How to enter the pediatric airway for bronchoscopy

BACKGROUND: Bronchoscopies are performed in childhood for diagnostic reasons (e.g. evaluation of stridor, unexplained cough, possible malformations) and therapeutic reasons (e.g. foreign body removal, management of the difficult airway). METHODS: Various procedures of entering the pediatric airways are presented, based on an overview of the literature and the experience of the authors. RESULTS: The advantages and disadvantages of direct fibreoptic bronchoscopy, bronchoscopy via face mask, via laryngeal mask airway, via tracheal tube, and for combined flexible and rigid bronchoscopy are discussed. In addition, practical aspects of bronchoscopy are considered, including local anesthesia, oxygen supplementation, monitoring, antibiotic treatment. CONCLUSIONS: Although inspection of the pediatric airways has become a well-accepted routine procedure with a high diagnostic yield, and bronchoscopies are well tolerated, it is important that the most appropriate means of access to the airways is chosen according to the indications and the age of the child.     

Flexible fiberoptic bronchoscopy

Although the availability of flexible fiberoptic bronchoscopy (FFB) has been a major advance in adult pulmonary medicine, the role of FFB in pediatric patients is not well defined. In this article, we try to review our 10-year experience in over 4,000 cases where FFB has been utilised. We feel that this procedure is safe, cost effective and is tolerated much better than the laryngoscopy or open tube bronchoscopy. It is rapid in diagnosing upper airway obstruction and can be done in an upright position.     

Antivenom therapy for snakebites in children: is there evidence?

PURPOSE OF REVIEW: A new Fab fragment antivenom (CroFab) for the treatment of crotaline envenomation, the predominant venomous snakebite in the United States, has drastically changed snakebite management since its release in December 2000. This review examines the evidence supporting the use of CroFab, with particular attention on the pediatric population. RECENT FINDINGS: The published experience with CroFab in humans consists of six studies and some case reports. These publications demonstrate that CroFab is highly efficacious in treating both the local and systemic toxic effects of crotaline envenomation. They identify an important phenomenon of recurrent or delayed toxicity in some patients. The studies report a very low incidence of acute or delayed hypersensitivity reactions to the antivenom. They suggest comparable efficacy and safety of CroFab in the pediatric population as in adults. SUMMARY: Based on limited data, CroFab has been shown to be a safe and efficacious antivenom for use in children as well as adults. Further studies are needed to refine our understanding of its efficacy, safety, indications, and dosing.     

纤维支气管镜对儿童难治性肺炎支原体肺炎的诊断治疗价值

肺炎支原体是儿童社区获得性肺炎主要病原体之一, 近年来, 难治性肺炎支原体肺炎发病率越来越高,儿童用药较为有限。纤维支气管镜在儿童难治性肺炎支气管肺炎的诊断及治疗方面有重要作用。该文从支气管镜下气管内膜病变、 灌洗液病原分析、 细胞因子分析、 支气管肺泡灌洗术、 气道清理及局部注药治疗等方面来阐述纤维支气管镜对儿童难治性肺炎支原体肺炎的诊断及治疗价值。     

Severe acute asthma in the child

OBJECTIVE: To present a current review about diagnosis and treatment of severe acute asthma, based on the reviewed publications and the author? personal experience. METHODS: We reviewed the most relevant articles about diagnosis and management of severe acute asthma. RESULTS: Severe acute asthma is an important cause of morbidity in children and it can usually lead to respiratory failure. The diagnostic (clinical manifestations and lung function tests) and treatment (oxygen, bronchodilators and steroids) are now well determined by the literature, and are very important for a good prognosis of every patient. CONCLUSIONS: Considering severe acute asthma a prevalent condition in pediatric emergency room and intensive care unit, the ability to make an early diagnosis of this condition, associated with a prompt treatment, are essential for an effective reduction in morbimortality rates.     

Underweight problems in Asian children and adolescents

Most reviews on weight status have focused on obesity, and little information on underweight children is available. This review aimed to examine the prevalence and trends of underweight status among Asian children and adolescent populations in the last two decades. A systematic review of publications between the years 1990 and 2010 was conducted. Underweight in children and adolescents was relatively more prevalent in the South and West Asian countries than in the East Asian countries. In general, underweight was more prevalent in boys within the South and West Asian countries, while it was more prevalent in girls within the East Asian countries. Increasing trends of prevalence of underweight were common among children and adolescents in South and West Asia. Specific public health policies should be formulated to combat the underweight problems in less-developed countries.     

Subacute sclerosing panencephalitis (SSPE) in an adolescent Ethiopian girl

Some 50 years have elapsed since Dawson first described a 16-year-old girl with an inclusion encephalitis. Since then, numerous publications on subacute sclerosing panencephalitis (SSPE) have appeared in the world literature. However, most of these reports are from the developed world. There have been few reports from Africa. One of them was from Kenya, where a retrospective analysis of EEGs of patients with epilepsy over a 5-year period identified 53 probable cases of subacute sclerosing panencephalitis (1). The other one was from South Africa where an incidence of 1.2 per million per year was reported on the basis of 15 cases collected from two hospitals in the Cape Province (2). No case, as yet, has been reported from Ethiopia. This paper reports SSPE presenting in an adolescent Ethiopian girl who had measles at the age of 18 months.     

