婴幼儿哮喘患儿潮气呼吸肺功能改变的特征

目的观察婴幼儿哮喘患儿在发作期与缓解期的潮气呼吸流速——容量曲线测定结果。方法选择婴幼儿哮喘患儿40例,于镇静后进行潮气呼吸流速容量曲线测定（TBFV）。主要参数有：每公斤潮气量（VT／kg）、呼吸频率（RR）、吸气时间（Ti）、呼气时间（Te）、吸呼比（Ti／Te）、达峰时间比（TPTEF／TE）、达峰容积比（VPEF／VE）,并对30例哮喘患儿经正规吸入治疗1～3月的缓解期进行复查。观察其改善情况。同时对40例无呼吸道疾病的婴幼儿进行肺功能检测,作为正常对照。结果哮喘组的潮气量与正常对照组无显著差异,其他各指标差异均有显著性（P〈0．01）。哮喘组经1～3月治疗后,复查TPEF／TE,VPEF／VE显著上升,但与对照组仍有显著差异,未能恢复正常水平。结论潮气呼吸肺功能测定能反映出婴幼儿哮喘的病理生理特点,可成为呼吸系统疾病诊断的重要补充。     

潮气呼吸肺功能检测对婴幼儿喘息性疾病的诊断价值

目的探讨潮气呼吸肺功能检测对婴幼儿喘息性疾病的诊断价值。方法收集2012年1月—2014年1月在我院住院的支气管哮喘患儿40例(哮喘组)、毛细支气管炎患儿40例(毛细组)及门诊体检健康婴幼儿40例(对照组)。均于平静呼吸状态下监测潮气呼吸肺功能,指标包括:单位质量内潮气量(Vt)、呼气时间(Te)、吸气时间(Ti)、呼吸频率(RR)、达到峰流速时间(TPTEF)、达到呼气峰流速时所呼吸气体体积(VPTEF)以及呼吸容积(Ve),计算呼吸比(Ti/Te)、达峰时间比(TPTEF/Te)以及达峰容积比(VPTEF/Ve)。哮喘组和毛细组患儿完成测试后,均给予0.5%沙丁胺醇雾化吸入治疗,3个月后进行复测。结果治疗前哮喘组和毛细组患儿RR高于对照组,Te、Ti、TPTEF/Te及VPTEF/Ve低于对照组(P0.05)。吸入沙丁胺醇后,哮喘组Vt、VPTEF/Ve及TPTEF/Te高于治疗前,毛细组RR、TPTEF/Te低于治疗前(P0.05)。结论潮气呼吸肺功能检测能够间接反映婴幼儿喘息性疾病的病理生理特征,为临床诊断提供参考。     

潮气呼吸肺功能、FeNO检测及支气管舒张试验用于低龄儿童哮喘疾病管理价值探讨

目的探讨潮气呼吸肺功能、FeNO检测及支气管舒张试验用于低龄儿童哮喘疾病管理临床价值。方法选取初次诊断儿童哮喘的低龄患儿108例为观察组,以同期来我院体检健康儿童80例为对照组;比较观察组和对照组的潮气呼吸肺功能指标水平、FeNO水平及观察组支气管舒张试验前后肺功能指标水平,并分析肺功能指标和FeNO水平的相关性。结果观察组急性期TPEF/TE、VPEF/VE、VT/kg及Ti/Te水平均显著低于缓解期、对照组(P0.05);观察组缓解期TPEF/TE、VPEF/VE及Ti/Te水平均显著低于对照组(P0.05);观察组急性期RR水平均显著高于缓解期、对照组(P0.05);观察组急性期支气管扩张剂应用后TPEF/TE、VPEF/VE、VT/kg及Ti/Te水平均显著高于应用前(P0.05);观察组急性期支气管扩张剂应用后RR水平显著低于应用前(P0.05);观察组急性期FeNO水平显著高于缓解期、对照组(P0.05);同时观察组缓解期FeNO水平显著高于对照组(P0.05);重度阻塞的哮喘患儿支气管舒张试验阳性率显著高于中度、轻度(P0.05);同时中度阻塞的哮喘患儿支气管舒张试验阳性率显著高于轻度(P0.05);Pearson相关性分析显示,哮喘急性期和缓解期患儿FeNO水平与潮气呼吸肺TPEF/TE和VPEF/VE间均无相关性(r=-0.035,-0.040,-0.043,-0.075,P=0.74,0.82,0.80,0.63)。结论潮气肺功能、FeNO检测及支气管舒张试验联合检测,可更为全面反映儿童哮喘患儿病变严重程度,有助于提高低龄儿童哮喘疾病管理水平。     

