Respiratory disease is unfortunately common in preterm infants with the archetype being bronchopulmonary dysplasia (BPD). BPD affects approximately 50,000 preterm infants in the U.S. annually with ...substantial morbidity and mortality related to its pathology (alveolar, airway, and pulmonary vasculature maldevelopment). Predicting the likelihood and severity of chronic respiratory disease in these children as they age is difficult and compounded by the lack of consistent phenotyping. Barriers to understanding the actual scope of this problem include few longitudinal studies, information limited by small retrospective studies and the ever‐changing landscape of therapies in the NICU that affect long‐term respiratory outcomes. Thus, the true burden of adult respiratory disease caused by premature birth is currently unknown. Nevertheless, limited data suggest that a substantial percentage of children with a history of BPD have long‐term respiratory symptoms and persistent airflow obstruction associated with altered lung function trajectories into adult life. Small airway disease with variable bronchodilator responsiveness, is the most common manifestation of lung dysfunction in adults with a history of BPD. The etiology of this is unclear however, developmental dysanapsis may underlie the airflow obstruction in some adults with a history of BPD. This type of flow limitation resembles that of aging adults with chronic obstructive lung disease with no history of smoking. It is also unclear whether lung function abnormalities in people with a history of BPD are static or if these individuals with BPD have a more accelerated decline in lung function as they age compared to controls. While some of the more significant mediators of lung function, such as tobacco smoke and respiratory infections have been identified, more work is necessary to identify the best means of preserving lung function for individuals born prematurely throughout their lifespan.
Introduction
Although prolonged respiratory symptoms following severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection have been described in adults, data are emerging that children ...also experience long‐term sequelae of coronavirus disease 2019 (COVID‐19). The respiratory sequelae of COVID‐19 in children remain poorly characterized. In this study we describe health data and respiratory findings in pediatric patients presenting with persistent respiratory symptoms following COVID‐19.
Methods
This study included patients referred to Pulmonary Clinic at the Children's Hospital of Philadelphia between December 2020 and April 2021 (n = 29). Inclusion criteria included a history of SARS‐CoV‐2 RNA positivity or confirmed close household contact and suggestive symptoms. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected.
Results
The mean age at presentation to clinic was 13.1 years (range: 4–19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months postacute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.8% of subjects. Many subjects were overweight or obese (62.1%) and 11 subjects (37.9%) had a prior history of asthma. Spirometry and plethysmography were normal in most patients. The six‐minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two‐thirds of the nine children tested.
Conclusion
Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with postacute COVID‐19 respiratory symptoms seen in an outpatient pulmonary clinic. Spirometry (and plethysmography when available), however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.
Tobacco smoke and nicotine exposure during prenatal and postnatal life can impair lung development, alter the immune response to viral infections, and increase the prevalence of wheezing during ...childhood. The following review examines recent discoveries in the fields of lung development and tobacco and nicotine exposure, emphasizing studies published within the last 5 years. In utero tobacco and nicotine exposure remains common, occurring in approximately 10% of pregnancies within the United States. Exposed neonates are at increased risk for diminished lung function, altered central and peripheral respiratory chemoreception, and increased asthma symptoms throughout childhood. Recently, genomic and epigenetic risk factors, such as alterations in DNA methylation, have been identified that may influence the risk for long-term disease. This review examines the impact of prenatal tobacco and nicotine exposure on lung development with a particular focus on nicotinic acetylcholine receptors. In addition, this review examines the role of prenatal and postnatal tobacco smoke and nicotine exposure and its association with augmenting infection risk, skewing the immune response toward a T-helper type 2 bias and increasing risk for developing an allergic phenotype and asthmalike symptoms during childhood. Finally, this review outlines the respiratory morbidities associated with childhood secondhand smoke and nicotine exposure and examines genetic and epigenetic modifiers that may influence respiratory health in infants and children exposed to in utero or postnatal tobacco smoke.
Ataxia telangiectasia: a review Rothblum-Oviatt, Cynthia; Wright, Jennifer; Lefton-Greif, Maureen A ...
Orphanet journal of rare diseases,
11/2016, Letnik:
11, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Ataxia telangiectasia (A-T) is an autosomal recessive disorder primarily characterized by cerebellar degeneration, telangiectasia, immunodeficiency, cancer susceptibility and radiation sensitivity. ...A-T is often referred to as a genome instability or DNA damage response syndrome.
