Contribution of viruses to severe pneumonia in children

ObjectiveCommunity acquired pneumonia (CAP) accounts for more than two million deaths per year in children less than 5 years of age, mostly in developing countries. Viruses causing CAP have been identified in up to 50% of patients in studies using the real-time polymerase chain reaction (PCR). This study aimed at screening of viral etiology among hospitalized children with severe pneumonia.MethodsIn this prospective study conducted at Cairo University Children’s Hospital from 31st March 2010 to 1st April 2011 on 733 children admitted with a clinical and radiological diagnosis of pneumonia, nasopharyngeal or throat swabs were analyzed for common respiratory viruses, including respiratory syncytial virus (RSV), human metapneumovirus (hMPV), influenza B (Flu B), human parainfluenza virus (hPIV), influenza A (H1N1) and adenovirus (ADV) using the real time PCR technique.ResultsOne or more respiratory viruses were detected in 311 patients. RSV was the most commonly detected virus isolated in 197(63.3%) followed by hPIV in 38(12.2%), hMPV in 34(10.9%) and ADV in 26(8.4%) patients. Six cases were positive for H1N1 making the virus the second least common, after Flu B, identified in a single patient in our study. Mixed infection with more than one respiratory virus was detected in 156(45%) cases.ConclusionRSV was the most predominantly isolated virus from all patients in addition to being the most common single virus to cause pneumonia in children with chronic diseases. Although the most commonly isolated virus in our study, RSV came third in causing complications following hPIV & H1N1, but this observation cannot be applied to the community.     

The multicenter Italian birth cohort study on incidence and determinants of lower respiratory tract infection hospitalization in infants at 33 weeks GA or more: preliminary results

BackgroundRespiratory syncytial virus (RSV) causes respiratory infections during the first year of life. Very premature infants have more severe diseases and also ‘late preterm infants’ may be more susceptible to the infection.Aim of the studyTo evaluate in an Italian cohort the incidence and risk factors of severe hospitalized lower respiratory tract infection (LRTI) induced or not by RSV during the first year of life.MethodsA cohort of 33^+ 0d–34^+ 6d wGA newborns paired with two sex- and age-matched 35^+ 0d–37^+ 6d wGA and ≥ 38^+ 0d wGA newborns were enrolled. Hospitalization for LRTI induced or not by RSV during the first year of life was assessed through phone interview at the end of the RSV season (November–March) and at the completion of the first year of life. The parents were asked to report hospitalization for any reason.Results1064 neonates were enrolled (November 2009–October 2010), 697 had at least one phone follow-up by September 2010. Babies of 33^+ 0d–34^+ 6d wGA were more frequently conceived through assisted fertilization technologies, born from cesarean delivery had more frequently acute perinatal risk factors and were more frequently twins. After a mean 6 month-follow-up, we registered 29 hospitalizations for LRTI induced or not by RSV. Hospitalizations were slightly and non-significantly more frequent in 33^+ 0d–37^+ 6d wGA infants. The risk of hospitalization was significantly 60% reduced in breastfed babies and four folds significantly increased during the RSV season.ConclusionThe very preliminary data of this ongoing study suggest that in ‘late-preterm’ infants some individual/environmental characteristics of the infants play a relevant role in determining the risk of severe RSV infection.     

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns

ObjectiveThe stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome.MethodThis study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours.ResultsThe sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8–22) stable microbubbles/mm²; control group = 100 (48–230) microbubbles/mm² (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85–0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm², the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively.ConclusionThe study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.     

Association between multiple respiratory viral infections and pediatric intensive care unit admission among infants with bronchiolitis

