Late-onset group B streptococcus infections and severe bronchopulmonary dysplasia in an extremely preterm born infant

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.</p

Improved lung function at age 6 in children born very preterm and fed extra protein post discharge

BACKGROUND: In very preterm-born children alveolar maturation is challenged and lung function is often compromised during childhood. So far, very few studies have focused on type of early nutrition and lung function in children born preterm.METHODS: This study is a six years follow-up of 281 very preterm-born infants (VPI) with a gestational age (GA) &lt; 32+0 weeks. Infants breastfed at discharge from hospital were randomized to unfortified (UHM) or fortified (FHM) mother's (human) milk, whereas those not breastfed received a preterm formula (PF). The intervention lasted until 4 months corrected age. At six years of age fractional exhaled nitric oxide (FeNO), airway resistance and occlusion measurements with reversibility were performed. Data on predisposition to asthma and allergy as well as possible allergic symptoms of the child were obtained with questionnaires.RESULTS: Outcome data was fully or partially available on 160 (66.9%) of 239 children. This included 49 (30.6%) children fed UHM, 58 (36,3%) fed FHM, and 53 (33,1%) fed PF. Successful FeNO measurements were obtained in 119 (74.4%) children and airway resistance measurements in 160. FeNO results were not significantly different between feeding groups. Children fed a protein enriched diet (FMH/PF) had the lowest, i.e. best, airway resistance; FHM-fed had lower values than UHM-fed (p=0.042) before, and PF-fed had significantly lower values than UHM-fed after beta-2-agonist inhalation (P=0.050). The tendency of lower airway resistance when protein enriched were the same in gender specific analyses. In SGA children the same tendency was found between PF- and UHM-fed (P=0.007 before and P=0.046 after beta-2-agonist inhalation). All values were within reference limits.CONCLUSIONS: Lung function in very preterm-born children may improve when fed a protein enriched nutrition post-discharge. This article is protected by copyright. All rights reserved.</p

Effect of indoor environmental interventions in the home on asthma in children and adolescents:A systematic review

Background: Asthma is the most frequent chronic respiratory disease in childhood. Children spend much time indoors and are therefore exposed to many indoor allergens and pollutants for several hours during day and night. Many different measures have been investigated in an attempt to reduce the different indoor asthma triggers. The objective of this review was to evaluate the effect on asthma in children and adolescents of home environmental interventions. Methods: A systematic review was conducted by searching five electronic databases and including randomised controlled trials studying the effect of environmental interventions, not aimed at tobacco smoke and smoke alone, on childhood allergic asthma. Data were extracted using a predefined template and quality of the evidence assessed using Cochrane risk-of-bias tool and the GRADE approach. Results: We identified 13,124 studies and included 54 of which 24 intervened on house dust mites, 3 on pet allergen, 4 on pest allergen, 17 on indoor air quality and 6 were multifaceted interventions. There was a high degree of heterogeneity, and only three studies of high quality. A significant effect was found in two high quality studies on mattress covers, four (1 high, 1 moderate, 2 very low quality) studies on nocturnal, temperature-controlled laminar airflow and low evidence for effect of multifaceted interventions. Apart from this no clear effects of other interventions were found. Conclusion: Multifaceted interventions, nocturnal laminar air flow and mitigating HDM exposure by mite-impermeable mattress covers are promising interventions. Future studies should use relevant asthma outcome measures and a rigorous study design based on experience from former studies.</p

Higher bone mineral density at six years of age in very preterm-born infants fed human milk compared to formula feeding:A secondary analysis of an RCT

In very preterm-born infants, nutritional intake is important to reduce the risk of severe metabolic bone disease including the risk of a lower bone mineral density (BMD). The aim of this study was to evaluate bone mineral content (BMC) and BMD (measured as BMC per bone area (BA)) at six years of age in very preterm-born infants fed different diets post-discharge. Data on this topic so far is insufficient, and with this study we aim to supply more useful data. A prospective follow-up study of 281 children born very preterm (gestational age ≤ 32 + 0 weeks) and enrolled in a multicentre RCT on post-discharge nutrition. Infants fed human milk (HM) were randomised respectively to be fed unfortified HM (UHM) or fortified human milk (FHM) from hospital discharge to four months' corrected age. Those not fed HM received a preterm formula (PF). At six years of age, BMD and BMC in all the children were established by means of a dual-energy X-ray absorptiometry (DXA) scan (Lunar Prodigy) and adjusted for sex, age, and anthropometrics. A total of 192 very preterm-born children (59 fed UHM, 67 FHM and 66 PF) had a DXA scan performed at median 6 (5.8-8.3) years of age. No significant difference was found comparing UHM and FHM according to height, weight, BA, BMC, and BMD at six years of age. However, a multiple regression analysis showed significantly improved BMD in breastfed children compared to PF-fed children. CONCLUSIONS: Fortified compared to non-fortified human milk post-discharge did not have an impact on BMD at 6 years of age in very preterm-born infants. Breastfed children demonstrated higher BMD than formula-fed children. WHAT IS KNOWN: • Adequate nutritional intake is important to improve growth and to reduce the risk of severe bone disease in very preterm born infants. • Bone mineralization is attained later in preterm born infants compared to term born infants. WHAT IS NEW: • Feeding human milk with fortification compared to non-fortified human milk did not improve bone mineral density in children born very preterm in this follow-up study at six years of age. • Feeding human milk compared to formula was associated with increased BMD at six years of age among very preterm born infants.</p

