Airway eicosanoids in acute severe respiratory syncytial virus bronchiolitis

We prospectively studied the levels of eicosanoids in intubated patients with severe bronchiolitis and compared them to electively intubated non-infected infants. LeukotrieneE(4) (LTE(4)), leukotrieneB(4) (LTB(4)), and prostaglandinE(2) (PGE(2)) levels were significantly increased (P <.01) from endotracheal (ET) aspirates of infants with bronchiolitis compared with controls, as were urinary LTE(4) levels (P <.001). We conclude that eicosanoids are increased in the tracheal aspirates and urine of children with bronchiolitis.     

Teenage asthma after severe infantile bronchiolitis or pneumonia

OBJECTIVE: The purpose of the study was to evaluate asthma at >13 y of age in children with infantile bronchiolitis or pneumonia. METHODS: In 1981-1982, 127 children at <2 y of age were hospitalized for bronchiolitis (n = 81) or pneumonia (n = 46). Respiratory syncytial virus (RSV) infection, eosinophilia and markers of atopy were assessed and recorded on admission. At a median age of 14.9 y, atopic and asthmatic symptoms were screened by a written questionnaire in 98/127 (77%) study subjects. RESULTS: Asthma was present, according to two definitions, in 14% to 23% in the original bronchiolitis and in 12% to 15% in the original pneumonia group. The figures were 8% to 17% in the RSV infection and 16% to 23% in the non-RSV infection group. Early asthma-predictive factors were repeated wheezing, atopic dermatitis and elevated blood eosinophils. All but one of the teenage asthmatics had allergic rhinitis. CONCLUSION: An increased risk for asthma persists until the teenage period after bronchiolitis and pneumonia in infancy. Both early and later atopy were significant risk factors. The present study was unable to demonstrate the association between early RSV infection and teenage asthma.     

Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis

AIM: To document the incidence and early evolution of hyponatraemia (serum sodium < 136 mmol l(-1)) associated with respiratory syncytial virus (RSV) bronchiolitis in infants requiring intensive care. METHODS: In a retrospective review over two winter seasons, 130 infants were admitted with confirmed RSV infection, of whom 39 were excluded because of either pre-existing risk factors for hyponatraemia: diuretic therapy (n = 14), cardiac disease (n = 10), renal disease (n = 2) or lack of admission sodium data (n = 13). RESULTS: The incidence of admission hyponatraemia in the remaining infants (median age 6 wk) was 33% (30/91), with 11% (10/91) exhibiting a serum sodium less than 130 mmol l(-1) . Hyponatraemic and normonatraemic infants were of a similar age (median 6 vs 7 wk, p = 0.82). With fluid restriction and diuretic therapy, the incidence of hyponatraemia at 48 h had decreased to 3.3%, odds ratio 0.07 (95% confidence interval 0.02-0.24, p < 0.001). Four infants (4%) suffered hyponatraemic seizures at admission (sodium 114-123 mmol l(-1)); three had received hypotonic intravenous fluids at 100-150 ml kg(-1) d(-1) before referral to intensive care. All four were managed successfully with hypertonic (3%) saline, followed by fluid restriction, resulting in immediate termination of seizure activity and normalization of serum sodium values over 48 h. CONCLUSION: Hyponatraemia is common among infants with RSV bronchiolitis presenting to intensive care. Neurological complications may occur and fluid therapy in vulnerable infants should be tailored to reduce this risk.     

Bronchoalveolar lavage cellularity in infants with severe respiratory syncytial virus bronchiolitis

Aim: To examine over time, the cellular response within the lungs of infants ventilated with respiratory syncytial virus (RSV) bronchiolitis and to compare this response in infants born at term with those born preterm. Methods: Non-bronchoscopic bronchoalveolar lavage (BAL) samples were taken from 47 infants (24 born at term and 23 born preterm) who were ventilated for RSV positive bronchiolitis and 10 control infants. BAL cellularity and differential cell counts were calculated using standard techniques. Results: Total cellularity in BAL over the first four days of ventilation in infants with RSV bronchiolitis was greater in term infants (median 2.2 (IQR 4.27) x 10⁶ cells/ml) compared with preterm infants (0.58 (1.28) x 10⁶ cells/ml). The magnitude of the cellular response in preterm infants with bronchiolitis was similar to that in the control group measured on day 1 (0.62 (0.77) x 10⁶ cells/ml). BAL cellularity decreased progressively from the time of intubation in term infants, but remained relatively constant in preterm infants up to seven days after intubation. Conclusions: There are differences in the magnitude and type of pulmonary cellular response in term and preterm infants ventilated with RSV bronchiolitis. The cellular response in term infants with bronchiolitis differs from that in a control group of infants. These differences may reflect variations in cellular recruitment in the lung and/or variations in airway calibre.     

