Prevalence and risk factors associated with wheezing in the first year of life

Objectiveto investigate the prevalence and risk factors associated with wheezing in infants in the first year of life.Methodsthis was a cross-sectional study, in which a validated questionnaire (Estudio Internacional de Sibilancias en Lactantes - International Study of Wheezing in Infants - EISL) was applied to parents of infants aged between 12 and 15 months treated in 26 of 85 primary health care units in the period between 2006 and 2007. The dependent variable, wheezing, was defined using the following standards: occasional (up to two episodes of wheezing) and recurrent (three or more episodes of wheezing). The independent variables were shown using frequency distribution to compare the groups. Measures of association were based on odds ratio (OR) with a confidence interval of 95% (95% CI), using bivariate analysis, followed by multivariate analysis (adjusted OR [aOR]).Resultsa total of 1,029 (37.7%) infants had wheezing episodes in the first 12 months of life; of these, 16.2% had recurrent wheezing. Risk factors for wheezing were family history of asthma (OR = 2.12; 95% CI: 1.76-2.54) and six or more episodes of colds (OR = 2.38; 95% CI: 1.91-2.97) and pneumonia (OR = 3.02; 95% CI: 2.43-3.76). For recurrent wheezing, risk factors were: familial asthma (aOR = 1.73; 95% CI: 1.22–2.46); early onset wheezing (aOR = 1.83; 95% CI: 1.75-3.75); nocturnal symptoms (aOR = 2.56; 95% CI: 1.75-3.75), and more than six colds (aOR = 2.07; 95% CI 1.43- .00).Conclusionthe main risk factors associated with wheezing in Fortaleza were respiratory infections and family history of asthma. Knowing the risk factors for this disease should be a priority for public health, in order to develop control and treatment strategies.     

Recurrent wheezing in preterm infants: Prevalence and risk factors

ObjectiveTo evaluate the prevalence and risk factors associated with progression to recurrent wheezing in preterm infants.MethodsThe cross-sectional study was carried out in 2014 and 2015 and analyzed preterm infants born between 2011 and 2012. The search for these children was performed in a university maternity hospital and a Special Immunobiological Reference Center. The evaluation was performed through a questionnaire applied during a telephone interview.ResultsThe study included 445 children aged 39 (18–54) months. In the univariate analysis, the risk factors with the greatest chance of recurrent wheezing were birth weight <1000 g, gestational age <28 weeks, living with two or more siblings, food allergy, and atopic dermatitis in the child, as well as food allergy and asthma in the parents. In the multivariate analysis, there was a significant association between recurrent wheezing and gestational age at birth <28 weeks, food allergy and atopic dermatitis in the child, and living with two or more children. Of the 445 analyzed subjects, 194 received passive immunization against the respiratory syncytial virus, and 251 preterm infants were not immunized. There was a difference between the gestational age of these subgroups (p < 0.001). The overall prevalence of recurrent wheezing was 27.4% (95% CI: 23.42–31.70), whereas in the children who received passive immunization it was 36.1% (95% CI: 29.55–43.03).ConclusionsPersonal history of atopy, lower gestational age, and living with two or more children had a significant association with recurrent wheezing. Children with lower gestational age who received passive immunization against the respiratory syncytial virus had a higher prevalence of recurrent wheezing than the group with higher gestational age.     

腺病毒肺炎患儿并发喘息的危险因素分析

目的:探讨儿童腺病毒(human adenovirus,HAdV)肺炎并发喘息的相关危险因素。方法:回顾性分析中国医科大学附属盛京医院儿科2019年1至12月期间因HAdV肺炎住院的2~5岁患儿97例、同期同龄非HAdV肺炎患儿100例的临床资料,再根据住院时有无喘息将97例HAdV肺炎患儿分为喘息组和非喘息组。对HA...     

尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素

目的 探讨尘螨阳性婴幼儿首次喘息后反复喘息发作的危险因素。方法 选取2014年8月至2015年2月间住院的首次喘息发作婴幼儿共1 236例,其中尘螨阳性387例,出院后随访1年,随访1年内再发喘息3次及3次以上的患儿设定为反复喘息组（n=67）,随访期间未再发生喘息的患儿设定为对照组（n=84）。采用单因素分析和多因素logistic逐步回归分析,探讨尘螨阳性的婴幼儿反复喘息发作的危险因素。结果 单因素分析显示,入院时年龄、入院前喘息时间、肺炎支原体感染率、流感病毒感染率与反复喘息发作相关联。多因素logistic逐步回归分析显示,入院时年龄较大（OR=2.21,P=0.04）、合并肺炎支原体感染（OR=3.54,P=0.001）为反复喘息发作的独立危险因素。结论 尘螨阳性的婴幼儿,特别是幼儿,若首次喘息时合并有肺炎支原体感染,则反复喘息发作的风险明显升高。     

婴幼儿喘息性社区获得性肺炎患儿血清炎症因子的变化

目的 通过测定婴幼儿喘息性社区获得性肺炎(CAP)患儿血清炎症因子的变化,了解婴幼儿喘息性肺炎是否与哮喘有相似的免疫机制。方法 喘息性CAP 47例、非喘息性CAP 42例、正常对照30例婴幼儿纳入该研究。比较3组间外周血C反应蛋白、降钙素原、可溶性髓系细胞触发受体-1、γ干扰素、白细胞介素4、白细胞介素10及骨膜蛋白水平。结果 喘息性和非喘息性肺炎组血降钙素原、可溶性髓系细胞触发受体-1、白细胞介素4、白细胞介素10 含量均高于正常对照组(PPP结论 婴幼儿喘息性肺炎存在γ干扰素/白细胞介素4比值失衡,存在气道嗜酸性粒细胞炎症,提示婴幼儿喘息性肺炎与哮喘有相似的免疫机制。     

外周血CD23表达阳性B淋巴细胞对婴幼儿喘息预后的早期预测作用

目的　探讨外周血CD2 3表达阳性B淋巴细胞 (CD2 3 /CD19 )在婴幼儿哮喘中的表达及对婴幼儿喘息预后的早期预测价值。方法　用流式细胞术测定 5 3例喘息性支气管炎 (喘息组 )、17例婴幼儿哮喘 (哮喘组 )、18例婴幼儿肺炎患儿 (肺炎组 )及 2 2例正常对照组儿童的外周血淋巴细胞CD2 3 /CD19 表达。并对 5 3例喘息性支气管炎做进一步随访。结果　 (1) 5 3例喘息性支气管炎患儿在随访 3年后 ,最终发展为儿童哮喘的有2 0例 (喘息Ⅰ组 ) ,喘息终止 33例 (喘息Ⅱ组 )。 (2 )婴幼儿哮喘组CD2 3 /CD19 表达较婴幼儿肺炎组、对照组增高 ,差异有显著性 (P <0 0 1) ;婴幼儿肺炎组与对照组比较差异无显著性 (P >0 0 5 )。 (3)喘息Ⅰ组CD2 3 /CD19 表达较婴幼儿肺炎组和对照组升高 (P <0 0 1) ,与婴幼儿哮喘组比较差异无显著性 (P >0 0 5 ) ;喘息Ⅱ组CD2 3 /CD19 表达与肺炎组、对照组比较差异无显著性 (P >0 0 5 )。 (4)喘息Ⅰ组CD2 3 /CD19 表达与喘息Ⅱ组比较差异有显著性 (P <0 0 1)。结论　婴幼儿哮喘及最终发展为哮喘的喘息性支气管炎患儿喘息早期表达CD2 3 /CD19 增高 ,CD2 3 /CD19 对婴幼儿喘息预后早期预测可能有重要价值。     

Neonatal sepsis as a risk factor for neurodevelopmental changes in preterm infants with very low birth weight

