Measurement of Interrupter Respiratory Resistance and Spirometry in Preschool Children: Influence of Respiratory Symptoms:

Pulmonary function tests play an important role in the diagnosis and management of respiratory diseases in children. The purpose of the study was to evaluate lung function using the interrupter resistance technique (Rint) and spirometry (flow-volume and volume-time) in preschool children and to correlate the findings with respiratory symptoms. We studied 103 children (65 males, 38 females; mean age 5.2±0.7 years; range 3.6–5.8). For each child we collected family history concerning: respiratory diseases, skin prick tests, smoking during maternal pregnancy, history of gestational and neonatal period. All children performed lung function tests (Rint and spirometry) and skin prick test for inhalant and food allergens. Twenty-eight subjects (27.2%) had respiratory symptoms (RS). Expiratory Rint were performed in all subjects and spirometry was carried out on 76 children (73.8%). Spirometric indices were not statistically different between subjects without respiratory symptoms (controls) and RS children except for FEF25–75 expressed as a percentage of the predicted value (RS: 81.5±13.7% vs controls: 94.5±15.8%; p <0.001). Rint mean values were significantly higher in RS children than in controls (RS: 135.6 ±24.8% vs controls: 102.4 ±21.7%; p< 0.0001). We found a statistically negative correlation between Rint and the following Spirometric indices: FEV0.5 (R= −0.696; p < 0.0001), FEV, (R= − 0.728; p < 0.0001) and FEF25–75 (R= −0.681; p < 0.0001). In preschool children with respiratory disease we found significantly higher mean values of Rint and lower FEF25-75 than in the control group and a significant negative relationship between Rint and Spirometric indices

Oral breathing and dental malocclusions.

Aim Aim of the present study was to evaluate existing correlations between oral breathing and dental malocclusions. Methods The study was conducted on a paediatric group of 71 oral breathers selected at the Allergology and Paediatric Immunology Department of Umberto I General Hospital, University of Rome "La Sapienza". The children were selected based on inclusion/exclusion criteria. Children aged 6 to 12 years with no history of craniofacial malformations or orthodontic treatment were included. The results were compared with a control group composed of 71 patient aged 6 to 12 years with nasal breathing. After their medical history was recorded, all patients underwent orthodontic/otolaryngological clinical examinations. The following diagnostic procedures were then performed: latero-lateral projection teleradiography, orthopantomogram, dental impressions, anterior rhinomanometry before and after administering a local vasoconstrictor nocturnal home pulse oximetry (NHPO) recording, spirometry test, skin prick test, study cast evaluation and cephalometric analysis following Tweed's principles. The intraoral examination assessed dental class type, overbite, overjet, midlines, crossbite, and presence of parafunctional oral habits such as atypical swallowing, labial incompetence, finger sucking and sucking of the inner lip. Evaluation of the study casts involved arch perimeter and transpalatal width assessment, and space analysis. Results The results showed a strong correlation between oral breathing and malocclusions, which manifests itself with both dentoskeletal and functional alterations, leading to a dysfunctional malocclusive pattern. Conclusions According to the authors' results, dysfunctional malocclusive patient makes it clear that the association between oral breathing and dental malocclusions represents a self-perpetuating vicious circle in which it is difficult to establish if the primary alteration is respiratory or maxillofacial. Regardless, the problem needs to be addressed and solved through the close interaction of the paediatrician, otorhinolaryngologist, allergologist and orthodontist

MEASUREMENT OF INTERRUPTER RESPIRATORY RESISTANCE AND SPIROMETRY IN PRESCHOOL CHILDREN: INFLUENCE OF RESPIRATORY SYMPTOMS

Pulmonary function tests play an important role in the diagnosis and management of respiratory diseases in children. The purpose of the study was to evaluate lung function using the interrupter resistance technique (Rint) and spirometry (flow-volume and volume-time) in preschool children and to correlate the findings with respiratory symptoms. We studied 103 children (65 males, 38 females; mean age 5.2 +/- 0.7 years; range 3.6-5.8). For each child we collected family history concerning: respiratory diseases, skin prick tests, smoking during maternal pregnancy, history of gestational and neonatal period. All children performed lung function tests (Rint and spirometry) and skin prick test for inhalant and food allergens. Twenty-eight subjects (27.2%) had respiratory symptoms (RS). Expiratory Rint were performed in all subjects and spirometry was carried out on 76 children (73.8%). Spirometric indices were not statistically different between subjects without respiratory symptoms (controls) and RS children except for FEF25-75 expressed as a percentage of the predicted value (RS: 81.5 +/- 13.7% vs controls: 94.5 +/- 15.8%; p <0.001). Rint mean values were significantly higher in RS children than in controls (RS: 135.6 +/- 24.8% vs controls: 102.4 +/- 21.7%; p< 0.0001). We found a statistically negative correlation between Pint and the following spirometric indices: FEV0.5 (R= -0.696; p <0.0001), FEV1 (R= - 0.728; p < 0.0001) and FEF25-75 (R= -0.681; p <0.0001). In preschool children with respiratory disease we found significantly higher mean values of Rint and lower FEF25-75 than in the control group and a significant negative relationship between Pint and spirometric indices