婴幼儿潮气呼吸肺功能的临床应用研究

目的研究潮气呼吸肺功能检查在婴幼儿常见的呼吸系统疾病诊断的临床价值。方法选择年龄2个月-3岁我院同期住院婴幼儿支气管肺炎48例、支气管哮喘37例、毛细支气管炎26例,完成潮气呼吸肺功能舒张试验,并对吸入支气管扩张剂前后的主要肺功能参数进行比较。结果吸入支气管扩张剂前哮喘组、毛支组分别与肺炎组比较达峰时间比TPTEF/Te和达峰容积比VPEF/Ve均有统计学差异(P 0. 05)。吸入支气管扩张剂后肺炎组、哮喘组、毛支组TPTEF/Te和VPEF/Ve均有所改善,且差异有统计学意义(P 0. 05)。结论通过潮气呼吸肺功能测定支气管肺炎、支气管哮喘、毛细支气管炎患儿均有不同程度的气道阻塞,给予支气管扩张剂后气道阻塞程度均有所改善。     

喘息对支气管肺炎患儿潮气呼吸肺功能的影响

目的观察喘息对支气管肺炎患儿潮气呼吸肺功能的影响。方法对54例支气管肺炎患儿分为观察组喘息组25例和对照组非喘息组29例,在肺炎急性期及恢复期分别测定潮气呼吸流速容量(TBFV)环图形及参数呼吸频率(RR)、每公斤体重潮气量(VT/kg)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、吸呼比(Ti/Te)、呼出和吸入50%潮气容积时的呼气流速与吸气流速之比(TEF50/TIF50),进行分析。结果 1.观察组急性期TBFV环图形分析及相关参数较对照组无统计学意义。2.观察组恢复期TBFV图形分析正常17例、阻塞性改变8例,较对照组正常26例、阻塞性改变3例,经χ2检验P0.05,有统计学意义。观察组恢复期达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)较对照组低,经t检验有统计学意义(P0.05)。结论观察组气道阻塞性病变恢复较对照组慢,喘息可影响支气管肺炎患儿气道阻塞性功能障碍的恢复。     

急性毛细支气管炎潮气呼吸肺功能改变的特征

近年来应用潮气呼吸流速一容量曲线（tidal breathingflow volume,TBFV）为检测婴幼儿的通气功能提供了可能,该操作简便,对患儿干扰小,通过对潮气流速曲线和呼吸参数的分析,可作为临床诊断、病情评估的重要补充。本研究通过对毛细支气管炎（简称毛支）患儿的TBF的检测,探讨其特点和重要呼吸参数的变化,为临床工作提供参考。     

潮气呼吸测定分析毛细支气管炎婴儿通气功能

目的　了解毛细支气管炎患儿通气功能状况、通气功能障碍类型及气道阻塞程度。方法　采用德国耶格公司的MasterScreen肺功能测定仪,测定74例毛细支气管炎患儿急性期潮气呼吸功能,分析潮气呼吸流速容量(TBFV)环、每千克体重潮气量(VT/kg)、呼吸频率(RR)、吸呼比(Ti/Te)、达峰时间比(TPF %TE)、达峰容积比(VPF %VE) ,确定通气功能状况、通气功能障碍类型及气道阻塞程度。结果　每千克体重潮气量下降,呼吸频率加快,达峰时间比和达峰容积比下降。TBFV环呈阻塞性改变40例(54 .1 % )、限制性改变6例(8.1 % ) )、混合性改变2 3例(31 .1 % )、正常5例(6 .8% )。轻度阻塞1 5例(2 3 .8% ) ,中度阻塞2 5例(39.7% ) ,重度阻塞2 1例(33.3 % ) ,极重度阻塞2例(3 .2 % )。结论　毛细支气管炎患儿存在明显通气功能异常,主要为阻塞性和混合性通气功能障碍。气道以中重度阻塞为主。     