Objectiveto evaluate neonatal sepsis as a risk factor for abnormal neuromotor and cognitive development in very low birth weight preterm infants at 12 months of corrected age.Methodsthis was a prospective cohort study that followed the neuromotor and cognitive development of 194 very low birth weight preterm infants discharged from a public neonatal intensive care unit. The Bayley Scale of Infant Development (second edition) at 12 months of corrected age was used. The outcomes were the results of the clinical/neurological evaluation and the scores of the psychomotor development index (PDI) and mental development index (MDI) of the Bayley Scale of Infant Development II. The association between neonatal sepsis and neuromotor development and between neonatal sepsis and cognitive development was verified by logistic regression analysis.Resultsmean birth weight was 1,119 g (SD: 247) and mean gestational age was 29 weeks and 6 days (SD: 2). Approximately 44.3%(n = 86) of the infants had neonatal sepsis and 40.7% (n = 79) had abnormal neuromotor development and/or abnormal psychomotor development index (PDI < 85) at 12 months of corrected age. On the mental scale, 76 (39.1%) children presented abnormal cognitive development (MDI < 85). Children with neonatal sepsis were 2.5 times more likely to develop changes in neuromotor development (OR: 2.50; CI: 1.23‐5.10). There was no association between neonatal sepsis and cognitive development impairment.Conclusionneonatal sepsis was an independent risk factor for neuromotor development impairment at 12 months of corrected age, but not for mental development impairment.     

急诊科反复喘息婴幼儿需要住院并接受呼吸支持治疗的预测因素

目的 反复喘息患者多为2岁以下的婴幼儿。在热带国家,对该人群住院期间接受呼吸支持治疗的风险的临床预测模型研究较少。该研究旨在评估就诊于哥伦比亚急诊科的反复喘息婴幼儿需要住院并接受呼吸支持治疗的临床预测因素。方法 该研究是一项回顾性队列研究,纳入了2019年1~12月期间在哥伦比亚Rionegro的两个三级中心医院就诊的所有患有2次或2次以上喘息发作的婴幼儿（年龄均小于2岁）。主要结局指标是住院加呼吸支持治疗。采用多因素logistic回归模型确定需要住院并接受呼吸支持治疗的独立预测因素。结果 共85名婴幼儿住院并接受呼吸支持治疗,其中34名（40%）予以高流量鼻导管吸氧,2名（2%）予以无创通气,6名（7%）予以机械通气,43名（51%）予以常规氧疗。多因素logistic回归模型分析显示,早产（OR=1.79,95% CI：1.04~3.10）、喂养困难（OR=2.22,95% CI：1.25~3.94）、鼻煽和/或咕噜声（OR=4.27,95% CI：2.41~7.56）和既往有1次以上喘息发作需要住院治疗（OR=3.36,95% CI：1.86~7.08）是需要住院并接受呼吸支持治疗的预测因素。该模型特异度高（99.6%）,鉴别度中等,曲线下面积为0.70（95% CI：0.60~0.74）。结论 该研究表明,早产、喂养困难、鼻煽和/或呼噜声,以及有1次以上需要住院治疗的喘息发作史,是急诊科就诊的反复喘息婴幼儿需要住院并接受呼吸支持治疗的独立预测因素。然而,还需收集更多的其他热带国家的证据来验证这个结论。     

Prevalence and factors associated with vitamin A deficiency in children and adolescents

ObjectiveTo identify the prevalence and factors associated with vitamin A deficiency (VAD) in children and adolescents.MethodsThis was a cross-sectional study involving 546 schoolchildren, aged between 7 and 14 years, of both genders, enrolled in public elementary schools. Blood was collected for measurement of serum retinol. The retinol concentration in the samples was determined by high performance liquid chromatography (HPLC). Data were collected on anthropometrics, dietary, demographic, and socioeconomic factors. Polytomous logistic regression was used to evaluate the associations of interest.ResultsApproximately 27.5% of the students had retinol values < 30 μg/dL. The multivariate analysis showed, after the appropriate adjustments, a positive and statistically significant association of moderate/severe VAD (OR = 2.19; 95% CI 1.17 to 4.10) and marginal VAD (OR = 2.34; 95% CI 1.47 to 3.73) with age < 10 years. There was also association of VAD moderate/severe (OR = 2.01; 95% CI 1.01 to 5.05) and borderline VAD (OR = 2.14; 95% CI: 1.08 to 4.21) with the anthropometric status of underweight. Lower intake of retinol was detected among those with severe VAD.ConclusionVAD is a health concern among children and adolescents. Lower weight and younger schoolchildren had greater vulnerability to VAD.     

