Forty-eight children, born at less than 33 weeks' gestation and without bronchopulmonary dysplasia (BPD) or Wilson-Mikity syndrome (WM) were studied at a mean age of 9.1 years, to identify the incidence and possible factors contributing to the development of long-term abnormalities in pulmonary function. As neonates, 30 children had hyaline membrane disease (HMD) of whom 21 required ventilation. Eighteen did not have HMD, of whom 9 required ventilation for nonrespiratory reasons. All patients had grown normally. Four of the 48 (8.3%) had clinical asthma, 5 had persisting chest x-ray abnormalities (10.6% of 47 chest x-rays performed), each having been ventilated for HMD. There was a close association between duration of ventilation, oxygen administration, and subsequent abnormal chest x-ray. Electrocardiogram and M-mode echocardiograms were normal in all but 2 patients. Only 3 patients had significant restrictive lung disease, 3 had evidence of significant airways obstruction, and 13 (27.7%) had signs of air trapping. Methacholine challenge was positive in 30 of 46 patients (65.2%). The incidence of a positive methacholine challenge did not correlate with history of HMD, duration of ventilation, or high oxygen administration. There is an increased incidence of airway hyperreactivity in survivors of prematurity, not associated with any identified therapeutic maneuver during the neonatal period.

Female↗

PubMedDate not supplied

Multiple factors limit exercise capacity in cystic fibrosis.

Exercise testing was performed in 50 patients with cystic fibrosis to determine whether hemodynamic factors limit exercise capacity in the disease. Prior to exercise testing, lung function and blood gas values were measured. Nutritional status was determined by calculating a weight for height (Wt for Ht) ratio for each subject. A progressive exercise test was used to determine maximum work capacity (Wmax). Cardiac output (Q) (indirect Fick method), and stroke volume (SV) were computed during steady-state exercise at 50% Wmax in 21 of 50 patients. Wmax, SV, Q, and lung function results are expressed as per cent predicted. The mean (+/- SD) Wmax was 75 +/- 23%. Multiple regression analysis showed that maximum voluntary ventilation, resting PaO2, and Wt for Ht accounted for 84% of the variance in Wmax. Although some patients had a reduced SV (mean = 96%) during steady-state exercise, all patients achieved a normal cardiac output (mean = 115%). SV correlated with resting PaO2 but not with lung function. We conclude that exercise capacity in cystic fibrosis is influenced by lung function, nutritional status, and resting hypoxemia, but not by cardiac function; the SV limitation noted in some patients may be due to increased pulmonary vascular resistance related to hypoxemia.

Adolescent↗

PubMedDate not supplied

Cold air challenge in children with asthma.

A study was designed to determine the sensitivity and specificity of a cold air bronchial provocation test. A total of 18 children with asthma (mean age 12 years) and 18 normal children (mean age 14 years) were studied. The cold air challenge consisted of a 4 min period of isocapnic hyperventilation of subfreezing air (mean temperature -15 degrees C). In-Induced response in forced expiratory volume in 1 sec (FEV1) expressed as a percentage of predicted normal values was obtained at 4, 6, and 8 min post-challenge. The average response to the cold air was a 27% decrease of FEV1 in asthmatics, which was significantly different from that of the normal children, who showed no statistically significant drop. In both the asthmatic and normal groups, the maximal drop in FEV1 had occurred by the time measurements 4 min post-challenge had been made. At that time, the smallest overlap was observed between normal and asthmatic children. This suggests that the fourth minute post-challenge can be chosen as a cut-off time to distinguish normal from asthmatic children. Considering a decrease of FEV1 greater than 10% as a positive test, the sensitivity of the cold air challenge was 95% and the specificity was 89%.

Asthma↗

PubMedDate not supplied

Normal values of maximal inspiratory and expiratory pressures with a portable apparatus in children, adolescents, and young adults.

Maximal inspiratory and expiratory mouth pressures (Plmax and PEmax) were measured over a wide age range using a cylindrical mouthpiece and a multiple trial procedure. Two hundred forty-three students and 30 adults were studied. In addition, a comparison of a cylindrical and a scuba-type mouthpiece was made in 16 subjects. Fifty percent of the subjects required five or more trials to achieve their maximal mouth pressures. Higher PEmax values were obtained using a cylindrical mouthpiece than with a scuba-type mouthpiece in 15 of the 16 subjects tested. Plmax was not affected by mouthpiece type. Males had higher Plmax and PEmax values than females except in the 8-10 years age group. Maximal mouth pressures correlated with age in boys only. Technical considerations, such as the number of trials and the type of mouthpiece used, are important determinants of maximal mouth pressure values.

Adolescent↗

PubMedDate not supplied

Forced vital capacity and maximal respiratory pressures in patients with mild and moderate scoliosis.

