Cord blood interleukin-8 levels correlate with airway flow limitation at eight years of age in ex-very low birth weight infants

Background. Exposure to prenatal inflammation increases the risk for development of bronchopulmonary dysplasia. Aim. To evaluate the correlation between cord blood and gastric aspirate levels of interleukine-6 (IL-6) and interleukine-8 (IL-8) in preterm infants, and lung function at the age of 8 years. Methods. Between 2000-2002 we recruited 129 infants of gestational age < 30 wks. The concentration of IL-6 and IL-8 were measured in gastric aspirate and cord blood. At the age of 8 years, 30 ex-preterm infants, with mean gestational age of 27 wks and mean birth weight of 955 g, returned for pulmonary function measurement. To exclude major bias, a comparison between the study group and non-responder group was done and showed no statistically significant difference with respect to perinatal characteristics, ventilation days, bronchopulmonary dysplasia and cytokine concentration. Results. Pulmonary function test measurments in children born preterm were lower than in their term pairs. However, only the difference in forced mid-expiratory flow (FEF25-75%) was statisticaly significant. The concentration of IL-6 and IL-8 in cord blood and in gastric aspirate inversely correlated to all parameters of lung fuction at the age of 8 years, however only correlations between the concentration of IL-8 in cord blood and forced expired volume in one second/forced vital capacity (FEV1/FVC) (r = -0.38, p = 0.04) and FEF 25%-75% (r = -0.44, p = 0.02) were statistically significant. Conclusion. These results show a negative correlation between the concentration of IL-8 in cord blood and FEF25%-75% and FEV1/FVC, which suggests the important role of IL-8 in early airway remodeling

Zdravljenje akutnega bronhiolitisa s kisikom

Akutni bronhiolitis je najpogostejša okužba spodnjih dihal pri otrocih, mlajših od dveh let. Zdravljenje akutnega bronhiolitisa je podporno. Poleg skrbi za primerno hidracijo je dodatek kisika otrokom s hipoksemijo praktično edini način zdravljenja teh otrok. Vrednost, ki jo dobimo s pulznim oksimetrom, je le posredna meritev dejanske vrednosti kisika v krvi in ne odrazi resnosti bolezni. Z dodatkom kisika sicer povišamo zasičenost hemoglobina s kisikom in tako zmanjšamo hipoksemijo, ne zdravimo pa osnovnega vzroka za njen nastanek. Kljub vsemu pulzna oksimetrija ostaja odločilna preiskava pri odločitvi glede zdravljenja s kisikom, saj z nobenim kliničnim znakom ne moremo natančno oceniti, ali gre pri otroku za hipoksemijo. Študije so pokazale, da pediatri pri oceni resnosti bolezni vse bolj zaupajo vrednosti zasičenosti kisika v krvi (SpO2) kot pa klinični oceni. Odkar je pulzna oksimetrija v uporabi, se je odstotek hospitaliziranih zaradi akutnega bronhiolitisa zvišal za približno 250 %. Smernice za obravnavo otrok z akutnim bronhiolitisom niso enotne glede vrednosti SpO2, ki zahtevajo zdravljenje s kisikom. V prispevku smo jih kritično ovrednotili in predstavili lastne izkušnje glede zdravljenja akutnega bronhiolitisa s kisikom

Physical fitness trajectories from childhood to adolescence in extremely preterm children

Objective: Cohort studies on physical fitness (PF) in former extremely preterm children are scarce and yield conflicting results. Therefore, this study aimed to assess the effect of extremely preterm birth on PF in school‐age with a focus on bronchopulmonary dysplasia (BPD). Methods: Eighty school‐aged children were enrolled in the longitudinal cohort study. Fifty were born extremely preterm (<completed 28 weeks of gestation): 19 had BPD, and 31 did not30 term‐born healthy children were included as controls. They were monitored annually throughout primary school (ages 7–14 years) with eight annual fitness testings within the Slovenian national surveillance system of children\u27s somatic and motor development (SLOfit). The physical fitness index (PFI), calculated as the mean of percentiles of eight fitness tests, was used as an indicator of overall PF. Generalised estimating equations were used to compare changes in PFI between ages 7 and 14 in the three cohort groups: preterm children with BPD, preterm children without BPD and term controls. Results: Preterm children with BPD had significantly and persistently lower PFI than preterm children without BPD and term‐born children throughout primary school age. Their PFI was less than half that of national median values (15.1st–19.7th percentile). Preterm children without BPD experienced progressive improvement in PFI during their school age (from 32.6th to 44.7th percentile of national median PFI values), while the ones with BPD did not. Conclusion: Extreme prematurity per se is not a risk factor for lower PF at school age. However, if complicated by BPD, PF is significantly and sustainably reduced

Better COVID-19 Outcomes in Children with Good Asthma Control

Factors associated with COVID-19 presentation in children with asthma are poorly defined. Our study aimed to assess the clinical course of COVID-19 in children with asthma, with particular attention to possible risk factors for severe disease and long-term sequelae in this group of patients. We assessed the occurrence of SARS-CoV-2 infection in children with asthma six months before their regular outpatient visit to the asthma clinic. Characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI) were compared. We focused on factors previously associated with COVID-19 severity. Twenty-seven percent of patients (57/210) reported exposure to SARS-CoV-2 infection. In the symptomatic group, 36% (15/42) reported symptoms of LRTI and 64% (27/42) of URTI. Poorer asthma control was observed in patients with LRTI compared to URTI (80% vs. 7%, p p = 0.026). We found no PFT deterioration post-COVID-19 in either group of patients. Our results suggest good asthma control and treatment adherence prior to infection are associated with better COVID-19 outcomes in children with asthma