BackgroundIt is unclear whether multiple respiratory viral infections are associated with more severe bronchiolitis requiring pediatric intensive care unit (PICU) admission. We aimed to identify the association between multiple respiratory viral infections and PICU admission among infants with bronchiolitis.MethodsWe performed a 1:1 case-control study enrolling previously healthy full-term infants (≤12 months) with bronchiolitis admitted to the PICU as cases and those to the general pediatric ward as controls from 2015 to 2017. Multiplex polymerase chain reaction (PCR) was used for detection of the respiratory viruses. We summarized the characteristics of infants admitted to the PICU and the general pediatric unit. Multivariable logistic regression analysis was used to fit the association between multiple respiratory viral infections (≥2 strains) and PICU admission.ResultsA total of 135 infants admitted to the PICU were compared with 135 randomly selected control infants admitted to the general pediatric unit. The PICU patients were younger (median: 2.2 months, interquartile range: 1.3–4.2) than the general ward patients (median: 3.2 months, interquartile range: 1.6–6.4). Respiratory syncytial virus (74.1%), rhinovirus (28.9%), and coronavirus (5.9%) were the most common viruses for bronchiolitis requiring PICU admission. Patients with bronchiolitis admitted to the PICU tended to have multiple viral infections compared with patients on the general ward (23.0% vs. 10.4%, P < 0.001). In the multivariable logistic regression analysis, bronchiolitis with multiple viral infections was associated with higher odds of PICU admission (adjusted odds ratio: 2.56, 95% confidence interval: 1.17–5.57, P = 0.02).ConclusionInfants with multiviral bronchiolitis have higher odds of PICU admission compared with those with a single or nondetectable viral infection.     

2013~2018年重庆地区2 066例急性下呼吸道感染住院患儿呼吸道合胞病毒流行特征分析

目的 研究急性下呼吸道感染住院患儿呼吸道合胞病毒（RSV）检出率、流行规律及临床特征。方法 收集2013年6月至2018年5月于重庆医科大学附属儿童医院呼吸中心住院的2岁以下急性下呼吸道感染（ALRI）患儿鼻咽抽吸物,采用多重PCR检测16种常见呼吸道病毒,分析RSV流行特征。结果 共纳入2 066例ALRI住院患儿,病毒检出阳性1 595份（77.20%）。其中RSV阳性检出826份（39.98%）。RSV阳性样本中,RSV-A阳性410份（49.6%）,RSV-B阳性414份（50.1%）,RSV-A与RSV-B均阳性2份（0.2%）。2013~2014年、2016~2017年主导流行亚型为RSV-B,2014~2015年、2017~2018年以RSV-A为主要检出亚型,2015~2016年为RSV-A与RSV-B共同流行。冬季检出率最高。RSV合并人鼻病毒为最常见的2种病毒混合检出组合（123份）。该组患儿较单一RSV检出患儿更易出现喘息（P=0.030）。在2 066例患儿中,单一RSV检出298份,RSV混合其他病毒检出148份,其他病毒检出389份,病毒检出阴性241份。RSV单一检出组较其他病毒检出组和病毒检出阴性组月龄更小,更易发生呼吸困难、呼吸衰竭及重症下呼吸道感染（P < 0.0083）。RSV-A阳性患儿中的男性比例高于RSV-B阳性患儿（P=0.004）,而临床表现二者未见显著差异。结论 2013~2018年重庆地区RSV-A与RSV-B既可分别主导流行,也可共同流行;RSV为急性下呼吸道感染住院患儿最主要病毒病原,易导致重症下呼吸道感染;RSV-A和RSV-B感染患儿临床表现无差异,但RSV-A更易感染男性患儿。     

The neonatal respiratory outcome in relation to timing of elective cesarean section at 38 versus 39 week gestation: A single center based study

BackgroundCesarean delivery per se is a risk factor of respiratory morbidity in term neonates and its timing is an adding factor of increased rates of respiratory complications.ObjectiveWe aimed to identify the association between elective cesarean delivery at 38 versus 39 week gestation and neonatal respiratory morbidity.Materials and methodsWe selected 200 pregnant women who underwent elective cesarean delivery at 38 or 39 week gestation at the Kasr El-Aini hospital. Mothers were subjected to ultrasound examination. Neonates with respiratory distress were subjected to laboratory investigations and chest X-ray.ResultsWe found no association between the development of any type of respiratory distress and maternal age or parity. The prevalence of respiratory morbidity was 25% in group A compared to 11% in group B (p = 0.01) and risk estimation showed that delivery at 38 weeks carries 2.7 time risk of having a newborn suffering from respiratory morbidity (95% CI: 1.2–5.8). TTN was observed in 11% of group A compared to 7% of newborns of group B (p = 0.6). RDS developed in 3 cases of group A, while none of group B developed RDS (p = 0.1). The rate of NICU admission, mechanical ventilation in the 1st 24 h and long hospital stay were insignificantly higher in group A (p>0.05). There were no neonatal deaths in both groups.ConclusionElective cesarean delivery at 39 week gestation is associated with a better neonatal respiratory outcome. Further studies are recommended to identify the best time of elective cesarean delivery associated with the least neonatal and maternal morbidity.     

Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhea and respiratory infections in institutionalized children

ObjectiveTo evaluate the incidence of diarrheal disease (DD) and acute respiratory infection (ARI) in children undergoing supplementation of zinc and other micronutrients through the use of sprinkles, as well as their acceptance by these patients.MethodThis was a randomized double-blinded clinical trial of 143 healthy institutionalized children, aged 6 to 48 months. They were randomized into two groups and received daily zinc and micronutrients – test group (sprinkles), or micronutrients without zinc - control group. Children were supplemented for 90 days and followed regarding the outcomes of DD and ARI.ResultsOf the randomized children, 52.45% belonged to the test and 47.55% to the control group. The incidence of DD in the test group was 14.7% and was 19.1% in the control group. The test group showed a lower risk of developing DD when compared to controls, but this finding was not statistically significant (RR = 0.77 [0.37 to 1.6], p = 0.5088). ARI had high incidence in both groups, 60% in the test group and 48.5% in the control group, with an increased risk of developing the disease in the test group, but with no statistical significance (RR = 1.24 [0.91 to 1.68], p = 0.1825). Regarding acceptance, the mean percentage of consumption, in days, of the entire content of the sachets containing sprinkles was 95.72% (SD = 4.9) and 96.4% (SD = 6.2) for the test and control groups, respectively.ConclusionsZinc supplementation through the use of sprinkles did not reduce the incidence of DD or ARI among the evaluated children. The sprinkles were well accepted by all study participants.     

6岁以下儿童急性下呼吸道感染的病毒病原及临床研究

目的　了解北京地区 6岁以下儿童中急性下呼吸道感染 (ALRI)患儿的病毒感染状况 ;探讨人类偏肺病毒 (hMPV)感染在儿童ALRI中的作用及所致支气管肺炎的临床特征。方法　 (1)采集 2 0 0 1年 2月至 2 0 0 3年 3月就诊于首都儿科研究所 4 4 6例年龄 1个月至 5岁的ALRI住院患儿的鼻咽分泌物 ,同时应用间接免疫荧光 (IFA)及病毒分离方法进行人类呼吸道合胞病毒 (hRSV)、流感病毒 (甲、乙型 )、副流感病毒 (Ⅰ、Ⅱ、Ⅲ型 )及腺病毒等 7种常见呼吸道病毒的病原检测。 (2 )采用逆转录聚合酶链反应 (RT PCR)方法对 2 0 0 2年 11月至 2 0 0 3年 3月住我院内科的ALRI患儿中经 7种呼吸道常见病毒病原检测阴性的 2 16份鼻咽洗液 ,进行了hMPV基因检测 ,并分析hMPV感染患儿的临床资料。结果　 (1) 4 4 6例患儿中 7种常见呼吸道病毒总阳性例数为 2 0 9例 (46 86 % ) ,hRSV阳性者最多为 16 3例 (36 5 5 % )。 (2 )在 2 16份上述 7种呼吸道病原检测阴性的标本中 6 9份测到hMPV阳性扩增产物 (31 9% ) ,占同期送检标本的 19 17%。结论　 (1)hRSV是北京地区冬春季节婴幼儿ALRI的主要病原。 (2 )2 0 0 2年 11月至 2 0 0 3年 3月我院ALRI住院患儿中有 19 17%与hMPV感染有关     

Comparison of three different noninvasive ventilation strategies as initial respiratory support in very low birth weight infants with respiratory distress syndrome: A retrospective study