Apnoea and bronchiolitis due to respiratory syncytial virus

ABSTRACT. A study was made of 146 children admitted to hospital with bronchiolitis due to respiratory syncytial virus. Fifteen subjects (10%) had apnoea. Six of the 16 infants (38%) less than two months of age had apnoea, compared with nine of 130 children (6.9%) over two months old (P<0.001). Nine of the 28 infants (32%) who were preterm had apnoea compared with six of 118 children (5.1%) over 37 weeks gestation (P<0.001).
Both early chronological age and prematurity are risk factors for the development of apnoea in children with RSV bronchiolitis.     

Length of stay after infant heart surgery is related to cognitive outcome at age 8 years

OBJECTIVE: To test the hypothesis that postoperative length of stay (LOS) after infant heart surgery might be an easily measured surrogate marker for various events that culminate in later adverse cognitive outcome. METHODS: Among 160 eligible patients with D-transposition of the great arteries undergoing reparative surgery in infancy, 155 (97%) were reevaluated at age 8 years with IQ and achievement testing. We explored whether LOS quartiles were associated with these outcomes when adjusting for perioperative and sociodemographic variables. RESULTS: Longer cardiac intensive care unit (CICU) LOS quartiles were associated at age 8 years with lower full-scale IQ (P=.02), lower verbal IQ (P=.02), and with tendencies toward lower performance IQ (P=.08) and math achievement (P=.08) in adjusted models. Compared with patients in the first quartile of CICU LOS, those in the fourth quartile had mean scores for full-scale IQ that were lower by 7.2 points (P=.01); verbal IQ, 7.3 points (P=.02); performance IQ, 5.8 points (P=.05); and math achievement, 6.0 points (P=.07). Analyses on hospital LOS quartile were similar. CONCLUSIONS: Longer postoperative LOS is associated with worse later cognitive function, even when adjusted for perioperative events, perfusion times, and sociodemographic variables. Further research is necessary to determine the mechanisms underlying this relation.     

Bronchoalveolar lavage cellularity in infants with severe respiratory syncytial virus bronchiolitis.

Aim: To examine over time, the cellular response within the lungs of infants ventilated with respiratory syncytial virus (RSV) bronchiolitis and to compare this response in infants born at term with those born preterm. METHODS: Non-bronchoscopic bronchoalveolar lavage (BAL) samples were taken from 47 infants (24 born at term and 23 born preterm) who were ventilated for RSV positive bronchiolitis and 10 control infants. BAL cellularity and differential cell counts were calculated using standard techniques. RESULTS: Total cellularity in BAL over the first four days of ventilation in infants with RSV bronchiolitis was greater in term infants (median 2.2 (IQR 4.27) x 10(6) cells/ml) compared with preterm infants (0.58 (1.28) x 10(6) cells/ml). The magnitude of the cellular response in preterm infants with bronchiolitis was similar to that in the control group measured on day 1 (0.62 (0.77) x 10(6) cells/ml). BAL cellularity decreased progressively from the time of intubation in term infants, but remained relatively constant in preterm infants up to seven days after intubation. CONCLUSIONS: There are differences in the magnitude and type of pulmonary cellular response in term and preterm infants ventilated with RSV bronchiolitis. The cellular response in term infants with bronchiolitis differs from that in a control group of infants. These differences may reflect variations in cellular recruitment in the lung and/or variations in airway calibre.     

Latent sensitisation to respiratory syncytial virus during acute bronchiolitis and lung function after recovery.

To determine whether latent sensitivity to respiratory syncytial virus antigen(s) occurs after infection, 27 infants with acute bronchiolitis were studied and compared with 15 hospital controls. Blood was collected for whole blood challenge, and histamine release was measured by a high performance liquid chromatography technique with fluorometric detection. There was a significantly greater histamine release to respiratory syncytial virus antigen(s) in those with bronchiolitis than in controls, expressed either in amount (median 154 nmol/l compared with 104 nmol/l) or percentage release (median 20% compared with 3%). There was a significant difference between index and control groups in terms of individual histamine responses. These findings strongly suggest that infants develop latent sensitivity to respiratory syncytial virus antigen(s) during the course of acute bronchiolitis. Serial lung function tests were performed in 15 infants. All infants had abnormalities of lung function at some stage, but the small numbers of subjects precluded comparison between ''sensitised'' and ''non-sensitised'' infants. Further study is indicated to define the relation of latent sensitisation and subsequent bronchial hyper-responsiveness after respiratory syncytial virus infection in infants.     