Risk factors in wheezing infants

BACKGROUND: Some lifestyle factors may be important for the occurrence of wheezing and there are considerable differences around the world. METHODS: Risk factors of wheezing were examined in 38 children (aged 6-24 months). Results were compared with healthy age-matched controls. RESULTS: Family history of atopy, asthma and eczematoid dermatitis, and parental and pregnancy smoking were all reported as being substantially more common in wheezing infants than in controls (P < 0.05 for each parameter). Living conditions showed that the incidence of wheezing in infants was more common in households with wooden floor coverings compared with controls, which used plastic floor coverings (P < 0.05). They also showed that 55.3% of wheezing infants and only 20% of controls were living in moist dwelling environments (P < 0.05). With regard to bedding, the incidence of wheezing in infants was higher in households using synthetic materials compared with controls (P < 0.05). A history of in utero and environmental tobacco smoke exposure was associated with increased risk of recurrent wheezing. Odds ratio and logistic regression analysis were done with presence of wheezing as the dependent variable and all risk factors of interest as independent variables. Family history of atopy, high household humidity levels, parental smoking and wooden floors used in the home were significant risk factors for wheezing. Skin test positivity and gastroesophageal reflux were determined in wheezing infants as 18.4 and 13.2%, respectively. CONCLUSION: Recurrent wheezing in infancy may be associated with many environmental and genetic factors. It is possible that allergen avoidance merely delays rather than prevents the development of allergic disorders.     

肥胖对哮喘预测指数阳性喘息婴幼儿治疗效果的影响

目的 探讨肥胖对哮喘预测指数（API）阳性喘息婴幼儿治疗效果的影响。方法 选取API 阳性的喘息婴幼儿208 例,按Kaup 指数分为肥胖组（93 例）和非肥胖组（115 例）。在急性喘息发作期给予综合治疗,缓解期给予吸入性糖皮质激素（ICS）布地奈德混悬液压缩泵雾化吸入治疗。根据临床控制情况调整ICS治疗用量,共治疗6 个月。治疗后2 周随访1 次,之后每月随访1 次。结果 治疗后2 周、1 个月肥胖组的临床症状缓解率分别为35.5% 及75.3%,低于非肥胖组的53.0% 和87.8%（P P 结论 肥胖可抑制API 阳性喘息婴幼儿对ICS 治疗的反应。     

早产儿医院感染危险因素临床分析

目的探讨早产儿医院感染发病的危险因素。方法回顾性分析2009—2012年本院新生儿科收治的早产儿病例资料,选择生后24 h内入院、住院时间>48 h、除外产前细菌感染史的病例,按照是否发生医院感染分为感染组与非感染组,将胎龄<32周、出生体重<1500 g等13项因素视为可疑危险因素,应用卡方检验及多因素非条件逐步Logistic回归分析明确早产儿医院感染的独立危险因素。结果共纳入588例早产儿,感染组259例,非感染组329例,单因素分析结果显示,胎龄<32周,出生体重<1500 g,开奶日龄>5天、机械通气、经外周中心静脉置管、动脉置管、住院时间>2周、预防性应用抗生素8项因素与医院感染相关;进一步Logistic多因素回归分析显示,胎龄<32周(OR=1.731,95%CI 1.054~2.875)、出生体重<1500 g(OR=1.843,95%CI1.052~3.286)及住院时间大于2周(OR=6.445,95%CI 3.883~10.694)为早产儿医院感染的独立危险因素。结论早产儿胎龄越小、出生体重越低、住院时间越长,越易发生医院感染;预防早产儿医院感染的有效措施为加强产前保健,从根本上减少早产儿及低出生体重儿的出生。     