新生儿生后肺功能变化情况的研究

目的研究足月新生儿肺功能参数正常值,为呼吸系统疾病的诊治和呼吸机参数的设定提供参考。方法收集2015年1月至2016年12月我院新生儿科住院的足月新生儿,选取正常体重足月儿150名,低体重足月儿100名,正常体重足月儿按日龄各分为A、B、C、D四组,低体重足月儿按日龄各分为a、b、c、d四组,日龄分别为出生后1d、7d、14d、28d,检测肺功能参数。采用肺功能仪,测量肺功能参数:潮气量(VT)、每公斤体重潮气量(VT/kg),呼吸频率(RR),,吸气时间(Ti),呼气时间(Te),吸呼比(Ti/Te),每分通气量(MV/kg),达峰时间比(TPTEF/TE),达峰容积比(VPEF/VE),25%、50%、75%潮气量时呼气流速(TEF25、TEF50、TEF75),呼吸系统的顺应性(Crs),呼吸系统阻力(Rrs)。结果正常体重足月儿和低体重足月儿RR随日龄增加呈降低趋势,VT、MV/kg、TEF25、TEF50值均随日龄增长而逐渐上升,均有统计学差异(P0.05)。低体重足月儿TPTEF/TE、VPEF/VE、Crs、TEF75值随日龄增长而逐渐上升,均有统计学差异(P0.05)。低体重足月儿与正常体重足月儿相比较,RR明显升高(P0.05),VT、TPEF/Te、VPEF/Ve、TEF25、TEF50、TEF75、Crs明显降低(P0.05)。结论本研究为建立足月新生儿肺功能参数正常值提供了参考,同时发现低体重足月儿会出现呼吸频率快,潮气量及功能残气量低、呼吸系统顺应性降低等特点。     

呼吸道合胞病毒毛细支气管炎患儿潮气肺功能检测及临床意义

对42例呼吸道合胞病毒(RSV)毛细支气管炎患儿(观察组)急性期、恢复期及20例正常组婴儿进行肺功能检查.结果 与正常组比较,观察组急性期呼吸频率(RR)升高,每千克体质量潮气量(Vt/kg)、吸呼时间比(tI/tE)、达峰时间比(tPTEF/tE)及达峰容积比(vPTEF/vE)下降(P<0.05,<0.01);与恢复期比较,RR、tI/tE、tPTEF/tE及vPTEF/vE有统计学差异(P<0.05);恢复期RR与正常组比较无统计学差异,但tPTEF/tE及vPTEF/vE仍有差异(P<0.05).提示RSV毛细支气管炎急性期肺功能主要表现为小气道阻塞性通气障碍,恢复期仍有小气道功能异常;潮气呼吸肺功能检查是判断其病情、评估疗效及预后实用和可靠的方法.     

非紫绀型先天性心脏病儿童术前潮气呼吸肺功能研究

目的:探讨非紫绀型先天性心脏病儿童术前潮气呼吸肺功能相关参数改变及其影响因素。方法:选择非紫绀型先天性心脏病儿童107例为研究对象,健康体检儿童48例为对照组,分别进行潮气呼吸肺功能检查。先天性心脏病儿童介入术中测定肺动脉平均压,并分别采集上腔静脉、肺动脉及主动脉(或左心房)血检测血氧饱和度及血红蛋白;按肺动脉平均压分为非肺高压组65例和肺高压组42例,并计算血流动力学指标。将3组儿童肺功能进行比较,对先天性心脏病儿童血流动力学指标与肺功能参数进行相关性分析。结果:从对照组、非肺高压组到肺高压组,每分钟通气量(MV)、潮气呼气峰流速(PTEF)、潮气峰流速/潮气量(PF/VE)水平逐渐增高,达峰时间(TPTEF)、达峰时间比(TPTEF/TE)、达峰容积(VPTEF)和达峰容积比(VPEF/VE)水平则逐渐降低,差异有统计学意义(P0.05)。肺动脉平均压与PF/VE、RR、Ti/Te呈正相关(r=0.31、0.25、0.257,P0.05),与TPTEF、Te呈负相关(r=-0.26、-0.283,P0.05);肺血管阻力与PF/VE、RR、Ti/Te呈正相关(r=0.306、0.247、0.218,P0.05),与MV、Ti、Te呈负相关(r=-0.205、-0.207、-0.264,P0.05)。结论:非紫绀型先天性心脏病儿童存在阻塞性通气功能障碍,随着肺动脉平均压力及肺血管阻力的升高,可合并限制性通气功能障碍。     

