Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU:a randomized controlled trial

The optimal dose regimen for intravenous (IV) treatment in children with severe acute asthma (SAA) is still a matter of debate. We assessed the efficacy of adding a salbutamol loading dose to continuous infusion with salbutamol in children admitted to a pediatric intensive care unit (PICU) with SAA. This multicentre, placebo-controlled randomized trial in the PICUs of four tertiary care children’s hospitals included children (2–18 years) with SAA admitted between 2017 and 2019. Children were randomized to receive either a loading dose IV salbutamol (15 mcg/kg, max. 750 mcg) or normal saline while on continuous salbutamol infusion. The primary outcome was the asthma score (Qureshi) 1 h after the intervention. Analysis of covariance models was used to evaluate sensitivity to change in asthma scores. Serum concentrations of salbutamol were obtained. Fifty-eight children were included (29 in the intervention group). Median baseline asthma score was 12 (IQR 10–13) in the intervention group and 11 (9–12) in the control group (p = 0.032). The asthma score 1 h after the intervention did not differ significantly between the groups (p = 0.508, β-coefficient = 0.283). The median increase in salbutamol plasma levels 10 min after the intervention was 13 μg/L (IQR 5–24) in the intervention group and 4 μg/L (IQR 0–7) in the control group (p = 0.001). Side effects were comparable between both groups. Conclusion: We found no clinical benefit of adding a loading dose IV salbutamol to continuous infusion of salbutamol, in children admitted to the PICU with SAA. Clinically significant side effects from the loading dose were not encountered.What is Known:• Pediatric asthma guidelines struggle with an evidence-based approach for the treatment of SAA beyond the initial steps of oxygen suppletion, repetitive administration of inhaled β2-agonists, and systemic steroids.• During an SAA episode, effective delivery of inhaled drugs is unpredictable due to severe airway obstruction.What is New:• This study found no beneficial effect of an additional loading dose IV salbutamol in children admitted to the PICU.• This study found no clinically significant side effects from the loading dose

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report

Retrograde colonic irrigation (RCI) using normal saline (NS) is a widely used method to treat constipation, or to prepare the bowels for colorectal surgeries in children. Using large amounts of NS during RCI could induce electrolyte disturbances. A case of extreme hyperchloremic metabolic acidosis following RCI with large volumes of NS in a neonate with Hirschsprung disease has not been described to date.We report a 24 days old patient with Trisomy 21 and Hirschsprung disease, that received RCI twice a day in a NS rectal bolus from day 10 of age, presenting with respiratory and circulatory insufficiency. Lab results showed extreme hyperchloremic acidosis, which was attributed to gastro-intestinal fluid resorption of large volumes of NS. The patient showed clinical improvement after supplementation of sodium bicarbonate and made an uneventful full recovery.This case report emphasizes the need to carefully monitor children for electrolyte disturbances, fluid balance, bodyweight and returned irrigation volumes when RCI is used with large volumes of NS for multiple days

Neonatal antibiotics in preterm infants and allergic disorders later in life

Allergic disorders are an important health problem worldwide, especially in developed countries. Besides the high disease burden and large impact on quality of life, it significantly increases annual healthcare costs.(1) Over the last decades prevalence of allergic disorders has significantly increased, particularly in children. (This article is protected by copyright. All rights reserved.

Effect of non-human neutral and acidic oligosaccharides on allergic and infectious diseases in preterm infants