BackgroundThere is inadequate evidence regarding which noninvasive ventilation (NIV) is superior for initial respiratory support of preterm infants with respiratory distress syndrome.ObjectivesTo compare the failure of noninvasive ventilation (NIV) and neonatal outcomes between nasal continuous positive airway pressure (NCPAP), bi-level positive airway pressure (BiPAP), and nasal intermittent positive pressure ventilation (NIPPV) as the initial respiratory support with less invasive surfactant administration (LISA) in very low birth weight (VLBW) infants.MethodsMedical records of 419 VLBW infants born at 26–30 weeks’ gestation who did not require intubation in the delivery room and were initially supported with either NCPAP (n = 221), BiPAP (n = 101), or NIPPV (n = 97) were retrospectively reviewed. The LISA approach was preferred in cases of surfactant requirement. The primary outcome was the failure of NIV within the first 72 h of life. Failure of NIV was defined as the persistence or recurrence of one or more of the following: hypoxemia, respiratory acidosis, more than one episode of apnea requiring bag and mask ventilation or more than six episodes of apnea requiring stimulation over a 6-h period. Data were analyzed using univariate and multivariate logistic regression analysis.ResultsFailure of NIV within the first 72 h of life was significantly higher in the NCPAP group (29.4%) compared with the BiPAP (12.9%) or NIPPV (12.4%) group (P < 0.001). However, the BiPAP and NIPPV groups were not different in terms of NIV failure (P = 0.91). Multivariable logistic regression analysis showed that antenatal steroid administration (OR: 0.49, 95% CI: 0.27–0.90; P = 0.02) and gestational age ˂ 28 weeks (OR: 2.03, 95% CI: 1.18–3.49; P = 0.01) were independent factors that influence failure of NIV within the first 72 h of life.ConclusionCompared with NCPAP, the use of NIPPV/BiPAP strategies for initial respiratory support can reduce the need for invasive ventilation in infants born at 26–30 weeks’ gestation.     

A prospective study of risk factors for neurological complications in childhood bacterial meningitis

ObjectiveTo prospectively analyze the prognostic factors for neurological complications of childhood bacterial meningitis.MethodsThis prospective study enrolled 77 children from 1 month until 16 years of age, treated for bacterial meningitis during the period of January 1, 2009 through December 31, 2010. 16 relevant predictors were chosen to analyze their association with the incidence of neurological complications. p-values < 0.05 were considered statistically significant.ResultsOf the 77 children treated for bacterial meningitis, 33 patients developed neurological complications (43%), and two children died (2.6%). The etiology of bacterial meningitis cases was proven in 57/77 (74%) cases: 32 meningococci, eight pneumococci, six Gram-negative bacilli, five H. influenzae, five staphylococci, and one S. viridans isolates were found. Factors found to be associated with increased risk of development of neurological complications were age < 12 months, altered mental status, seizures prior to admission, initial therapy with two antibiotics, dexamethasone use, presence of focal neurological deficit on admission and increased proteins in cerebrospinal fluid (CSF) (p < 0.05). Initial pleocytosis > 5,000 cells/mm³, pleocytosis > 5,000 cells/mm³ after 48 hours, CSF/blood glucose ratio < 0.20, female gender, previous treatment with antibiotics, community-acquired infection, duration of illness > 48 hours, presence of comorbidity, and primary focus of infection were not associated with increased risk for the development of neurological complications.ConclusionAge < 12 months and severity of clinical presentation at admission were identified as the strongest predictors of neurological complications and may be of value in selecting patients for more intensive care and treatment.     

Vitamin D deficiency at pediatric intensive care admission

Objectiveto assess whether 25hydroxivitaminD or 25(OH)vitD deficiency has a high prevalence at pediatric intensive care unit (PICU) admission, and whether it is associated with increased prediction of mortality risk scores.Methodprospective observational study comparing 25(OH)vitD levels measured in 156 patients during the 12 hours after critical care admission with the 25(OH)vitD levels of 289 healthy children. 25(OH)vitD levels were also compared between PICU patients with pediatric risk of mortality III (PRISM III) or pediatric index of mortality 2 (PIM 2) > p75 [(group A; n = 33) vs. the others (group B; n = 123)]. Vitamin D deficiency was defined as < 20 ng/mL levels.Resultsmedian (p25‐p75) 25(OH)vitD level was 26.0 ng/mL (19.2‐35.8) in PICU patients vs. 30.5 ng/mL (23.2‐38.6) in healthy children (p = 0.007). The prevalence of 25(OH)vitD < 20 ng/mL was 29.5% (95% CI: 22.0‐37.0) vs. 15.6% (95% CI: 12.2‐20.0) (p = 0.01). Pediatric intensive care patients presented an odds ratio (OR) for hypovitaminosis D of 2.26 (CI 95%: 1.41‐3.61). 25(OH)vitD levels were 25.4 ng/mL (CI 95%: 15.5‐36.0) in group A vs. 26.6 ng/mL (CI 95%: 19.3‐35.5) in group B (p = 0.800).Conclusionshypovitaminosis D incidence was high in PICU patients. Hypovitaminosis D was not associated with higher prediction of risk mortality scores.     