Predictive value of infant lung function testing for airway malacia

Airway malacia is present in a small proportion of wheezing infants. The usefulness of infant lung-function testing (ILFT) in ruling out malacia in wheezy infants is unknown. We assessed the predictive value of ILFT parameters for airway malacia diagnosed by flexible bronchoscopy. Thirty-two term infants (mean (SD) age, 11.0 (4.6) months) with chronic wheeze unresponsive to asthma treatment underwent ILFT prior to bronchoscopy. Functional residual capacity measured by plethysmograph (FRCp), maximal flow at FRC (V'max(FRC)), and tidal breathing parameters were obtained. Expiratory flow-volume curves were visually examined for tidal flow limitation. Malacia was observed during bronchoscopy in 20 infants. V'max(FRC) (Z-score) was significantly lower in the group with malacia as compared with the group without malacia. Lung-function measurements had a low negative predictive value and sensitivity. While flow limitation during tidal breathing was highly predictive and 100% specific for airway malacia, only half of the infants with malacia had tidal flow limitation. In this selected group of infants, routine lung function testing could not discriminate between infants with and without airway malacia. However, the presence of tidal flow limitation was 100% predictive and specific for airway malacia.     

Persistent wheezing and gastroesophageal reflux in infants

We have evaluated the presence of gastroesophageal reflux (GER) and the effect of its treatment in 12 infants (mean age, 7 months; range, 4–11 months) with persistent wheezing not responding to bronchodilators and anti-inflammatory asthma medications. All patients had GER on cineradiography and significant acid reflux on 24 hour pH monitoring (percentage of time pH < 14 ranged from 6.1 to 47%). All infants were initially treated with prokinetic agents and with receptor histamine antagonists in addition to aggressive pulmonary therapy. Six patients treated medically had substantially decreased use of asthma medications, completely discontinuing them within 2–4 months. Two patients, though significantly improved, require intermittent asthma therapy. Four patients responding poorly to GER and asthma treatment for 2 months to 2 years had fundoplications. These had an excellent outcome over 1–4.5 years follow-up; only one patient required further asthma medications. Pulmonary function testing was done in six patients before and after 6–8 weeks of therapy indicating significant improvement in peripheral airflow: terminal flow/peak tidal expiratory flow (TEF₂₅/PTEF), and percentage of total expiratory time to reach peak tidal expiratory flow (T_p/T_e or T_me/T_e). Our experience suggests that evaluation for GER should be considered in infants with persistent wheezing. Aggressive medical and possibly surgical therapy for GER may resolve persistent wheezing. Pediatr Pulmonol. 1994; 18:39–44. © 1994 Wiley-Liss. Inc.     

Ultrasonographic study of postcibal gastro-esophageal reflux and gastric emptying in infants with recurrent respiratory disease

AIM: To check the utility of postcibal ultrasonography for the evaluation of reflux in relation to gastric emptying in infants with recurrent respiratory symptoms and to link imaging with clinical data. METHODS: Esophageal reflux (hyperechoic retrograde filling) and gastric emptying (antral areas) were quantified before and after ingestion of a standard formula in 35 untreated infants (13 with chronic cough, 22 with recurrent bronchitis) and in 31 controls. RESULTS: The prevalence of abnormal (≥8 episodes) postcibal refluxes was 74% in patients and 3% in controls. Number, duration of the longest episode and extent of refluxes were significantly higher in patients compared to controls. Number of refluxes was higher in patients with symptomatic refluxes than in those without. Infants with recurrent bronchitis had more refluxes than those with chronic cough and controls. Extent and timing of gastric emptying were similar in patients and controls. CONCLUSION: Esophageal ultrasonography is a useful and physiological test in infants with recurrent respiratory diseases, which have a high prevalence of abnormal postcibal esophageal reflux and a gastric emptying similar to that of normal controls. Esophageal reflux is more severe in subjects with recurrent bronchitis than in those with chronic cough.     