IgG subclasses in wheezing infants

The wheezing infant is a common but difficult patient to approach diagnostically. The prevalence of IgG subclass antibody deficiency in wheezing infants is still controversial. We studied serum concentration of IgG subclasses in 38 wheezing infants (aged 6–24 months who had not received systemic steroids before investigation) and in 30 healthy age matched control (aged 6–24 months). The prevalence of one or more IgG subclass deficiency was 31.6% in wheezing infants and 26.7% in controls. There was no significant difference in prevalence of IgG subclass deficiency between patients and controls (p>0.05). The mean concentration of IgG subclasses in patients were compared with controls. There was no significant difference in mean serum concentration of IgG1, G2 and G3 subclasses. But there was a trend towards higher concentrations of IgG4 in wheezing infants and this difference for IgG4 was significant (p<0.01). However, IgG subclass deficiency was found in 25% and 36.4% of wheezing infants who had experienced from two to four and five or more wheezing episodes in two years, respectively (p>0.05). These findings suggest that wheezing in infancy is not associated with IgG subclass deficiency and in wheezing infants low IgG subclass levels do not increase the frequency of wheezing.     

新生儿先天性膈疝死亡危险因素分析

目的 探讨导致先天性膈疝（congenital diaphragmatic hernia,CDH）死亡的危险因素.方法 回顾性分析近10年来诊断明确的37例CDH患儿,分析其临床特点和危险因素,利用非条件多元回归进行死亡危险因素分析.结果 37例患儿中有29例进行了手术,其中CDH总病死率为32.4％（12/37）,手术病死率为13.8％ （4/29）.存活组（25例）与死亡组（12例）间,在出生体重[（3.12±0.41）kg vs （2.66±0.65） kg]、住院年龄[（135.14 ±209.71）h vs （6.67 ±7.79）h]、住院时间[（16.52±6.23）d vs （1.25 ±1.38）d]、氧合指数[（239.55±115.95） mmHg vs （96.10±59.18） mmHg,1 mmHg=0.133 kPa]、早期产前诊断（3例vs 6例）、右侧膈疝（1例vs 4例）、心脏畸形（2例vs 6例）和持续性肺动脉高压（3例vs 7例）等差异有统计学意义（P＜0.05）.通过多元回归分析,CDH的死亡危险因素分别为产前诊断（OR=20.97,95％ CI 1.60～ 275.78）,低氧合指数（OR=18.12,95％ CI 0.80 ～ 123.12）和心脏畸形（OR=22.0,95％CI 1.46～332.32）.结论 CDH有较高的病死率,死亡危险因素为产前诊断、低氧合指数和心脏畸形.     

婴幼儿喘息的病因及相关危险因素分析

目的：调查婴幼儿喘息的病因及相关危险因素。方法：回顾性复习180例喘息婴幼儿的临床资料,采用logistic回归分析调查喘息发作的危险因素。结果：病因分布中由病毒诱发的喘息占33.3%,哮喘占19.4%,支原体感染占6.7%,胃食道反流占12.8%,支气管肺发育畸形占4.4%,早产占7.8%,父母吸烟以及特殊环境占15.6%。多因素logistic回归分析显示,父母过敏史、患儿食物以及吸入变应原致敏、病毒感染、支原体感染、早产、特殊环境等7个因素最终进入主效应模型,与喘息发作有显著相关性。结论：婴幼儿喘息发作以病毒诱发为主,哮喘的比例也相对较高,遗传因素、自身特应性、环境因素与喘息发作密切相关。     

Risk factors for neonatal death in the capital city with the lowest infant mortality rate in Brazil

Objectives

To analyze the risk factors for neonatal death in Florianópolis, the Brazilian city capital with the lowest infant mortality rate.

