患儿呼出气一氧化氮检测与气道可逆性相关性研究

目的　探讨哮喘患儿呼出气一氧化氮（FeNO）水平与气道可逆性的相关性及其在哮喘患儿病情评估中的临床意义。方法　选取2014年11月至2015年11月于中国医科大学附属盛京医院小儿呼吸内科门诊就诊的5～14岁哮喘患儿161例,根据病情分为过敏组与非过敏组,2组均进行FeNO及支气管舒张试验测定,分析2组患儿FeNO水平与支气管舒张改善率的相关性。结果　（1）过敏组的哮喘患儿FeNO水平明显高于非过敏组（P＝0.002）。（2）过敏组的哮喘患儿FeNO水平与支气管舒张的改善率呈显著正相关（P＜0.05）,与基础肺功能1秒用力呼气容积占预计值的百分比（FEV1%）、1秒率占预计值的百分比（FEV1/FVC%）、50%用力呼气流速占预计值的百分比（FEF50%）、25%用力呼气流速占预计值的百分比（FEF25%）、中段呼气流速占预计值的百分比（FEF75/25%）呈负相关（P＜0.05）,与用力肺活量占预计值的百分比（FVC%）、用力呼气峰流速占预计值的百分比（PEF%）、75%用力呼气流速占预计值的百分比（FEF75%）无明显相关性（P＞0.05）;（3）非过敏组的哮喘患儿FeNO水平与支气管舒张改善率及基础肺功能均无明显相关性（P＞0.05）。结论　对于存在过敏体质的哮喘患儿,FeNO水平与气道可逆性存在显著正相关,可作为该类哮喘患儿预测气道可逆性及评估哮喘病情的一个良好的无创性指标。而对于无过敏体质的哮喘患儿,FeNO水平则不能有效反映其气道可逆性变化。     

阿奇霉素对哮喘儿童支气管高反应性的影响

目的探讨阿奇霉素对轻、中度哮喘儿童支气管高反应性（BHR）的影响。方法轻、中度哮喘儿童30例，用皮质激素吸入（剂量为轻度哮喘50μg／d，中度哮喘100μg／d）4周后，分为A、B两组，进入试验观察。所有病例继续应用糖皮质激素吸入，剂量同前。A组16例，加用阿奇霉素口服，剂量为每次5mg／kg，每周2次。B组14例。试验期为8周。两组在试验开始和结束时均用诱导痰液进行淋巴细胞百分率、嗜酸粒细胞百分率、中性粒细胞百分率检测。结果A组其诱导痰液的淋巴细胞、中性粒细胞百分率与B组比较，差异均具有显著性（P〈0．05）。结论小剂量阿奇霉素口服8周，并联合吸入糖皮质激素治疗轻、中度哮喘儿童的BHR明显降低。     

非嗜酸细胞性哮喘研究进展

支气管哮喘（哮喘）是由多种细胞[嗜酸性粒细胞（EOS）、肥大细胞、T淋巴细胞、中性粒细胞及呼吸道上皮细胞等]和细胞组分共同参与的呼吸道慢性炎性疾病。以往研究多认为哮喘呼吸道局部改变是以EOS为主的炎性反应,近年来一些诱导痰检查发现部分哮喘呼吸道局部炎性反应并非以EOS为主,而是以其他细胞如中性粒细胞、淋巴细胞、肥大细胞等为主,因此有研究将哮喘分为嗜酸细胞性哮喘（EA）和非嗜酸细胞性哮喘（NEA）两个亚型,前者呼吸道局部以EOS炎性反应为主,后者呼吸道局部则以非EOS炎性反应为主。本文就NEA发病机制及可能病因等进行综述。     