Short-term supplementation of non-human neutral and acidic oligosaccharides during the first postnatal weeks may enhance the maturation of the immune response in preterm infants and may lead to less allergic and infectious diseases during the first year of life. In a randomized controlled trial, 113 preterm infants (gestational age <32 weeks and/or birth weight <1500 g) were allocated to receive enteral neutral and acidic oligosaccharide supplementation or placebo between days 3 and 30 of life. The median age at follow-up was not different in both groups: 12 months corrected age (interquartile range [IQR], 11-15) in the prebiotic mixture group and 12 months corrected age in the placebo group (IQR, 10-19), respectively. In addition, baseline patient, maternal, and environmental characteristics were not different between the prebiotic mixture (n = 48) and placebo (n = 46) group. Incidence of allergic and infectious diseases was assessed by validated questionnaires. In total, 94/98 (96 %) of the eligible, surviving infants participated in this follow-up study. The incidence of atopic dermatitis (odds ratio [OR], 0.80; 95 % confidence interval [CI], 0.24-2.67), bronchial hyper-reactivity (OR, 1.04; 95 % CI, 0.38-2.87) and infections of the upper respiratory (OR, 0.95; 95 % CI, 0.37-2.44), lower respiratory (OR, 1.03; 95 % CI, 0.37-2.88), and gastrointestinal (OR, 1.77; 95 % CI, 0.55-5.73) tract was not different between the groups. Adjustment for potential confounding factors did not change the results of the primary analysis. Conclusion: Short-term enteral supplementation of non-human neutral and acidic oligosaccharides during the neonatal period in preterm infants does not decrease the incidence of allergic and infectious diseases during the first year of lif

Glutamine-enriched enteral nutrition in very low-birth-weight infants

Objective: To determine the effect of glutamine-enriched enteral nutrition in very low- birth- weight infants on the incidence of allergic and infectious diseases during the first year of life. Design: Follow- up study. Setting: Tertiary care hospital. Participants: All surviving infants who participated in a trial of glutamine- enriched enteral nutrition in very low-birth-weight infants. Intervention: Enteral glutamine supplementation ( L- glutamine, 0.3 g/ kg per day) from 3 through 30 days of life. Main Outcome Measures: The incidence of allergic and infectious diseases during the first year of life, as assessed by means of validated questionnaires. Results: Seventy- seven of 90 infants ( 86%) participated in the follow- up study. Baseline patient, maternal, and environmental characteristics did not differ between the glutamine- supplemented ( n= 37) and control ( n= 40) groups, except for the incidence of serious neonatal infections and child care attendance. After adjustment for confounding factors, the risk for atopic dermatitis was lower in the glutamine- supplemented group ( odds ratio [ OR], 0.13; 95% confidence interval [ CI], 0.020.97). However, the incidence of bronchial hyperreactivity ( OR, 0.34; 95% CI, 0.10- 1.21) and infections of the upper respiratory ( OR, 0.99; 95% CI, 0.35- 2.79), lower respiratory ( OR, 0.39; 95% CI, 0.13- 1.24), and gastrointestinal ( OR 1.25, 95% CI 0.23- 6.86) tracts was not different between the treatment groups. Conclusions: Glutamine- enriched enteral nutrition in very low- birth- weight infants decreased the incidence of atopic dermatitis during the first year of life but had no effect on the incidence of bronchial hyperreactivity and infectious diseases during the first year of lif

Neurodevelopmental outcomes of very low-birth-weight infants after enteral glutamine supplementation in the neonatal period

Aim: To determine the effect of neonatal glutamine-enriched enteral nutrition in very low birth weight (VLBW) infants on neurodevelopmental outcome at 2 years of age. Methods: Eighty-eight out of one hundred two infants participating in the initial study were eligible for the follow-up study (13 died, one exclusion due to a chromosomal abnormality). Neurodevelopmental outcome (neurologic status, vision, hearing and Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales of Infant Development II) was evaluated at the corrected age of 2 years. To adjust for potential confounders, data were analyzed by multiple linear or logistic regression (for continuous and dichotomous variables, respectively) Results: Seventy-two out of eighty-eight (82%) infants participated in the follow-up study: 40 and 32 infants in glutamine-supplemented and control groups, respectively. The incidence of neither an MDI nor a PDI <= 85 was different in glutamine-supplemented and control groups (MDI <= 85: 27 and 19%, p = 0.17; PDI <= 85: 28 and 16% p = 0.16, respectively). The incidence of neurodevelopmental impairment was not different between both groups (OR: 2.16, 95% CI: 0.64-7.28). Conclusions: A positive effect of neonatal glutamine-enriched enteral nutrition in VLBW infants on neurodevelopmental outcome at 2 years of age was not found in this stud