Treatment of recurrent acute wheezing episodes in infancy with oral salbutamol and prednisolone

The aim of this study was to investigate the role of oral salbutamol and prednisolone in the treatment of acute episodes of wheezing in infants under 15 months of age. Sixty-two acute episodes of wheezing were studied in 59 babies (age range 3–14 months; mean 7 months), who had all suffered at least one previous wheezy episode. Patients were randomised to receive either salbutamol and prednisolone, salbutamol and placebo or double placebo. Parents were requested to keep a diary card record of twice daily scoring of their baby's symptoms over the next 14 days. A significantly greater number of treatment failures occurred in the placebo group compared to babies treated with oral salbutamol (relative risk 2.51; 95% confidence intervals for relative risk 1.09–5.79). There was no difference in the number of treatment failures between babies treated with a combination of salbutamol and placebo and those treated with salbutamol and prednisolone (relative risk 0.71; 95% confidence intervals for relative risk 0.18–2.80).Conclusion This study demonstrates that oral salbutamol is beneficial in the treatment of acute episodes of wheezing in infancy. A combination of oral salbutamol and oral prednisolone appeared to have no additional benefit over treatment with oral salbutamol alone.     

极低出生体质量儿支气管肺发育不良的临床高危因素分析

目的 探讨极低出生体质量儿发生支气管肺发育不良(bronchopulmonary dysplasia,BPD)的临床高危因素.方法 回顾性分析2006年9月至2009年9月我院NICU收治的49例极低出生体质量儿的临床资料,分为BPD组(n=15)和非BPD组(n=34),分析BPD发生的可能危险因素.结果与非BPD组相比,BPD组患儿在胎龄[(29.30±1.48)周vs(30.54±1.60)周]、院内获得性感染(9例vs 10例)、宫内感染(9例vs 8例)、持续气道正压通气时间[(12.47±5.83)d vs(4.24±4.19)d]、高浓度氧疗时间[(1.47±1.41)dvs(0.18±0.63)d]、动脉导管未闭(5例vs 1例)等方面比较,差异有统计学意义(P均＜0.05).Logistic回归分析结果显示持续气道正压通气时间以及宫内感染是极低出生体质量儿发生BPD的高危因素(P＜0.05).结论 预防宫内感染可降低BPD的发生率和严重程度,长时间的持续气道正压通气可能预示早期BPD的发生.     

Risk factors associated with bronchial asthma in school going children of rural Haryana

Bronchial asthma is one of the most common illnesses in children. Factors influencing development of asthma have not been studied in rural population. 2000 school going children from five schools of Chhainsa and Dayalpur Primary Health Centre area in Ballabgarh Block of Haryana state were screened for presence of symptoms of asthma using a questionnaire suggested by International Study of Asthma and Allergy in Children (ISSAC). 40 children were identified as cases of bronchial asthma. For each child with asthma two age and sex matched nonasthmatic controls were selected from the study population. History, clinical examination and in-depth interview were carried out for all cases and controls. Factors associated with presence of symptoms of asthma on multivariate analysis were passive smoking (OR 3.33, 95% CI 1.85–7.65), pets at home (OR 5.5, 95% CI 1.04–29.15), and absence of windows in living rooms (OR 4.03, 95% CI 1.17–13.79). Factors such as family history of asthma, history of worm infestation, fuel used for cooking, location of kitchen and food allergy were not significant on statistical analysis. Thus, passive smoking, inadequate ventilation and pets (dogs and cats) at home are significant risk factors associated with presence of symptoms of asthma in rural children.     

婴幼儿喘息与呼吸道合胞病毒肺炎支原体感染及过敏的关系

目的了解婴幼儿喘息性疾病与呼吸道合胞病毒、肺炎支原体感染的关系,同时进行常见食物过敏原和吸入过敏原筛查,旨在探讨婴幼儿喘息与呼吸道合胞病毒、肺炎支原体感染及过敏的关系及其与支气管哮喘的相关性。方法对2000-01—2003-12在南京中医药大学附属医院就诊的232例下呼吸道感染的婴幼儿进行呼吸道合胞病毒、肺炎支原体抗体的检测,并进行过敏原检测,收集特异性体质的表现及家族史,对有喘息症状的部分患儿进行随访。结果喘息组患儿以上2种病原体感染率高于非喘息组;81例喘息患儿随访中,有67.90%(55例)的患儿转为哮喘,这部分患儿的特应性体质表现及家族史与发病密切相关。结论婴幼儿喘息性疾病与呼吸道合胞病毒、肺炎支原体感染密切相关,过敏是婴幼儿反复发生喘息性疾病的重要危险因素。