The world-wide prevalence of A-T is estimated to be between 1 in 40,000 and 1 in 100,000 live births.
A-T is a complex disorder with substantial variability in the severity of features between affected individuals, and at different ages. Neurological symptoms most often first appear in early childhood when children begin to sit or walk. They have immunological abnormalities including immunoglobulin and antibody deficiencies and lymphopenia. People with A-T have an increased predisposition for cancers, particularly of lymphoid origin. Pulmonary disease and problems with feeding, swallowing and nutrition are common, and there also may be dermatological and endocrine manifestations.
A-T is caused by mutations in the ATM (Ataxia Telangiectasia, Mutated) gene which encodes a protein of the same name. The primary role of the ATM protein is coordination of cellular signaling pathways in response to DNA double strand breaks, oxidative stress and other genotoxic stress.
The diagnosis of A-T is usually suspected by the combination of neurologic clinical features (ataxia, abnormal control of eye movement, and postural instability) with one or more of the following which may vary in their appearance: telangiectasia, frequent sinopulmonary infections and specific laboratory abnormalities (e.g. IgA deficiency, lymphopenia especially affecting T lymphocytes and increased alpha-fetoprotein levels). Because certain neurological features may arise later, a diagnosis of A-T should be carefully considered for any ataxic child with an otherwise elusive diagnosis. A diagnosis of A-T can be confirmed by the finding of an absence or deficiency of the ATM protein or its kinase activity in cultured cell lines, and/or identification of the pathological mutations in the ATM gene.
There are several other neurologic and rare disorders that physicians must consider when diagnosing A-T and that can be confused with A-T. Differentiation of these various disorders is often possible with clinical features and selected laboratory tests, including gene sequencing.
Antenatal diagnosis can be performed if the pathological ATM mutations in that family have been identified in an affected child. In the absence of identifying mutations, antenatal diagnosis can be made by haplotype analysis if an unambiguous diagnosis of the affected child has been made through clinical and laboratory findings and/or ATM protein analysis.
Genetic counseling can help family members of a patient with A-T understand when genetic testing for A-T is feasible, and how the test results should be interpreted.
Treatment of the neurologic problems associated with A-T is symptomatic and supportive, as there are no treatments known to slow or stop the neurodegeneration. However, other manifestations of A-T, e.g. immunodeficiency, pulmonary disease, failure to thrive and diabetes can be treated effectively.
Timed-pregnant C57BL/6J mice were exposed to 2.4% nicotine in propylene glycol (PG) or 0% nicotine /PG once a day from gestational day 15 until delivery. After delivery, offspring and mothers were ...exposed to E-cigarette vapors for an additional 14 days from postnatal day 2 through 16. Following their last exposure serum cotinine levels were measured in female juvenile mice. Male mice underwent behavioral testing at 14 weeks of age to assess sensorimotor, affective, and cognitive functional domains.
Adult male mice exposed to 2.4% nicotine/PG E-cigarette vapors had significantly more head dips in the zero maze test and higher levels of rearing activity in the open field test compared to 0% nicotine/PG exposed mice and untreated controls. In the water maze test after reversal training, the 2.4% nicotine/PG mice spent more than 25% of time in the new location whereas the other groups did not.
Adult male mice exhibited increased levels of activity in the zero maze and open field tests when exposed to E-cigarette vapor containing nicotine during late prenatal and early postnatal life. These findings indicate that nicotine exposure from E-cigarettes may cause persistent behavioral changes when exposure occurs during a period of rapid brain growth.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Electronic cigarette (E-cigarettes) emissions present a potentially new hazard to neonates through inhalation, dermal and oral contact. Exposure to nicotine containing E-cigarettes may cause ...significant systemic absorption in neonates due to the potential for multi-route exposure. Systemic absorption of nicotine and constituents of E-cigarette emissions may adversely impact weight and lung development in the neonate. To address these questions we exposed neonatal mice to E-cigarette emissions and measured systemic cotinine levels and alveolar lung growth.