Rehabilitation and outcome after severe head injury.

After severe head injury, many children continue to experience major cognitive and behavioural problems and consequent educational difficulties, even after good physical recovery. Forty three children referred to the regional multidisciplinary head injury rehabilitation team are described. The clinical outcome at a median interval of 13 months after injury showed that 18 (42%) had persistent neurological impairment and 15 (35%) had an identified need for special educational support. Thirty seven children were further assessed for psychiatric morbidity, cognitive impairment, and classroom performance. Rutter behavioural questionnaires were sent to parents and teachers of head injured index cases and classmate controls matched for age and sex. Index parents scored their children significantly worse in both 'health' and 'habits' and more cases than controls had scores suggesting a psychiatric disorder. Teachers scored index cases significantly worse for five of the traits questioned, but discriminated cases from controls less decisively than parents. Index cases were significantly disadvantaged on teachers' assessments of classroom skills and performance. A need for improved support and training of staff who teach head injured children was identified.     

The outcome of bacterial meningitis in children is related to the initial antimicrobial therapy

Even when highly effective antibiotic therapy is provided to patients, death and long-term disabilities are common outcomes of acute bacterial meningitis (BM) in developing countries. The aim of this study was to analyze how the outcome of disease was related to the initial antimicrobial therapy used to treat the patients. We analyzed 277 children younger than 16 years of age who were treated for BM in the Hospital of Infectious Diseases in Prishtina, Kosova, over a six-year period. Of the 277 children treated for BM, 36.1% of cases were given initial antimicrobial therapy with one antibiotic, 63.2% of cases received two antibiotics and 0.7% of the cases received three antibiotics. Of the 60 patients who had neurologic complications (NC), 50 (28.6%) were treated with two antibiotics, 9 (9%) received one antibiotic and 1 patient was treated with three antibiotics. The antibiotics used most often as monotherapy were penicillin G (63 cases) and ceftriaxone (33 cases). The incidence of NC was higher in children treated with ceftriaxone (NC=22%, mortality [M]=3%) compared with patients treated with penicillin G (NC=3%, M=0). The most commonly used combination of antibiotics was ceftriaxone with chloramphenicol (82 cases) followed by penicillin G with chloramphenicol (63 cases). The incidences of NC and M were higher in children treated with ceftriaxone and chloramphenicol (NC=43%, M=8%) compared to children treated with penicillin G and chloramphenicol (NC=13%, M=3%). The initial treatment of BM with penicillin G did not result in death and was associated with a lower incidence of NC compared with the use of ceftriaxone. The combination of penicillin G and chloramphenicol resulted in a lower incidence of NC and M compared with the combination of ceftriaxone and chloramphenicol.     

T280M variation of the CX3C receptor gene is associated with increased risk for severe respiratory syncytial virus bronchiolitis

BACKGROUND: Recent data suggest that immunologic response during respiratory syncytial virus (RSV) infection is partially modified through interaction of viral G glycoprotein with the host's chemokine receptor, CX3CR1. We hypothesized that two nonsynonymous, single-nucleotide polymorphisms of the CX3CR1 gene (CX3CR1-V249I and CX3CR1-T280M) that disrupt the affinity of CX3CR1 for its natural ligand (fractalkine) could also affect the G glycoprotein-CX3CR1 pathway. METHODS: To test the hypothesis, DNA samples were obtained from 82 children hospitalized for RSV bronchiolitis in a 1-year period. One hundred twenty sex-matched healthy adults, without a history of severe lower respiratory tract infections, formed the control group. RESULTS: Epidemiologic data showed an increase in the RSV infection rate during the late winter season, with a peak rate in early spring. Genotyping revealed predominance of the 280M-containing genotypes (M/M or T/M) in cases compared with controls (37.8% versus 20.8%, respectively; odds ratio, 2.03; 95% confidence interval, 1.1-3.9; P = 0.025), demonstrating an association between the common CX3CR1-T280M variations and increased risk of severe RSV bronchiolitis. CONCLUSIONS: Our findings support the hypothesis of the pivotal role of the G glycoprotein CX3CR1 pathway in the pathogenesis of RSV bronchiolitis and propose CX3CR1 as a potential therapeutic target.