Exhaled breath condensate pH in infants and children with acute and recurrent wheezy bronchitis

The analysis of exhaled breath condensate (EBC) is a promising new method to measure airway inflammation. So far only limited data exist about methodological issues of EBC sampling in infants and young children. We evaluated 18 children with acute wheezy bronchitis (median age 24.3 months (min-max: 4-89.9)), 54 children with recurrent wheezy bronchitis (median age 52.5 months (7.2-94.8)), and 32 healthy controls (median age 49.6 months (25.3-67.8)). EBC was sampled with a modified commercially available EBC-sampler, pH was measured after deaeration. EBC volume was significantly correlated to age (r = 0.56, P < 0.001). EBC pH was significantly decreased in all patients compared to the healthy controls (acute wheezy bronchitis 7.87 (7.16-8.19), P = 0.003, recurrent wheezy bronchitis 7.86 (6.95-8.39), P = 0.002, and healthy controls 8.04 (7.81-8.87), respectively). There were no significant differences of the EBC pH between the disease groups. When divided into different subgroups, an influence of inhaled steroid treatment was found with steroid-naive recurrent wheezers having significantly lower EBC pH levels compared to healthy controls (7.80 (6.95-8.37), P = 0.018), but not so steroid treated (7.94 (7.24-8.39), P = 0.055). Both, recurrent wheezers with or without a positive allergy test had significantly lower EBC pH compared to healthy controls (7.91 (6.95-8.37), P = 0.007 and 7.82 (7.32-8.39), P = 0.005, respectively). This study indicates that EBC can be collected with a modified commercially available EBC sampler in infants and young children. Further studies need to be performed to evaluate the relevance and meaning of pH differences of EBC in this age group.     

Inhaled nebulized adrenaline improves lung function in infants with acute bronchiolitis

Beta2-agonists have questionable symptomatic effect in infants with acute bronchiolitis, whereas inhaled, nebulized racemic adrenaline, commonly used in Norway, appears (clinically) to be effective. Limited lung function observations during acute bronchiolitis exists, and less for assessing possible effects inhaled adrenaline. In this preliminary study, tidal flow-volume loops were measured in 16 infants with acute bronchiolitis and seven healthy controls (mean age 7.9 and 4.4 months, respectively), with repeated measurements 15 min after inhaled nebulized racemic adrenaline (4 mg diluted in 2 ml saline) in nine bronchiolitis patients. The ratio of time to reach peak tidal expiratory flow to total expiratory time (tPTEF/tE) was significantly reduced in children with acute bronchiolitis (mean, 95% CI) (0.08, 0.05-0.10) compared to controls (0.31, 0.18-0.43), with significant improvement after inhaled racemic adrenaline 0.19 (0.13-0.25), parallel with significant clinical improvement. Lung function (tPTEF/tE) was reduced in infants with acute bronchiolitis and improved significantly after inhaled racemic adrenaline. Inhaled racemic adrenaline is potentially an important alternative for treating infants with acute bronchiolitis.     

Development of Lung Function in Preterm Infants During the First Two Years of Life

IntroductionIt remains unclear if prematurity itself can influence post delivery lung development and particularly, the bronchial size.AimTo assess lung function during the first two years of life in healthy preterm infants and compare the measurements to those obtained in healthy term infants during the same time period.MethodsThis observational longitudinal study assessed lung function in 74 preterm (30 + 0 to 35 + 6 weeks’ gestational age) and 76 healthy term control infants who were recruited between 2011 and 2013. Measurements of tidal breathing, passive respiratory mechanics, tidal and raised volume forced expirations (V’maxFRC and FEF_25–75, respectively) were undertaken following administration of oral chloral hydrate sedation according to ATS/ERS recommendations at 6- and 18-months corrected age.ResultsLung function measurements were obtained from the preterm infants and full term controls initially at 6 months of age. Preterm infants had lower absolute and adjusted values (for gestational age, postnatal age, sex, body size, and confounding factors) for respiratory compliance and V’maxFRC. At 18 months corrected postnatal age, similar measurements were repeated in 57 preterm infants and 61 term controls. A catch-up in tidal volume, respiratory mechanics parameters, FEV_0.5 and forced expiratory flows was seen in preterm infants.ConclusionWhen compared with term controls, the lower forced expiratory flows observed in the healthy preterm group at 6 months was no longer evident at 18 months corrected age, suggesting a catch-up growth of airway function.     

Clinical signifcans of longitudinal determination of immunoglobulin values in infants with acut respiratory diseases.

