Paediatric respiratory reviews
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Food allergy and asthma are both atopic diseases and therefore frequently co-exist. Food allergy is common in childhood, affecting approximately 8% of infants. The diagnosis is based on a suggestive history supported by skin-prick testing, serum specific IgE or food challenge. ⋯ The mechanism underlying this connection is unclear. The co-existence of food allergy should be considered in any child with asthma. Where food allergy is confirmed, steps should be taken to avoid these foods as this may considerably improve asthma control.
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Extracorporeal life support (ECLS) has become an accepted therapeutic measure in the treatment of infants, children and adults with reversible respiratory or cardiac failure. The principle behind ECLS involves obtaining access to drain blood from the venous circulation into the extracorporeal circuit where it is oxygenated and cleansed of carbon dioxide before being returned to the circulation. The UK Collaborative ECMO Trial showed that an ECLS policy was clinically effective in terms of improved survival without a rise in severe disability at age 1 year. ⋯ The value of ECLS in paediatric and, more recently, adult respiratory failure is becoming clearer. ECLS has a vital role to play in the support of paediatric cardiac surgery programmes. Recent advances include newer oxygenators, greater use of less invasive veno-venous support and the use of ECLS to support novel therapies used to treat severe congenital diaphragmatic hernia.
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Paediatr Respir Rev · Mar 2003
Review Historical ArticleOxygen monitoring in preterm babies: too high, too low?
A small randomised trial in 1952 showed that excess oxygen use might well be causing a major epidemic of retinal blindness in preterm babies. That single study of just 65 babies was enough to throw doubt on a longstanding treatment strategy of oxygen therapy and highlighted just how powerful a tool the randomised controlled trial could be. ⋯ It is now time the same question was asked of babies less than a month old. This is particularly important in babies of less than 28 weeks' gestation, who currently remain at serious risk of chronic lung disease and permanent retinal damage.
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Paediatr Respir Rev · Mar 2003
ReviewApproaches to the initial respiratory management of preterm neonates.
Newly born preterm infants often require respiratory support. Various approaches have been taken to provide this support, including elective intubation and ventilation, prophylactic surfactant and continuous positive airway pressure (CPAP). Elective intubation and ventilation allow the clinician to take control of the baby's airway and reduce the support as tolerated. ⋯ Many neonatologists, however, advocate a less aggressive approach to the provision of support, which includes the application of early nasal CPAP with intubation and ventilation only if necessary. Avoiding intubation may be effective in minimising ventilator-induced lung injury, but withholding surfactant may be detrimental to the infant. In this paper, we examine the advantages and disadvantages of the different approaches that can be taken in providing respiratory support to preterm neonates shortly after birth and examine some strategies that integrate them.