轻-中度哮喘患儿气道炎症类型与病情、糖皮质激素疗效的关系

目的探讨轻-中度支气管哮喘患儿初始治疗前气道炎症类型与病情及吸入糖皮质激素治疗反应的关系。方法以87例轻-中度哮喘患儿作为研究对象,在糖皮质激素吸入治疗(ICS)前进行痰液诱导及诱导痰细胞学分析,酶联免疫荧光法测定痰液嗜酸粒细胞阳离子蛋白(ECP)、ELISA法检测痰液IL-8、TGF-β1,儿童肺功能仪检测基础肺功能和小气道通气指标、乙酰甲胆碱(Mch)支气管激发试验测定气道高反应性(AHR)。20例健康体检儿童作为对照组,应用SPSS13.0软件进行统计学分析。结果87例轻-中度哮喘患儿根据诱导痰液EOS%分为嗜酸性粒细胞哮喘组(EA)64例,非嗜酸性粒细胞哮喘组(NEA)23例,EA与NEA组ICS治疗前痰液细胞学构成比、诱导痰上清液ECP、IL-8差异有统计学意义(P<0.05);两组间FEV1%预测值(FEV1%pred)、PEF%pred、中-重度AHR%、小气道阻塞(%)、痰液TGF-β1水平等指标差异有统计学意义(P<0.05)。ICS治疗4周后EA组基础肺功能指标、气道高反应性、小气道通气功能明显改善,而NEA组改善不明显。多元逐步回归分析结果表明初治痰液EOS%、FEV1%预测值、痰液TG...     

哮喘儿童不同时期血清白细胞介素-8、白细胞介素-17及痰液中性粒细胞的变化

目的 探讨白细胞介素(interleukin,IL)-8、IL-17及气道中性粒细胞在儿童哮喘发病中的作用.方法 2007年1月至2009年1月,常州市儿童医院收治的符合儿童哮喘诊断,经过诱导痰液检测的12例非嗜酸粒细胞哮喘患儿为哮喘组;以12例健康儿童为对照组.对哮喘组患儿急性期、恢复期及对照组进行诱导痰的细胞分类检查和ELISA方法检测血清IL-8和IL-17浓度.结果 哮喘急性期患儿血清中IL-8[(357.84 ±215.36) pg/ml]、IL-17[(62.76 ±44.13) pg/ml]及诱导痰的中性粒细胞百分比[(43.14±5.79)％]明显高于缓解期[(164.95 ±60.22) pg/ml、(34.57±11.82) pg/ml、(23.25±3.75)％]及对照组[(88.68±38.76) pg/ml、(20.35±10.02) pg/ml、(13.34±3.21)％],差异有统计学意义(P＜0.01);缓解期IL-8、IL-17及诱导痰的中性粒细胞百分比仍高于对照组,差异有统计学意义(P＜0.05,P＜0.01).结论 IL-8、IL-17趋化中性粒细胞聚集于气道,参与加重支气管哮喘发作.     

Bibliometric data: a disaster for many non-American biomedical journals

Bibliometric data published by the Institute of Scientific Information in Philadelphia (ISI), and which was previously discussed in Acta Paediatrica , has increasingly been used despite all the relevant and severe criticism that has been raised against this method of evaluating individual research results and grading scientific journals. It is obvious that the present trend regarding the use of bibliometric data as a basis for priorities and funding of research and for the promotion of individual scientists favours American-oriented research projects at the expense of those that are based on concepts of predominantly European relevance.

Conclusion: For the future of non-American research, it is important that no single super-power, i.e. the USA, should dominate scientific priorities. The condition for efficient European competition is that European Centres with high levels of competence for creative research and training of scientists from all over the world are established. In addition, it is important that the results of European research are published in prestigious European journals, as was the situation before World War II.     

alpha -SMOOTH MUSCLE ACTIN DISTRIBUTION IN THE PULMONARY VASCULATURE COMPARING HYPOPLASTIC AND NORMAL FETAL LUNGS

We investigated the intra-acinar pulmonary vascular muscularization in the developing human fetal lung between the 17th and 24th gestational weeks, that is, during the canalicular phase of lung development. Fifteen hypoplastic and 25 normal developed lungs were included in this study using monoclonal alpha -smooth muscle (sm) actin antibodies for smooth muscle detection. Computer-aided image analysis was performed for morphometrical measurements and statistical evaluation. Alphasm-actin-immunoreactive intra-acinar vessels down to a luminal diameter of less than 10 mu m were detected in hypoplastic as well as in normally developed lungs. Crucial differences presented as follows: significantly higher density of intra-acinar vessels, especially due to alpha -sm-actin-negative vessels less than 30 mu m in luminal diameter, in the control group; significantly higher alpha -sm-actin immunoreactivity per section unit as well as per vessel in the hypoplastic lung group. As suggested by others, alpha-sm-actin-positive cells of the intra-acinar vessel wall in the developing human lung were demonstrated to be smooth muscle cells, their immediate precursors, and pericytes. We conclude that the increased alpha -sm-actin immunoreactivity represents muscularization of the vessel wall in functional terms and may be regarded as one structural cause among others for the establishment of persistent fetal circulation in hypoplastic lungs.     

