Weight gain in infancy and post‐bronchiolitis wheezing

Aim: Low birth weight, high birth weight and excessive weight gain after birth may be risk factors for asthma in childhood, but their associations with wheezing in early childhood are poorly studied. The aim of the study was to evaluate birth weight, weight gain in early infancy and overweight in infancy assessed by weight for length (WFL) as risk factors for wheezing after hospitalization for bronchiolitis in early infancy. Methods: In all, 127 full‐term infants hospitalized for bronchiolitis at age <6 months have been followed up until the mean age of 1.5 years. The weights and lengths of the infants were measured on admission to hospital and at the control visit. Birth weights were obtained from the hospital records. Results: Both occurrence and recurrence of post‐bronchiolitis wheezing were associated with birth weight >4000 g and the recurrence of post‐bronchiolitis wheezing with WFL >110% at age 1.5 years. The associations were robust to adjustments with gender and allergy. Higher weight gain from birth to hospitalization at age <6 months was associated with wheezing in the subgroup of children with birth weight >4000 g. Conclusion: High birth weight and the development of overweight may be associated with post‐bronchiolitis wheezing in infancy.     

Comparison of Epinephrine to Salbutamol in Acute Bronchiolitis

Objective

An appropriate treatment of acute viral bronchiolitis can reduce the symptoms, hospitalization duration and exorbitant costs which is imposed on the families and insurance organizations. This study was conducted to determine the efficacy of epinephrine in comparison with salbutamol in the treatment of the disease.

Methods

Forty infants aged one month to 2 years with acute bronchiolitis in Amin and Al-Zahra hospitals, during 2008, were enrolled in this study. The participants were randomized in two treatment groups to receive epinephrine 0.1 ml/kg or salbutamol 0.15 mg/kg. Three doses of each medication were prescribed at intervals of 20 minutes and continued every 10 minutes after the third dose. The patients in both groups were monitored and rated by RDAI, number of the hospitalized days in the hospital, level of oxygen saturation and vital signs.

Findings

Mean hospitalization duration was 3.3±1.1 and 3±0.9 in the patients receiving salbutamol and epinephrine, respectively (P=0.03). There was a significant difference in assessing RDAI index between the two groups (P=0.03). There were no differences in SPO2, PR, or RR variables in the studied intervals in both groups (P>0.05).

Conclusion

Regarding the effect of epinephrine on reduction of hospitalization duration and the RDAI index in patients with acute bronchiolitis, it seems that using epinephrine instead of salbutamol could be more effective in the management of the disease.     

儿童闭塞性细支气管炎的核素肺灌注/通气显像研究

目的 了解闭塞性细支气管炎(BO)患儿的核素肺V/Q显像表现及该项检查在BO患儿临床诊断、病情评估、预后判断方面的价值.方法 前瞻性分析2005年2月至2011年4月在首都医科大学附属北京儿童医院呼吸感染中心确诊的30例BO患儿(男18例,女12例,年龄7个月～ 14岁)的核素肺V/Q显像资料,对不同病情和不同预后的BO患儿分别加以分析,比较其各自累及的肺段数.结果 30例BO患儿肺灌注显像异常25例(83.3％),肺通气显像异常27例(90.0％).异常肺V/Q匹配者13例(48.1％),不匹配者1例(3.7％),反向不匹配者13例(48.1％).3例轻度病情患儿中,1例肺V/Q显像正常,另2例仅1个肺段受累.10例中度病情患儿肺灌注显像异常平均累及3.7个肺段,肺通气显像异常平均累及5.6个肺段.17例严重病情患儿平均6.0个肺段肺灌注显像异常,平均8.2个肺段肺通气显像异常.30例患儿出院后随访到24例,其中8例病情加重患儿肺灌注显像异常累及肺段数量及受损程度明显高于16例复查好转患儿.结论 BO患儿的肺V/Q显像呈现肺段性、多发性肺灌注和(或)通气稀疏或缺损.该显像方法对BO患儿的临床诊断、病情评估及预后判断有重要意义.     