¿Mejora la administración de helio mediante cánula nasal de bajo flujo la dificultad respiratoria en lactantes con bronquiolitis aguda por virus respiratorio sincitial? Estudio aleatorizado controlado

Objectives

The aim of our study is to evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by respiratory syncytial virus.

2011至2014年上海单中心下呼吸道感染住院患儿常见病原体流行病学研究

目的 分析近3年上海一家医院下呼吸道感染(LRTI)住院患儿中呼吸道合胞病毒（RSV）、腺病毒（ADV）、副流感病毒（PIV）、流感病毒（FLU）、人偏肺病毒（MV）、沙眼衣原体（CT）和肺炎支原体（MP）7种常见病原体的流行病学特征,为上海地区儿童LRTI的预防与诊治提供数据支持。 方法 收集2011年10月至2014年9月于复旦大学附属儿科医院就诊的LRTI住院患儿,取其鼻咽部抽吸物,使用直接免疫荧光法或实时荧光定量PCR技术检测上述7种呼吸道病原体,并对其流行病学特征行描述性分析。 结果 3年的呼吸道病原体总检出率为44.0%(6 301/14 334),MP的检出率最高（17.5%）,其次为RSV(13.9%）和PIV(5.6%）。男、女呼吸道病原体的总检出率差异无统计学意义（χ2=0.68,P=0.408）。0~6月龄患儿以RSV检出率最高,>2岁患儿以MP检出率最高。RSV和CT随着年龄的增长检出率显著降低,MP的检出率随着年龄增长而显著升高。RSV的检出率高峰出现在冬季,夏季少见。ADV在春夏季检出率较高,而在秋季少见。PIV和MP检出率的高峰主要出现在夏季,FLU在1月份有暴发性的流行,MV的检出高峰主要出现在每年3月份;CT全年散发,无明显季节特征。病原体混合感染的总检出率为2.9％,在7~12月龄患儿中检出率最高,其中以MP合并其他病原体感染为主,最常见为MP+RSV的混合感染。 结论 多种病原体导致上海地区儿童的LRTI,不同病原体显示出不同的流行季节、年龄分布等流行特征。     

A comparison of cytokine responses in respiratory syncytial virus and influenza A infections in infants

Respiratory syncytial virus (RSV) infection is a major cause of bronchiolitis in infants while influenza A infection usually manifests as upper respiratory tract infection. We hypothesised that the immunological responses of infants to RSV infection and influenza A infection are different. This prospective study was undertaken to compare the cytokine responses during RSV and influenza A infection. Sera and nasopharyngeal aspirates (NPA) were collected from infants with a coryzal illness with or without wheeze who were admitted to the paediatric wards during 1998. Cytokines, adhesion molecules, RANTES, IgE and eosinophil cationic protein (ECP) were measured by enzyme linked immunosorbent assay or fluorescence enzyme immunoassay. The diagnosis of RSV and influenza infections was based on direct immunofluorescence and viral culture. Of the 39 infants studied, RSV infection was confirmed in 11 patients and Influenza A in 10 patients. All RSV patients and one influenza A patient had wheeze during the infection. The serum concentrations of interleukin (IL)-4 and IL-5, regulated upon activation normal T cell expressed and secreted (RANTES) and soluble intercellular adhesion molecule 1 (sICAM-1) in infants with RSV infection were significantly higher than those with influenza A infection (all P < 0.02). The concentration of tumour necrosis factor-α (TNF-α) in NPA was significantly lower in infants with RSV infection (P < 0.01). Conclusion A predominant T helper cell type 2 cytokine and related immunological response was observed in infants with respiratory syncytial virus infection whereas a predominant pro-inflammatory cytokine response was observed in infants with influenza A infection. This may explain the different clinical manifestations of the two viral infections in infants. Received: 17 April 2000 / Accepted: 13 September 2000     

Very early feeding in stable small for gestational age preterm infants: a randomized clinical trial