Lung function and maximal respiratory pressures of 24 adolescent females with mild-to-moderate idiopathic scoliosis (spinal curvature 10-60 degrees) were determined and compared with 38 age- and sex-matched controls. Twelve patients with moderate scoliosis (Cobb angle 35-60 degrees) had significantly reduced mean values for FVC (% predicted) and maximal inspiratory pressure (MIP), as compared to the controls. Twelve patients with mild scoliosis (Cobb angle less than 35 degrees) had normal mean values for FVC and maximal respiratory pressures, but five individual patients had FVC values less than 80% predicted. All but one of the patients with mild scoliosis had normal MIP values. FVC (% predicted) was significantly correlated with the degree of spinal curvature (r = -0.466; P less than 0.05) but was not related to MIP. These results indicate that reduced FVC values do occur in patients with mild-to-moderate idiopathic scoliosis and suggest that these low FVC values can be attributed to the rib cage deformity rather than to an inability to generate adequate inspiratory pressures.

Adolescent↗

PubMedDate not supplied

Obstructive sleep apnea: a complication of burns to the head and neck in children.

Explore the source record for details and available documents.

Burns↗

PubMedDate not supplied

Efficacy of inhaled tobramycin in the treatment of pulmonary exacerbations in children with cystic fibrosis.

Two forms of treatment of acute pulmonary exacerbations in patients with cystic fibrosis were compared: intravenous ticarcillin (300 mg drug per kg per day) and tobramycin (10 mg drug per kg per day) versus the same intravenous antibiotic therapy plus inhaled tobramycin (80 mg three times per day). The 16 patients in the intravenous plus inhaled tobramycin group were similar to the 12 control patients in age, sex, Schwachman scores, pulmonary function and pretreatment colony counts of Pseudomonas aeruginosa in sputum. Treatment resulted in significant improvement in clinical status and pulmonary function without any apparent differences in the two groups. However, intravenous plus inhaled tobramycin resulted in temporary eradication of P. aeruginosa in 63% of the patients compared to 25% in the intravenous only group (P = 0.03). Suppression of P. aeruginosa in sputum cultures did not correlate with clinical response to treatment. No renal toxicity or elevations of serum tobramycin were observed in the intravenous plus inhaled tobramycin group.

Adolescent↗

PubMedDate not supplied

Controlled trial of ceftazidime vs. ticarcillin and tobramycin in the treatment of acute respiratory exacerbations in patients with cystic fibrosis.

A randomized controlled trial was undertaken to compare ceftazidime vs. the combination of ticarcillin and tobramycin in the treatment of acute respiratory exacerbations of mild to moderate severity in patients with cystic fibrosis. The two antibiotic regimens were equally effective in terms of clinical improvement: 16 of 17 in the ceftazidime group and 11 of 13 in the ticarcillin/tobramycin group were judged to be improved by the patients and attending physicians and were observed to show improvement in symptom scores, vital signs, body weight and pulmonary function. Ceftazidime was more effective bacteriologically in reducing colony counts of Pseudomonas aeruginosa in the sputum. Neither regimen affected Pseudomonas cepacia. Resistance to multiple antibiotics developed in six of 12 isolates of nonmucoid P. aeruginosa in patients receiving ticarcillin/tobramycin, which was significantly more than occurred in the ceftazidime group. There was no correlation between clinical and bacteriologic outcomes in either treatment group. No clinically important adverse effects were observed.

Adolescent↗

PubMedDate not supplied

Growing older with cystic fibrosis: psychologic adjustment of patients more than 16 years old.

The 79 female and 147 male patients constituting the population with cystic fibrosis (CF) aged 16 years and older attending The Hospital for Sick Children were asked to complete the Cornell Medical Index (CMI) and Tennessee Self-Concept Scale (TSCS); 64 female (81%) and 112 male (76%) subjects participated. Analysis of CMI results showed 43% of female subjects to have moderate to severe emotional disturbance compared to 19% of male subjects. This female : male ratio for severity of emotional disturbance is found in ostensibly healthy groups, but the percentages of disturbance approach values for medical patient populations. The frequency of emotional disability is greater in those more than 20 than in those 16-19 years old. The TSCS results portray a generally normal self-concept except for scores of positive physical self and psychosis for patients aged 20 years and older; these scores approach psychiatric values, suggesting that some reality distortion facilitates emotional adjustment to adult life with CF. The TSCS and CMI results correlate significantly, indicating a connection between self-concept and emotional status. However, TSCS and CMI scores do not correlate with measures of disease severity except for correlations between lung function and physical self-concept in older male patients. These results suggest that psychologic functioning is independent of the degree of physical impairment in older patients with CF, with the long-surviving male patients more realistically appraising the limitations their disease imposes and utilizing denial and minimization to a lesser degree. Demographic data on the clinic population reveal that most patients aged 16 years and older cope with their intellectual, developmental, and socioeconomic tasks commensurate with normal age expectations.

Adolescent↗