Safe feeding practices for infants and young children

Objective : To review local and overseas experience of food asphyxia in children and to examine aspects of safe childhood eating practices.
Methodology : Inpatient separation information data for childhood hospital admissions in South Australia were searched for episodes of food-induced airway obstruction and case records of the Department of Histopathology at the Women's and Children's Hospital were searched for cases of fatal food asphxia.
Results : While other forms of injury to young children appear to be declining in numbers, episodes caused by choking on food have remained relatively constant. The increase in average length of hospital stay (from 2.8 days in 1989-90 to 5.2 days in 1993-94) also suggests that the episodes have been more severe. Two fatal cases were also found.
Conclusions : Choking due to food inhalation is a problem with potentially fatal consequences. Young children are particularly at risk as they have immature dentition and control of swallowing, and lack experience of food. Although young children should avoid potentially dangerous foods such as raw carrot sticks and raw apples, certain currently available information packages for parents recommend these foods.     

经支气管镜介入治疗在气道发育异常中的应用

支气管镜是诊治儿童呼吸系统疾病不可缺少的方法之一,是儿童肺介入治疗技术不断发展的基础。随着临床经验的不断积累及支气管镜在儿科的广泛应用,其价值得到了一致肯定。该文将对经支气管镜介入治疗在气道发育异常中的应用概况作一综述。     

Ethical dilemmas in seeking consent for a postmortem examination

The past two years have seen considerable focus on postmortem practice. This largely follows two inquiry reports from the Bristol Royal Infirmary and Royal Liverpool Children's Hospital and the associated public reaction. In response, there have been numerous further publications which include guidelines and declarations of intent from the Department of Health; some important responses are still in draft form. Although it might be supposed that these changes will affect only pathologists, it is the process of consent that is the main focus of most recommendations. Paediatricians will need far more knowledge of the issues around the postmortem examination than formerly. There is still some uncertainty and debate as to the limits of discussions that may be needed before postmortem consent can be considered informed. This article will review aspects of usual postmortem practice and some of the issues raised by the various recent reports. Emphasis will be placed on the concerns of parents revealed over the past year or so.     

儿科介入呼吸病学技术进展

随着儿科支气管镜术的发展、临床经验的积累,适应证不断地扩大,其在儿童呼吸系统疾病中的作用越来越重要。现通过介绍近年来儿科支气管镜术的新技术,如经支气管镜球囊扩张术、经支气管镜消融术、经支气管镜支架置入术、经支气管镜肺活检术、经支气管镜针吸活检术等,简要阐述儿童介入肺科学新技术进展情况。     

Flexible bronchoscopy in children: Indications and general considerations

There is considerable interhospital variability in the practice of flexible bronchoscopy in children. The present report aims to provide some recommendations that are supported by the Spanish Society of Pediatric Pulmonologists. We review the indications, contraindications, equipment, setting and personnel involved in flexible bronchoscopy, as well as the pre-procedure preparation of the patient, medications, post-procedure monitoring, complications, care and maintenance of instruments, and informed consent. These recommendations may be adopted, modified or rejected according to clinical needs and constraints.     

Evolution in pediatric health care

Background: There is disturbing evidence of escalating chronic disease among children – a phenomenon that is extracting a heavy toll from individuals, families, and health‐care systems. Methods: This review was prepared by assessing medical and scientific literature available from Medline, as well as by reviewing numerous books, conference proceedings, and government publications. Results: Knowledge translation in medical science, the process whereby new research is incorporated into clinical practice, remains lethargic. Nutritional and environmental factors have recently been recognized as common determinants of modern illness, and various diagnostic techniques in molecular medicine are now available to facilitate diagnosis of disease etiology. Conclusions: A re‐evaluation of the current pediatric clinical paradigm is required in light of emerging research from fields such as epigenetics, molecular medicine and environmental health. Education about these branches of medical science should be integrated into pediatric medical education, and important research information from these disciplines should be incorporated into public health care and clinical practice relating to children.     

Infections in the malnourished: with special reference to malaria and malnutrition in the tropics

The inter-relationship of malnutrition and infections is generally accepted as being synergistic, one promoting the other. Nevertheless, numerous published reports are available which highlight the contrary, that is, antagonism of poor nutrition to infections. This presentation is a review of such publications with emphasis on malaria and malnutrition in the tropics. The data presented suggest that the effect of poor diets on human malaria is related to the level of protein and energy intake, which in turn have important bearings not only on clinical nutrition but also on nutrition policy and planning, particularly in famine and famine relief. The data highlight the necessity for the integration of nutritional programmes and anti-malarial activities in areas where famine and malaria co-exist.     

