Response of cord blood cells to environmental, hereditary and perinatal factors : a prospective birth cohort study

Many studies investigating the impact of individual risk factors on cord blood immune cell counts may be biased given that cord blood composition is influenced by a multitude of factors. The aim of this study was to comprehensively investigate the relative impact of environmental, hereditary and perinatal factors on cord blood cells.; In 295 neonates from the prospective Basel-Bern Infant Lung Development Cohort, we performed complete blood counts and fluorescence-activated cell sorting scans of umbilical cord blood. The associations between risk factors and cord blood cells were assessed using multivariable linear regressions.; The multivariable regression analysis showed that an increase per 10μg/m3 of the average nitrogen dioxide 14 days before birth was associated with a decrease in leukocyte (6.7%, 95% CI:-12.1,-1.0) and monocyte counts (11.6%, 95% CI:-19.6,-2.8). Maternal smoking during pregnancy was associated with significantly lower cord blood cell counts in multiple cell populations. Moreover, we observed sex differences regarding eosinophilic granulocytes and plasmacytoid dendritic cells. Finally, significantly increased numbers of cord blood cells were observed in infants exposed to perinatal stress. Cesarean section seems to play a significant role in Th1/Th2 balance.; Our results suggest that all three: environmental, hereditary and perinatal factors play a significant role in the composition of cord blood cells at birth, and it is important to adjust for all of these factors in cord blood studies. In particular, perinatal circumstances seem to influence immune balance, which could have far reaching consequences in the development of immune mediated diseases

An Adverse Reaction in the Pediatric Sleep Laboratory

We present a case of a 15-month-old boy with Cornelia de Lange Syndrome (NIPBL gene mutation). On a PSG, central sleep apnea (central apnea-hypopnea index of 19/hour) and nocturnal hypoventilation (transcutaneous CO2 > 50 mmHg for 53% of the night) were found. A positive pressure initiation study was aborted because the patient developed a serious adverse reaction. The differential diagnosis included a skin fragility condition versus an allergic contact dermatitis to the interface; this could be from the povidone-iodine solution used to clean the NiPPV interface or from the plastic of the interface itself. A skin biopsy was performed which was normal. The reaction was likely secondary to an allergic contact dermatitis from the povidone-iodine solution used to clean the NiPPV interface. The patient is currently tolerating NiPPV

An Adverse Reaction in the Pediatric Sleep Laboratory

We present a case of a 15-month-old boy with Cornelia de Lange Syndrome (NIPBL gene mutation). On a PSG, central sleep apnea (central apnea-hypopnea index of 19/hour) and nocturnal hypoventilation (transcutaneous CO2 > 50 mmHg for 53% of the night) were found. A positive pressure initiation study was aborted because the patient developed a serious adverse reaction. The differential diagnosis included a skin fragility condition versus an allergic contact dermatitis to the interface; this could be from the povidone-iodine solution used to clean the NiPPV interface or from the plastic of the interface itself. A skin biopsy was performed which was normal. The reaction was likely secondary to an allergic contact dermatitis from the povidone-iodine solution used to clean the NiPPV interface. The patient is currently tolerating NiPPV.Peer Reviewe

ROHHAD syndrome and evolution of sleep disordered breathing

Abstract Background Rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) is a rare disease with a high mortality rate. Although nocturnal hypoventilation (NH) is central to ROHHAD, the evolution of sleep disordered breathing (SDB) is not well studied. The aim of the study was to assess early manifestations of SDB and their evolution in ROHHAD syndrome. Methods Retrospective study of children with ROHHAD at two Canadian centers. All children with suspected ROHHAD at presentation underwent polysomnography (PSG) to screen for nocturnal hypoventilation. PSG findings at baseline and follow-up were collected. Interventions and diagnostic test results were recorded. Results Six children were included. The median age of rapid onset obesity and nocturnal hypoventilation (NH) was 3.5 and 7.2 years respectively. On initial screening for ROHHAD 4/6 (66.7 %) children had obstructive sleep apnea (OSA), 1/6 (16.7 %) had NH and 1/6 (16.7 %) had both OSA and NH. Follow up PSGs were performed in 5/6 children as one child died following a cardiorespiratory arrest. All children at follow up had NH and required non-invasive positive pressure ventilation. Additionally, 3/6 (50 %) children demonstrated irregular breathing patterns during wakefulness. Conclusions Children with ROHHAD may initially present with OSA and only develop NH later as well as dysregulation of breathing during wakefulness. The recognition of the spectrum of respiratory abnormalities at presentation and over time may be important in raising the index of suspicion of ROHHAD. Early recognition and targeted therapeutic interventions may limit morbidity and mortality associated with ROHHAD

Simple^a and adjusted^b associations of cord blood cells with environmental risk factors.

<p>Simple<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0200236#t003fn002" target="_blank">^a</a> and adjusted<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0200236#t003fn003" target="_blank">^b</a> associations of cord blood cells with environmental risk factors.</p

Simple^a and adjusted^b associations of cord blood cells with perinatal risk factors.

<p>Simple<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0200236#t004fn002" target="_blank">^a</a> and adjusted<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0200236#t004fn003" target="_blank">^b</a> associations of cord blood cells with perinatal risk factors.</p

a+b. Adjusted^a effect of perinatal stress factors on mDCs, pDCs, and pDCs/ mDCs ratio in multivariable models using a) NO₂ and b) PM₁₀ exposure during last 14 days before the birth.

<p>^a adjusted for sex, gestational age, birth order, gestational age, mode of delivery, CTG, maternal smoking during pregnancy, maternal atopy, change in the gating strategy, and season of birth.</p

Population characteristics.

<p>Population characteristics.</p

Duration of antibiotic treatment.

<p>Box plots of the distribution of the duration of antibiotic (AB) treatment (in days) for children and adolescents with lower respiratory tract infection (LRTI) in the procalcitonin (PCT) and control group.</p

Trial profile.

<p>Trial profile.</p