Whole-body mineral measurements in Swedish adolescents at 17 years compared to 15 years of age

Aim: To provide reference data for bone mineral variables in 15- and 17-y-old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background.

Methods: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual-energy X-ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses.

Results: In the 15-y-old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17-y-olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17-y-olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation.

Conclusion: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.     

The potential role of rapamycin in pediatric transplantation as observed from adult studies

Although pediatric patient and renal graft survival rates have shown marked improvements during the past decade, the persistent toxicities of immunosuppressive drugs and chronic allograft attrition remain major obstacles in transplant therapy. Results in adult patients suggest that complete steroid withdrawal is possible in the majority of recipients under treatment with a cyclosporin A-rapamycin (CsA RAPA) regimen. Furthermore, preliminary studies suggest that a marked reduction in the dose of CsA may be possible under the umbrella of RAPA coverage. The gain in immunosuppressive efficacy afforded by RAPA has not only been obtained without an increased morbidity owing to infectious or neoplastic causes, but also with the potential for reducing the incidence and/or progression of chronic rejection.     

VARICELLA ZOSTER VIRUS INFECTIONS IN THE PEDIATRIC STEM CELL TRANSPLANT PATIENT

Varicella zoster virus (VZV), a member of the human herpesvirus family, causes the clinical syndromes of chickenpox during primary infection and shingles on later reactivation. In immunocompromised patients, including those undergoing hematopoietic stem cell transplantation, VZV can produce life-threatening infections. The most serious forms of VZV infection involve hematogenous dissemination of the virus to vital organs, such as the lung, brain, and liver. Advances in immunoprophylaxis, antiviral chemotherapy, and vaccine development have provided effective tools to limit the morbidity and mortality previously associated with VZV infection in hematopoietic stem cell transplant patients. In this review, we discuss virologic aspects of VZV, pathogenesis of VZV infection, methods of viral diagnosis, clinical manifestations of infection in both normal and immunocompromised patients, and available preventative and therapeutic measures.     

Génétique des schizophrénies : mise en perspective des schizophrénies à début précoce et autres pathologies du développement

Schizophrenia (SCZ) is a severe brain disorder characterized by hallucinations, delusions, flat and/or inappropriate affect and cognitive impairment. The lifetime risk is about 0.5% with heritability of 65–85%. The prevalence of early-onset schizophrenia (defined here as before 15 years of age) has not been well studied, but is likely to be 5–10% of all cases. The rarity of early-onset SCZ has made it difficult to study. We focus on genetic studies of adults with schizophrenia, highlighting results for early-onset schizophrenia where available. Prior to the past 5 years, studies failed to find replicable association or linkage between SCZ and specific genes when appropriate statistical corrections for multiple testing were used. Many false positive results were probably reported using the candidate gene approach. Recently, the development of single nucleotide polymorphism (SNP) “chips” has permitted large genome-wide association study (GWAS) analyses that suggest that across all age groups, a proportion of genetic risk can be attributed to a large number of common SNP, each with a very small effect on risk (odds ratios of 1.1 or less). The greatest known genetic effect is conferred by the 1.5–3 Mb 22q.11.2 deletions, which occurs in ∼ 1/4000–1/6000 births with SCZ developing in 20–30% of carriers. Large SNP and aCGH microarray studies have now identified associations between SCZ and other rare, large copy number variations (CNV, insertions and deletions) with high odds ratios (5–10), including deletions of 1q21, 2p16.3 (neurexin-1 gene), 3q29 and 15q13.3, and duplications of 16p11.2. Some of these CNV are also associated with autism or other developmental disorders as well as epilepsy or intellectual deficiency, suggesting some overlap in the mechanisms that contribute to risks of these disorders. Based on preliminary data from larger-scale analyses in progress, approximately 1–2% of cases carry a CNV that has been clearly associated with SCZ (ORs 4–12). Whole exome and genome sequencing studies of large adult samples will be the next steps to identify rarer SCZ-associated mutations, including point mutations and smaller as well as rarer CNV. Genetic findings are beginning to contribute to an understanding of biological mechanisms of SCZ risk and may lead to new approaches to treatment.     