毛细支气管炎患婴不同体位潮气肺功能测定的比较

目的观察不同体位对毛细支气管炎患婴潮气肺功能测定的影响。方法对45例毛细支气管炎患婴分别测定仰卧位、侧卧位的潮气肺功能,比较潮气量(tidal volume,VT)、呼吸频率(respiratory rate,RR)、吸呼比(Ti/Te)、达峰时间比(TPTEF/TE)及达峰容积比(VPTEF/VE)的差异。结果右前倾侧卧位呼吸频率低于仰卧位,差异有显著性意义;右前倾侧卧位潮气量、达峰容积比、达峰时间比明显高于仰卧位,差异有极显著性意义。结论右前倾侧卧位肺功能指标优于仰卧位,毛细支气管炎急性期采取侧卧位有利于临床治疗。     

氨溴特罗辅助治疗毛细支气管炎疗效观察

目的:观察氨溴特罗辅助治疗毛细支气管炎临床疗效.方法:对88例毛细支气管炎的患儿随机分为两组,两组患儿均采用抗感染、止咳、吸痰、雾化等常规治疗,治疗组加用氨溴特罗,观察比较两组疗效.结果:治疗组在咳嗽、咳痰、喘息、肺部哮鸣音、肺部湿口罗音等的消失时间和总治疗时间等方面均短于对照组,差异有统计学意义(P＜0.01),未见明显不良反应发生.结论:氨溴特罗辅助治疗毛细支气管炎安全、有效.     

孟鲁司特治疗婴幼儿毛细支气管炎的临床观察

目的:观察孟鲁司特治疗婴幼儿毛细支气管炎的疗效。方法:48例婴幼儿毛细支气管炎患儿在常规治疗同时口服孟鲁司特,1～2岁每次4mg,每晚顿服,<1岁每次4mg隔日晚顿服,共用4周。随机选择45例作为对照组予常规治疗,观察患儿喘息好转时间及药物雾化吸入次数、激素应用及随访6个月喘息反复发作情况。结果:口服孟鲁司特组,喘息好转时间短于对照组,P<0.01;药物雾化吸入次数及激素应用少于对照组,P<0.01,且可减少喘息反复发作。结论:口服孟鲁司特治疗婴幼儿毛细支气管炎有较好疗效。     

A case series of paediatric high flow nasal cannula therapy

IntroductionHigh flow nasal cannula is an emerging treatment option in Paediatric Intensive Care Units for paediatric patients in acute respiratory distress. Yet there is a paucity of literature describing its clinical application in various presenting pathophysiologies.AimTo describe three cases with differing underlying pathophysiologies and their response to high flow nasal cannula oxygen therapy.MethodPatients admitted to the Paediatric Intensive Care Unit with bronchiolitis, asthma and cardiomyopathy, and treated with high flow nasal cannula therapy were searched in the Paediatric Intensive Care database. The most representative cases were chosen to review.ResultsOne infant and two children were reviewed. All were commenced on high flow nasal cannula therapy in the Paediatric Intensive Care Unit and all demonstrated an improvement in their work of breathing. There was also a substantial improvement in their haemodynamic status. No patient required escalation to other forms of respiratory therapy.ConclusionHigh flow nasal cannula therapy is a viable treatment option for a range of patients presenting to the Paediatric Intensive Care Unit with acute respiratory distress. More invasive methods of respiratory support may be avoided by the use of high flow nasal cannula therapy.     

甲基强的松龙治疗RSV毛细支气管炎疗效评价

目的 评价甲基强的松龙对RSV毛细支气管炎的治疗效果。方法 将31毛细支气管炎患儿随机分为两组。对照组:采用综合治疗。治疗组:综合治疗并加用甲基强的松龙每日2mg/kg,静脉滴注。于0,2,4,6天评价疾病严重程度。结果 第2天治疗组评分明显低于对照组(3.6±1.6比5.8±2.2,(P<0.05),而第6天两组无显著性差异(1.8±0.8比2.1±1.1,P<0.05)。结论 甲基强的松龙可早期改善RSV毛细支气管炎患儿临床症状。     

沙丁胺醇及溴化异丙托品联合吸入佐治小儿毛细支气管炎疗效分析

目的 探讨沙丁胺醇及溴化异丙托品吸入治疗小儿毛细支气管炎的疗效。方法 将80例确诊毛细支气管炎患儿随机分为两组，两组均采用综合治疗，观察组加用沙丁胺醇和澳化异丙托品吸入。结果 观察组在呼吸系统症状，降低气道阻力方面明显改善。结论 沙丁胺醇及澳化异丙托品联合吸入可改善毛细支气管炎的症状，改善肺功能，疗效确切，方便而副作用少。     

Follicular Bronchiolitis: A Rare Cause of Bronchiolitis Obliterans Syndrome After Lung Transplantation: A Case Report

This case report is the first confirmed case of follicular bronchiolitis (FB), a rare bronchiolar disorder characterized by peribronchiolar lymphoid follicles, in a series of over 400 lung transplantations performed in our center. It is to our knowledge, the first publication describing FB after lung transplantation (LTx), presenting as chronic allograft dysfunction or bronchiolitis obliterans syndrome (BOS).