Neonatal mice were exposed to E-cigarettes for the first 10 days of life. E-cigarette cartridges contained either 1.8% nicotine in propylene glycol (PG) or PG vehicle alone. Daily weights, plasma and urine cotinine levels and lung growth using the alveolar mean linear intercept (MLI) method were measured at 10 days of life and compared to room air controls. Mice exposed to 1.8% nicotine/PG had a 13.3% decrease in total body weight compared to room air controls. Plasma cotinine levels were found to be elevated in neonatal mice exposed to 1.8% nicotine/PG E-cigarettes (mean 62.34± 3.3 ng/ml). After adjusting for sex and weight, the nicotine exposed mice were found to have modestly impaired lung growth by MLI compared to room air control mice (p<.054 trial 1; p<.006 trial 2). These studies indicate that exposure to E-cigarette emissions during the neonatal period can adversely impact weight gain. In addition exposure to nicotine containing E-cigarettes can cause detectable levels of systemic cotinine, diminished alveolar cell proliferation and a modest impairment in postnatal lung growth.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
The objective of our study was to examine whether outpatient respiratory morbidities in infants with bronchopulmonary dysplasia (BPD) are influenced by the human milk consumption.
Methods
...Caregivers of subjects recruited from a BPD clinic completed questionnaires regarding breast milk intake and respiratory outcomes.
Results
One‐hundred eighty‐eight caregivers completed the questionnaire. Of these, 173 (92.0%) reported that the child received some breast milk. Infants who received breast milk for fewer months were more likely to be non‐white, and have a lower household income, public insurance, and secondhand smoke exposure. A longer receipt of breast milk was associated with reduced likelihoods of emergency department visits, systemic steroid courses, and cough or chest congestion, and a trend towards a lower risk of re‐hospitalizations.
Conclusions
Longer duration of breast milk intake was associated with markers of higher socio‐economic status, and reduced likelihood of acute and chronic respiratory morbidities among preterm infants with bronchopulmonary dysplasia.
Rationale
Bronchopulmonary dysplasia (BPD) is a major complication of premature birth and the most common cause of chronic lung disease in infancy. Previous studies have shown that children with a ...history of BPD have impaired lung function in childhood compared to their term counterparts. However, little is known about potential modifiable factors that alter lung function trajectories and subsequent respiratory morbidity in this population.
Objectives
To identify potential modifiable risk factors for the development of impaired lung function in patients with a history of prematurity and bronchopulmonary dysplasia.
Methods
Growth parameters (birth, 2 years old, 6 years old) and pulmonary function testing (6 years old) were retrospectively reviewed for subjects (n = 598) recruited from an outpatient BPD clinic who were born ≤36 weeks gestation and were ≥5 years of age.
Results
Of the 598 recruited subjects, 88 (14.7%) performed adequate pulmonary function testing at approximately 6 years of age. The mean forced expiratory volume in 1 s global lung initiative (GLI) Z‐score was −1.31 with lower values associated with Nissen fundoplication. The mean forced vital capacity GLI Z‐score was −0.72 with lower values associated with higher amounts of oxygen required at time of initial hospital discharge and Nissen fundoplication.
Conclusion
Our study found that children with BPD have lower predicted lung function values. Although growth parameters at age 2 and 6 years did not correlate with lung function values at 6 years of age; use and greater requirement for supplemental oxygen and the presence of a Nissen fundoplication at discharge were associated with lower lung function. Prospective studies should focus on identifying modifiable risk factors that could minimize the impact of BPD on later lung function.
Introduction
Infants born prematurely are at high risk for morbidities, including lung disease (bronchopulmonary dysplasia BPD). Little is known regarding environmental factors that can impact ...outcomes in BPD. We sought to assess the role of traffic‐related air pollution (TRAP) on respiratory outcomes in BPD.
Methods
A total of 784 subjects were included from the Johns Hopkins BPD clinic. Caregivers completed questionnaires on environmental exposures and respiratory outcomes (acute care use and chronic symptoms). Distance to the nearest major roadway was derived from subjects’ geocoded residential addresses.
Results
Approximately half of the subjects (53.8%) lived within 500 m of a major roadway. Subjects who lived within 500 m of a major roadway were more likely to be non‐white (P = .006), have a lower estimated household income (P < .001) and live in more densely populated zip codes (P < .001) than those who lived further than 500 m away. For every 1 km increase in distance between residence and roadway, the likelihood of activity limitations decreased by 35% (P = .005). No differences in acute care use were seen with proximity to major roadways.
Conclusions
Proximity to a major roadway was associated with chronic respiratory symptoms, such as activity limitations (eg, dyspnea), and tended to be associated with nighttime symptoms as well. Self‐reported minorities and families with lower estimated household incomes may be more likely to be exposed to TRAP. Further research is necessary to define the effects of TRAP versus other sources of indoor and outdoor air pollution as well as to determine the best ways of combatting pollution‐related respiratory morbidities.
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