Archives of disease in childhood
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A retrospective review of children who needed mechanical ventilation for severe bronchiolitis identified 62 cases over a 10 year period. The mean age at initiation of ventilation was 73 days (range: 14-201). Compared with a group of 150 children in hospital for bronchiolitis but not transferred to the intensive care unit, these 62 cases were significantly younger (73.0 compared with 166.3 days), and smaller (4.5 compared with 6.8 kg), and significantly more had been born prematurely (40% compared with 16%). ⋯ Duration of ventilation was significantly longer in children with a low gestational age at birth and a positive familial history of atopy. There were no deaths, and no patient developed pneumothorax or pneumomediastinum. Mechanical ventilation is well tolerated and safe in acute bronchiolitis.
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We recorded the respiratory history by questionnaire in a 7 year old cohort of children whose birth weight was under 2000 g and an unselected reference group of local schoolchildren of the same age. Complete data were obtained in 121 low birthweight children (90% of those studied): 62 who had no neonatal respiratory illness, 25 who had oxygen treatment only, and 34 who received mechanical ventilation (of whom 10 had bronchopulmonary dysplasia). The low birthweight children were no more likely to wheeze than the reference group, but frequent and troublesome cough was significantly more common, especially among children of very low birth weight (under 1500 g) who had received neonatal respiratory treatment. ⋯ The prevalence of cough at the age of 7 was independently associated with the level of neonatal intensive care as defined by oxygen score. Although there was no excess of wheeze in the cohort compared with the reference group, there was a weak correlation between wheeze and the neonatal oxygen score as well as with maternal smoking. Loss of schooling due to respiratory symptoms in the nine months before this study was no greater in children of low birth weight than in the reference group.
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Lung function was recorded in a cohort of 130 age specific children of low birth weight (under 2000 g) and a reference population of 120 unselected local schoolchildren at 7 years of age. Children of the cohort were similar in height and forced vital capacity to the reference group, but had significantly reduced forced expiratory volume in 0.75 second and expiratory flow indices. Although neonatal respiratory illness was associated with reduced airway function, we were unable to confirm that this was a consequence of oxygen treatment or mechanical ventilation. ⋯ The reduction in airway function observed in the low birthweight children was associated with cough but not wheeze. The disparity between the relatively well preserved vital capacity and reduced airway function suggests that very low birth weight, and hence prematurity, has its greatest effect on the subsequent growth of airway function. The absence of an association between neonatal oxygen score or mechanical ventilation and childhood lung function suggests that the long term effect of neonatal respiratory treatment is small compared with that of birth weight, maternal smoking, and male sex.
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Case Reports
Night blindness and conjunctival xerosis caused by vitamin A deficiency in patients with cystic fibrosis.
Forty three patients with cystic fibrosis, aged 8-44 years (median 16 years), were examined for evidence of vitamin A deficiency. Eight patients had abnormal dark adaptation tests and three had conjunctival xerosis. Serum vitamin A and retinol binding protein concentrations were significantly lower in the affected patients who were also more likely to have abnormal liver function tests. ⋯ In four patients dark adaptation tests were repeated. Three were normal, but one patient required three further doses of water miscible vitamin A and a daily supplement of 12,000 IU vitamin A before her dark adaptation threshold returned to normal. Adolescents with cystic fibrosis are liable to develop night blindness and conjunctival xerosis, particularly if they have liver disease or fail to take daily vitamin supplements.