输尿管软镜在小儿泌尿外科中的应用进展

本综述介绍了输尿管软镜术在小儿泌尿外科的应用进展,总结了历年国际及国内范围的相关报道,分别从上尿路结石、上尿路肿瘤、肾盂输尿管连接部梗阻(UPJO)、肾盏憩室、尿道狭窄等方面做了详细的描述.通过讨论可知输尿管软镜术对小儿上尿路疾病的诊疗有着不可或缺的地位,对一些特殊的下尿路疾病也可发挥其独特的优势,取得良好的效果.但其在小儿泌尿外科的开展尚未成熟,仍需要更多规范的临床科研工作,推动小儿输尿管软镜手术的大量开展,以进一步提高我国小儿泌尿外科微创治疗水平.     

硬质气管镜术在现代儿科介入呼吸病学的应用

硬质气管镜是诊断及治疗气道疾病的有效技术, 但操作风险大、 并发症多。近年随着设备改良和技术进步, 硬质气管镜操作的安全性有所提高, 临床应用开始增多。在硬质气管镜的临床应用中, 临床医师应多根据临床经验进行判断,熟练掌握插入技术, 了解应用指征,保证其安全有效地应用。     

Fibreoptic bronchoscopy without general anaesthetic.

We have used flexible fibreoptic bronchoscopy using sedation and local anaesthesia in 50 children aged 2-19 years (median 10) using an Olympus BFP20 instrument. Indications were opportunistic pneumonias (n = 11), persistent atelectasis (n = 11), recurrent pneumonia (n = 7), miscellaneous lower airway disease (n = 7), recurrent wheezing (n = 3), haemoptysis (3), to diagnose infection or rejection of heart-lung transplants (n = 3), stridor (n = 2), suspected airway compression (n = 1), evaluation of tracheostomy (n = 1), and suspected foreign body (n = 1). In 43 cases (86%) the diagnosis was related to the primary indication. In five (10%) unrelated abnormalities were found, and five (10%) were normal. In 13 (26%) treatment was altered as a result of flexible fibreoptic bronchoscopy. Complications were transient respiratory arrest (n = 2), hypoxia (n = 2), pneumonia (n = 2), and laryngospasm (n = 1). All complications were followed by complete recovery. Our results suggest that flexible fibreoptic bronchoscopy is safe. Advantages over rigid bronchoscopy include greater visual range, fewer complications, and the avoidance of a general anaesthetic. Though invasive it can yield important diagnostic and therapeutic information.     

经支气管镜治疗儿童塑型性支气管炎的疗效

塑型性支气管炎(PB)是引起儿童严重呼吸窘迫的一种呼吸急症,支气管镜在儿童PB的诊断及治疗中有重要作用,儿科临床医师应提高对其的认识水平,并熟悉掌握经气管镜治疗PB的时机、硬式气管镜或软式气管镜的选择、经气管镜介入治疗的疗效及支气管镜治疗的安全性,使更多的PB患儿在支气管镜的检查及治疗中获益。     

Use of subtelomeric fluorescence in situ hybridization in cytogenetic diagnosis

During the last few years there has been an increasing number of reports of chromosomal abnormalities identified by subtelomeric fluorescence in situ hybridization testing in children with unexplained mental retardation. As more children are identified with subtelomeric deletions, duplications, and cryptic unbalanced rearrangements by this testing, questions have arisen regarding the appropriate use of this new technology. A review of current knowledge regarding the clinical phenotypes seen in these patients as well as of newer information regarding the use of this new cytogenetic test in areas outside clinical genetics may help to determine which patients would benefit from its use.     

食管闭锁术后食管气管瘘复发再手术的临床分析

目的：分析食管闭锁（EA）术后食管气管瘘复发（RTEF）再手术的临床资料,总结RTEF的原因、诊断方法及再手术的经验。方法回顾性分析2005年1月至2013年12月我们收治的10例EA术后RTEF患儿的临床资料,其中男7例,女3例,再手术平均年龄为19个月,平均体重为8.3kg,所有病例均为GrossⅢ型;10例中有9例曾接受经右胸食管气管瘘结扎＋食管端端吻合术。结果在初次手术中有4例（4/10）瘘管并未切断。9例（9/10）复发瘘管的食管端开口于原食管吻合口狭窄处或近端食管。8例（8/10）术后存在不同程度吻合口狭窄,1例合并吻合口瘘。再手术前所有患儿行食管欧乃派克造影检查,确诊和疑似RTEF分别为5例（5/10,50％）、4例（4/10,40％）。所有RTEF通过胃镜及支气管镜确诊（10/10,100％）。患儿均接受再次进胸手术,平均手术时间3.2h,平均术后住院时间为15.8d。术后均获随访3～96个月,食管造影提示所有病例均治愈,未再发生RTEF。结论 EA术后RTEF与初次手术瘘管处理不当、食管吻合口局部炎症反应等因素有关,需再次手术治疗,再手术的疗效及患儿预后良好。