INACTIVATION OF PULMONARY SURFACTANT AND THE TREATMENT OF ACUTE LUNG INJURIES

Inactivation of pulmonary surfactant may be important in acute lung injury and acute respiratory distress syndrome. Treatment of surfactant dysfunction by instilling exogenous surfactants may improve gas exchange and pulmonary mechanics. Surfactants used for treatment vary in their attributes and effects, so when various surfactants are considered for therapy, resistance to inactivation is an important consideration. Animal models of acute lung injury exist in which the relative merits of surfactants can be compared. We hypothesize that the surfactants most resistant to inactivation in vitro will be the ones that are most effective in treatment of animal models of acute lung injury. Surfactants with higher concentrations of surfactant proteins (specifically A, B, and C) are more resistant to inactivation. Nonionic polymers mimic surfactant proteins in preventing surfactant inactivation under some conditions. Adding nonionic polymers to surfactant containing minimal amounts of SP-B and SP-C markedly improves lung function of animals with lung injury. Making surfactants more "inactivation-proof" may improve surfactant therapy of acute lung injuries.     

Plasma Proinsulin and C-Peptide Concentrations in Children with Hyperinsulinaemic Hypoglycaemia

ABSTRACT. Plasma concentrations of proinsulin and C-peptide were measured in five children presenting with svere hypoglycaemia associated with elevated plasma levels of immunoreactive insulin (IRI) in order to determine whether the profile of circulating B-cell products related to the underlying pathophysiology of the pancreas. Results were compared with data from 13 normal infants. Four children, three neonates and a nine year old girl, were subjected to partial or total pancreatectomy. The neonates had nesidioblastosis, nesidioblastosis with a microadenoma, and a functional abnormality without histological derangement respectively; the older child had a localised adenoma. The remaining child, a neonate, had transient hypoglycaemia and elevated IRI levels associated with hyperlactataemia and hyperalaninae-mia. All the children had markedly elevated plasma proinsulin concentrations; the highest levels were seen in the child with an isolated adenoma and in the neonate with nesidioblastosis and a microadenoma. Both of these children also had substantially elevated plasma C-peptide concentrations. The remaining three neonates had plasma C-peptide levels, which although in the normal range for normoglycaemia were inappropriately elevated during hypoglycaemia. It is concluded that elevated proinsulin and C-peptide concentrations are seen in children with hypoglycaemia associated with increased plasma IRI levels and that the profile of the concentrations does not provide a reliable marker for the nature of the underlying pancreatic abnormality.     

Growth tracks in early childhood

Aim: Child growth is modulated by numerous factors and, particularly in infancy and early childhood, often tends to follow apparently irregular patterns, with many centiles crossed before the later growth channels are reached. The aim of this study was to visualize the diversity of individual growth. Design: The study investigated 333 girls and 329 boys without chronic illnesses from four paediatric practices in Kiel, Germany. The children were measured on natural     

Residual pulmonary hypertension in children after treatment with inhaled nitric oxide: a follow-up study regarding cardiopulmonary and neurological symptoms

Inhaled nitric oxide is a potent vasodilator in acute severe pulmonary hypertension and is increasingly used as rescue treatment in intensive care algorithms aiming at reducing severe hypoxaemia in neonates and children. Although the immediate effects may seem impressive, longterm outcome regarding residual pulmonary hypertension and other sequelae has been studied in only a very few patients. The aim of the present study was to evaluate residual pulmonary hypertension, cardiopulmonary or neurological symptoms in children after treatment with inhaled nitric oxide in severely hypoxaemic and/or pulmonary hypertensive mechanically ventilated children. The study was performed in four paediatric intensive care units in university hospitals in Sweden, Norway and Australia. Patients who had received inhaled nitric oxide as part of their intensive care treatment for severe hypoxaemia and/or pulmonary hypertension, and in whom 6 mo had elapsed since treatment, were included for evaluation. Thus 36 paediatric or neonatal patients were examined for circulatory, respiratory or neurological disorders with clinical examination, echocardiography, chest X-ray and a capillary blood sample. Four patients with congenital heart disease had residual pulmonary hypertension. Nine patients were receiving bronchodilators. Sixteen patients had minor (n = 15) or moderate (n = 1) changes on a chest X-ray. One patient had a possible delay in psychomotor development. Conclusions: In spite of the severity of their primary illness, we found that the overwhelming majority of the surviving children were asymptomatic and doing well. The few residual circulatory and respiratory symptoms could be related to the initial condition.