ObjectiveTo examine the effect of initiating very early feeding on time-to-reach full feeding in stable, small for gestational age (SGA) preterm infants.MethodPreterm infants with gestational age below 37 weeks and birth weight below the 10^th percentile were randomly allocated to a very early (within 24 hours of birth) feeding regimen or delayed (after 24 hours of birth) feeding. All infants had in utero evidence of absent or reverse diastolic flow. Infants unable to start early feeding were excluded. Time-to-reach full feeding, feeding progression, and related morbidity were compared. Electrogastrography (EGG) was used to measure pre- and postprandial gastric motility on the second and seventh day after feeding initiation.ResultsSixty infants were included in the study, 30 in each group. Infants included in the very early feeding regimen achieved full enteral feeding sooner than controls (98 ± 80-157 vs. 172 ± 123-261 hours of age, respectively; p = 0.004) and were discharged home earlier (p = 0.04). No necrotizing enterocolitis (NEC) was documented in both study groups. Gastric motility was improved at day seven after feeding initiation in both study groups, with no difference between groups.ConclusionsStable SGA preterm infants on a very early feeding regimen achieved full enteral feeding and were discharged home significantly earlier than those on a delayed regimen, with no excess morbidity.     

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.     

南京地区急性呼吸道感染儿童支原体、衣原体和常见呼吸道病毒病原学分析

目的：了解南京地区急性呼吸道感染（acute respiratory infection, ARI）儿童除细菌外的其他病原微生物感染情况,指导临床诊断和治疗。方法应用荧光定量PCR法检测肺炎支原体（MP）和沙眼衣原体（CT）,直接免疫荧光法检测呼吸道合胞病毒（RSV）、腺病毒（ADV）、甲型和乙型流感病毒（IVA和IVB）、副流感病毒1、2、3型（PIV-1、2、3）、人偏肺病毒（hMPV）。结果1 592例标本中,MP和CT阳性率分别为25.7%、2.4%;总呼吸道病毒阳性率为40.9%,其中RSV最常见,占阳性病毒株的61.3%,其次为PIV-3、hMPV,分别为6.7%、4.9%。病原体的混合感染率为6.7%,混合感染主要发生在1岁以内婴儿,有68例,占混合感染的63.6%。结论病毒感染是南京地区婴幼儿ARI的主要原因,RSV是首要病毒病原,MP也是常见的ARI病原体,1岁以内婴儿混合感染率高。［中国当代儿科杂志,2010,12（6）：450-454］     

Point-of-care lung ultrasound in children with bronchiolitis in a pediatric emergency department

ObjectivesThis study assessed the association between findings of lung ultrasound (LUS) performed in the pediatric emergency department (PED) on infants with bronchiolitis and need for respiratory support.MethodsAn observational study was carried out in the PED during the epidemic seasons in two consecutive years. Infants diagnosed with bronchiolitis who fulfilled the inclusion criteria were evaluated. A group of six pediatricians performed LUS and classified lung findings into four groups: normal pattern (A), moderate interstitial pattern (B1), severe interstitial pattern (B2), and isolated consolidation (C). The relationship between LUS findings and need for respiratory support was explored. An expert sonographer, blinded to the results, reviewed the ultrasound studies to determine the interobserver reliability.ResultsA total of 200 infants were included (mean age 5.7 months ± 4.4 SD); 65 (32.5%) obtained moderate clinical scores, while 23 (11.5%) needed respiratory support at admission and 34 (17.0%) at 48 h. The ultrasound findings in the PED were the following: A = 89 (44.5%), B1 = 55 (27.5%), B2 = 34 (17%), and C = 22 (11%). Age less than 6 weeks and moderate bronchiolitis were correlated with abnormal LUS (P < 0.005). The severity of interstitial ultrasound pattern has some correlation with an increased need for respiratory support. The interobserver concordance was high (0.95, confidence interval: 0.92–0.98).ConclusionLUS is a feasible tool that may help to confirm the clinical impression and assess the need for respiratory support in children with bronchiolitis, but further multicenter studies are needed.     

Comparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy children

Objectiveto compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables.Methodsthis was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%.Results40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3 ± 2.1 years, mean height was 1.5 ± 0.1 m, and mean weight was 40.8 ± 12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9% ± 19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r = 0.373, p = 0.018) and negative correlation with cardiac rate at the end of the test (r = -0.518, p < 0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r = -0.311, p = 0.051).Conclusionsasthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.