Pediatric pulmonology
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Pediatric pulmonology · Jul 2017
Clinical TrialCFTR-dependent chloride efflux in cystic fibrosis mononuclear cells is increased by ivacaftor therapy.
The Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) potentiator ivacaftor (Kalydeco®) improves clinical outcome in G551D cystic fibrosis (CF) patients. Here, we have investigated whether ivacaftor has a clinical impact on non-G551D gating mutations and function of circulating leukocytes as well. ⋯ In patients with non-G551D mutations, ivacaftor improved both chloride transport in sweat ducts and chloride efflux in MNC, that is, functions directly imputed to CFTR.
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Pediatric pulmonology · Jul 2017
Effect of ventilator mode on patient-ventilator synchrony and work of breathing in neonatal pigs.
Patient-ventilator asynchrony can result in increased work of breathing (WOB) and need for increased sedation, as well as respiratory muscle fatigue and prolonged mechanical ventilation. Different ventilator modes may result in varying degrees of asynchrony and WOB. ⋯ Asynchrony and WOB are highest with SIMV/VC plus PS. If SIMV is utilized, SIMV/PRVC plus a PS that optimizes tidal volume may be preferable. PRVC has the least asynchrony and WOB in the injured lung.
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Pediatric pulmonology · Jul 2017
Review Meta AnalysisIntratracheal Administration of Budesonide-Surfactant in Prevention of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants: A Systematic Review and Meta-Analysis.
Despite the near universal adaptation of gentle mechanical ventilation, surfactant use and non-invasive respiratory support, bronchopulmonary dysplasia (BPD) remains one of the most common respiratory morbidities in very low birth weight (VLBW) infants. Thus, the objective of this review was to evaluate the efficacy of intra-tracheal administration of budesonide-surfactant mixture in preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. MEDLINE, EMBASE, and PubMed were searched for randomized clinical trials in which intra-tracheal administration of budesonide-surfactant was used to prevent BPD in infants. ⋯ Meta-analysis of the two clinical trials revealed that infants who received intra-tracheal instillation of budesonide-surfactant mixture demonstrated 43% reduction in the risk of BPD (RR: 0.57; 95%CI: 0.43-0.76, NNT = 5). Although mortality was not different between the groups (OR: 0.61; 95%CI: 0.34-1.04), a 40% reduction was observed in the composite outcome of death or BPD in the budesonide-surfactant group (RR: 0.60; 95%CI: 0.49-0.74, NNT = 3). Thus, this review concludes that intra-tracheal administration of budesonide-surfactant combination was associated with decreased incidence of BPD alone or composite outcome of death or BPD in VLBW infants though there is a need for larger trials before it can be recommended as a standard of care.
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Pediatric pulmonology · Jul 2017
Case ReportsRare cause for hemoptysis in an adolescent: Bronchial capillary hemangioma.
Hemoptysis is rare in children and adolescents. We describe an 11-year-old girl who presented with hemoptysis, cough, and exertional dyspnea. Radiologic and bronchoscopic assessment revealed a pedunculated mass in the right main stem bronchus with a ball valve effect. ⋯ The tumor could be excised bronchoscopically, and histologic examination showed a capillary hemangioma. In the literature, bronchial hemangiomas are described in infants and adults. This case demonstrates that bronchial hemangioma should also be taken into consideration as a cause of hemoptysis in adolescents.