The evaluation of adenoid hypertrophy and obstruction grading based on rhinomanometry after nasal decongestant test in children

OBJECTIVES: Adenoid hypertrophy (AH) is a very common problem in children. Nasal Fiberoptic Endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. The aim of our study was to analyze the grade of nasal obstruction caused by AH, in a group of children, with rhinomanometry standard and after ND test versus NFE. PATIENTS AND METHODS: Two hundred and eighty-four of 300 collaborative children, diagnosed as chronic oral breathers, were enrolled. All children underwent a complete physical examination, anterior active rhinomanometry and a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using Nasal Fiberoptic Endoscopy (NFE). RESULTS: At rhinomanometry nasal obstrucion was found of grade 1 in 102 (35.9%) children, of grade 2 in 41 (14.4%), of grade 3 in 52 (18.3%), of grade 4 in 37 (13%) and of grade 5 in 52 (18.3%). Those patients were tested also with rhinomanometry after ND: grade 1 in 108 (38%) children, grade 2 in 52 (18.3%), grade 3 in 56 (19.7%), grade 4 in 23 (8.1%) and grade 5 in 45 (15.8%). At NFE: 83 (29.2%) patients presented a grade 0, 73 (28.7%) a grade 1, 51 (17.9%), 34 (11.9%) a grade 3 and 43 (15.1%) a grade 4. Comparing the grade of nasal obstruction in NFE and in RM after ND we found a great correlation for grade 1 and grade 5 (respectively 84.3% and 79,1%, p < 0.001) and low correlation for the others grades of obstruction. When compared to NFE, rhinomanometry test after ND had 81.1% sensitivity and 84.3% specificity. Operating Characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to Rhinomanometry after ND vs NFE. CONCLUSIONS: Rhinomanometry after ND, compared to rmhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children. RM after ND is a great tool to assess the severity of nasal obstruction. In fact, the minimum and maximum degrees of obstruction to the RM after ND correlate significantly (p < 0.01) with those of NFE

The good bugs: the use of probiotics in pediatrics

Purpose of review There is growing evidence encouraging the use of probiotics in many conditions in children. However, given the wide number of probiotics available and contradictory data in the literature, the health-care provider is often faced with uncertainness about whether or not to use probiotics and which one(s) to choose. We here review current hypotheses regarding the efficacy and safety of probiotics and evaluate the available data on the use of probiotics in most common diseases in children. Considering that probiotics have strain-specific effects, we will focus on individual probiotic strains rather than on probiotics in general. Recent findings Strain-specific efficacy was clearly demonstrated with Lactobacillus rhamnosus GG and Saccharomyces boulardii I-745 in the treatment of acute infectious diarrhea, Lactobacillus reuteri DSM 17938 in infantile colics, Lactobacillus rhamnosus GG, and VSL#3 in irritable bowel syndrome. In addition, encouraging results are seen for use of probiotics in necrotizing enterocolitis, food allergy, and nonalcoholic fatty liver disease. However, the data available for constipation are to be considered somewhat equivocal. The clinical relevance of these findings indicates that healthcare providers need to take strain-specificity and disease specificity of probiotics into consideration when recommending probiotic for their patients

The role of rhinomanometry after nasal decongestant test in the assessment of adenoid hypertrophy in children