The immunoglobulin values (IgM, IgA, IgG) were determined longitudinally in 73 infant with acute obstructive bronchitis; with acute obstructive bronchitis associated with bronchopneumonia; with bronchopneumonia. The immunoglobulin values were determined by single radial immunodiffusion method. The comparison of time of clinical recovery and x-ray clearing on the one hand and the normalisation of immunoglobulin values on the other hand was done too. It was found that the high immunoglobulin values were maintained after the clinical recovery and x-ray clearing the longest period of time in infants with acut obstructive bronchitis. In infants with acute obstructive bronchitis associated with bronchopneumonia the high immunoglobulin values were maintained very long but they were normalised on the 34-30th day of clinical recovery and x-ray clearing. In infants with bronchopneumonia the high immunoglobulin values were maintain considerably shorter and they were normalised on the 6th day after the clinical recovery. Whit regard to different time of normalisation of immunoglobulin values in infants with acute obstructive bronchitis associated with bronchopneumonia it was concluded that the longitudinal determination of immunoglobulin values has clinical significance since it can be found which of these two diseases is dominant.     

Relationship between bronchial hyperresponsiveness and development of asthma in wheezy infants

STUDY OBJECTIVES: To evaluate the relationship between bronchial hyperresponsiveness (BHR) in infants with wheezing and the subsequent development of asthma. INTERVENTION: Bronchial reactivity to inhaled methacholine (BRm) during the infantile period was studied using the transcutaneous partial pressure of oxygen (tcPO(2)) method. Children were followed long-term for the development of asthma. PATIENTS: Fourteen children with bronchiolitis (mean age, 0.7 years) and 48 with wheezy bronchitis (mean age, 2.3 years) were enrolled. For comparison, 40 children with asthma (mean age, 4.6 years) and 27 healthy control subjects without chronic respiratory disease (mean age, 2.7 years) were studied. MEASUREMENTS: Consecutive doses of methacholine were doubled until a 10% decrease in tcPO(2) from baseline was reached. The cumulative dose of methacholine (Dmin) at the inflection point of tcPO(2) (Dmin-PO(2)) was recorded. RESULTS: During > 10 years of follow-up, seven patients with bronchiolitis developed asthma and all patients in the higher BRm set developed asthma, compared with none in the lower BRm set. In the wheezy bronchitis group, Dmin-PO(2) values in the 32 patients who developed asthma were lower than those in patients who had not developed asthma (p < 0.001). CONCLUSIONS: We concluded that there is a tendency for infants with a clinical diagnosis of bronchiolitis or wheezy bronchitis and who show BHR in the infantile period to develop asthma. The presence of increased BHR after infantile respiratory diseases associated with wheezing may be a prelude to the development of childhood asthma.     

Effect of extensively hydrolyzed milk formula on growth and resistance to bronchitis and atopic dermatitis in infants and toddlers.

OBJECTIVE: This study aimed to evaluate the adverse effects of extensively hydrolyzed milk formula on growth in infants and toddlers. METHODS: Prospectively, 45 infants and toddlers with a positive history of cow's milk allergy confirmed by positive skin prick test and high IgE levels for either alpha-lactalbumin, beta-lactoglobulin, or casein and positive single-blind food challenge received extensively hydrolyzed milk formulas for 1 year. Sex-normalized percentiles of heights and weights of infants and toddlers before their enrollment in the study were compared to those at the end of the study. The contribution of breastfeeding, early use of bottle feeding and intake of adapted or special milk formulas, and history of bronchitis and atopic dermatitis on toddlers' growth were also evaluated by multivariate analysis. RESULTS: Similar percentiles of the children's weight and height were observed at the beginning of the study and 1 year later. According to the multivariate analysis, sex, breastfeeding, early bottle feeding, ingestion of adapted or special milk formulas, atopic dermatitis, and bronchitis were not correlated with either the children's weight or height at diagnosis of the allergy or at 1 year of follow-up (P > .10). Weights and heights were not different between toddlers who had atopic dermatitis or bronchitis during the study period and those who did not. CONCLUSIONS: Growth of infants and toddlers with cow's milk allergy was not affected by the intake of extensively hydrolyzed milk for 1 year. Atopic dermatitis and bronchitis did not appear to have any deleterious effect on these children's growth.