The Danish National Database for Asthma

AIM OF THE DATABASE: Asthma is the most prevalent chronic disease in children, adolescents, and young adults. In Denmark (with a population of 5.6 million citizens), >400,000 persons are prescribed antiasthmatic medication annually. However, undiagnosed cases, dubious diagnoses, and poor asthma management are probably common. The Danish National Database for Asthma (DNDA) was established in 2015. The aim of the DNDA was to collect the data on all patients treated for asthma in Denmark and to monitor asthma occurrence, the quality of diagnosis, and management. STUDY POPULATION: Persons above the age of 6 years, with a specific focus on 6–44 years, are included. The DNDA links three existing nationwide registries of administrative records in the Danish health care system: the National Patient Register, the National Health Insurance Services Register, and the National Prescription Registry. For each year, the inclusion criteria are a second purchase of asthma prescription medicine within a 2-year period (National Prescription Registry) or a diagnosis of asthma (National Patient Register). Patients with chronic obstructive pulmonary disease are excluded, but smokers are not excluded. DESCRIPTIVE DATA: A total of 366,471 prevalent patients with asthma have been identified (year 2014 – as a preliminary test search). This number is in agreement with the estimates of ~400,000 inhabitants that are available for patients with possible asthma in Denmark. Data encompass the following quality indicators: annual asthma control visits and pharmacological therapy. MAIN VARIABLES: The variables included are spirometry, as well as tools for diagnosis (including allergy testing), smoking status, height, weight, and acute hospital admissions and unscheduled visits. CONCLUSION: DNDA is available from January 1, 2016

Pulmonary Morbidity in Congenital Diaphragmatic Hernia Survivors Treated at a Non-ECMO Center From 1998 to 2015:A Cross-Sectional Study

Introduction: A main feature of CDH is lung hypoplasia and the related presentation of pulmonary hypertension and cardiac dysfunction. Multiple factors influence pulmonary status after CDH: degree of hypoplasia, ventilator-induced injury, altered growth and development of pulmonary structures, reduced diaphragm function and chest wall abnormalities. The evolution of pulmonary sequela in this population is still unclear. We aimed to describe the pulmonary status of our population of CDH-survivors and evaluated on risk factors. Methods: CDH-survivors (1998−2015) were included and performed lung function tests and chest X-rays. Results: Fifty-one (51/71, 71.8%) participated. Median age was 12.2 (5.5–21.4) years, 28 (54.9%) male, 42 (82.4%) had left-sided hernias, 10 (19.6%) needed patch-repair and median length of stay in hospital was 28.0 (IQR 18.5–61.6) days in Table 1. Spirometry including bronchodilator response (BDR)-test, body plethysmography, and diffusion capacity, were available for 48, 42, and 40 participants. The mean (SD) z-score for FEV1 and FVC was −0.26 (1.70) and −0.28 (1.70). Twenty-one (43.8%) had obstructive patterns and six had positive BDR. TLC mean (SD) z-score was −0.18 (1.10). Four showed restricted/mixed patterns and 13 showed signs of hyperinflation. Increased RV/TLC-ratio and reduced FEV1 was associated with longer time on mechanical ventilation. Diffusion capacity was decreased in three cases. Chest X-ray revealed hernia recurrence (13.9%) and scoliosis (38.9%). Conclusion: Mild obstructive impairment and hyperinflation was frequent in our CDH cohort and only a small subset of restrictive disorders were identified. We advocate follow-up by a specialized multidisciplinary team through childhood and into adulthood.</p

From neonatal lung function to lung function and respiratory morbidity at 6-year follow-up

Background: Lung function is traceable from infancy to adulthood. Only a few studies have examined lung function from birth to childhood longitudinally in children born moderate to late preterm. We aimed to investigate how prematurity and lung function in the neonatal period are related to lung function and respiratory morbidity at age 6 in former moderate to late preterm children compared with children born at term. Methods: Lung function was measured in a cohort of moderately to late preterm (n = 48) and term-born (n = 53) infants in the neonatal period by FeNO, and tidal breathing flow-volume loops (TBFVL) and at age 6 (n = 52) by spirometry, whole-body plethysmograph and impulse oscillation combined with a respiratory symptom questionnaire. Results: Moderate to late preterm children had a higher TPEF/TE ratio neonatally (42.6% vs. 33.7%, p = 0.02) and a lower % predicted orced expiratory volume in the first second at age 6 (94.4% vs. 101.9%, p = 0.01) compared to term-born children. We found a significant association between the variability of neonatal tidal volume and effective airway resistance at age 6 (β = −0.34, p = 0.03). No association between neonatal FeNO or TBFVL and respiratory morbidity at 6-year follow-up was shown. Conclusion: Children born moderate to late preterm had lower lung function at age 6 than term-born children. We did not find evidence for the use of neonatal tidal breathing parameters as a predictor for subsequent respiratory morbidity or lung function, however sample size was small.</p

A child with mastocytosis and lymphomatoid papulosis

A change in clinical behavior of a disease should prompt search for differential diagnoses. Here, the appearance of ulcerated skin nodules in a preexisting cutaneous mastocytosis revealed a concurrent lymphomatoid papulosis - a CD30+ lymphoproliferative skin disease with histological features of a malignant lymphoma, but with a benign self-healing course.</p

Multidisciplinary Management of Mastocytosis : Nordic Expert Group Consensus

Mastocytosis is a heterogeneous group of diseases defined by an increased number and accumulation of mast cells, and often also by signs and symptoms of mast cell activation. Disease subtypes range from indolent to rare aggressive forms. Mastocytosis affects people of all ages and has been considered rare; however, it is probably underdiagnosed with potential severe implications. Diagnosis can be challenging and symptoms may be complex and involve multiple organ-systems. In general it is advised that patients should be referred to centres with experience in the disease offering an individualized, multidisciplinary approach. We present here consensus recommendations from a Nordic expert group for the diagnosis and general management of patients with mastocytosis.Peer reviewe