Introduction: Nasal respiratory obstruction is a very common otolaryngologic problem, often caused by adenoid hypertrophy (AH). Nasal fiberoptic endoscopy (NFE) represents the gold standard method to diagnose AH. Rhinomanometry represents a valid diagnostic support. Objective: The aim of our study was to analyze the diagnostic value of rhinomanometry after nasal decongestant (ND) test for the evaluation of adenoid hypertrophy in children. Materials and methods: Seventy-one of 97 collaborative children, aged 6-12 years, affected by upper airways obstructive symptoms and diagnosed as 'chronic oral breathers' by a standardized questionnaire were included in the study. The first evaluation included a complete physical examination, anterior rhinoscopy and anterior active rhinomanometry. Patients with a positive rhinomanometry underwent a second rhinomanometry after the administration of the nasal decongestant (ND) xylometazoline. All children were evaluated using nasal fiberoptic endoscopy (NFE). Results: At rhinomanometry a normal nasal airflow was found in 19 (26.8%) of children while nasal obstruction was underlined in 52 (73.2%). These patients were tested also with rhinomanometry after ND which confirmed the presence of nasal obstruction in 29 (55.7%) of patients. All patients included in the study underwent a NFE: 34 (47.8%) of them presented severe AH with an occlusion >75% of the choanal opening (grade >= 3) and 37 (52.2%) presented no or a mild form of AH (grade < 3). When compared to NFE, rhinomanometry test after ND had 82.7% sensitivity and 82.6% specificity. Positive predictive value and negative predictive value were 85.7% and 79.2%, respectively. Two receiver operating characteristic (ROC) curves were derived using data related to rhinomanometry vs NFE, and to rhinomanometry after ND vs NFE. Conclusions: Rhinomanometry after ND, compared to rhinomanometry, is more specific and useful to evaluate nasal obstruction due to AH in children, and it may be helpful to avoid unnecessary surgical procedures in children with temporary nasal obstruction. (C) 2011 Elsevier Ireland Ltd. All rights reserved

AN INFANT WITH DIAPHRAGMATIC EVENTRATION AND RESPIRATORY DISTRESS

The authors report a rare case of partial diaphragmatic eventration in a 4-month-old infant with recurrent wheezing and low serum IgA values. Because of persistent respiratory symptoms after therapy with inhaled short-acting beta 2 agonists and inhaled nebulized corticosteroids, surgery was undertaken to correct the defect. Despite surgery, the clinical symptoms did not improve. Consequently, gatroesophagel reflux was considered and the diagnosis was confirmed with pH-metry, after which the infant was started on a protonic pump inhibitor therapy (PPI), achieving clinical improvement. Our experience suggests that in infants with congenital diaphragmatic eventration who present with respiratory distress gastro-oesophageal reflux should be suspected, and PPI therapy should be started before planning surgery

Changes in skin prick test reactivity over 7-14 years in a population of food allergy children and asthmatic sympoms.

Background: Allergic disorders are an increasing health problem among children.Aim: to describe the prevalence of sensitization to common food and inhalant allergens at different ages and the association with asthmatic symptoms.Methods: 174 children with positive Skin Prick Test (SPT) to at least one food allergen <36 months were called after a follow-up period of 7-14 years to repeat SPT, to complete a questionnaire about asthmatic symptoms, and to perform spirometry.Results: 174 children complete the questionnaire: 25.8% had wheezing, 34.4 % had dry cough and 35.6% reported diagnosis of asthma. At the first observation 65 (37.3%) had positive SPT only to food allergens (F) and 109 (62.6%) had sensitization to food and inhalant allergens (F+I). At the second observation in the group with single sensitization to F 50% lost sensitization, 10% retained sensitization to food and developed sensitization to inhalants (F+I) and 40% showed sensitization only to inhalants. In the group with double sensitization (F+I) at the first observation: 50% remained positive to both allergens (F+I), more than 40% were positive only to inhalants and a small percentage (< 10%) became negative. The sensitization profiles differed significatly between two groups (F and F+I). FEV1 and FEF 25-75 were significantly lower in the group F+I at the first observation than in the group F (< p 0-01).Conclusion: We found an association between changes in SPT positivity and the development of asthmatic symptoms. The double sensitization (F+I) as well as the early sensitization to atlants would seem to correlate with the persistence of the allergy and with the development of respiratory disease

Primary school children often underestimate their nasal obstruction

Background: No consensus has ever been reached about the correlation between nasal resistance and the subjective sensation of nasal patency.The aim of the present study was to better define whether primary school and secondary school aged children correctly estimate their nasal obstruction. Materials and methods:Two hundred eighty four children (168 males and 116 female) aged between 6 and 14 years (9.5+2.9 years) affected by Pediatric Allergic Rhinitis underwent Rhinomanometry and they were considered as correctly estimating their nasal obstruction when the grade of nasal patency corresponded to the severity of the NOSE score, overestimating when the grade of nasal patency was 1 when compared to the severity of the score. Results: Correlation between NOSE score and nasal patency was statistically significant (r-0.74; p12 overestimate (34.7%) their symptoms more frequently than children among other age ranges (p<0.001). Conclusion: Although NOSE score approximately allow to quantify nasal obstruction, in children, especially between 6 and 9 years of age, an objective measurement of nasal patency should be performed to better define the therapeutic approach