Medicine and Health Sciences Commons^™

Direct Lung Sampling Indicates That Established Pathogens Dominate Early Infections In Children With Cystic Fibrosis., Peter Jorth, Zarmina Ehsan Md, Amir Rezayat, Ellen Caldwell, Christopher Pope, John J. Brewington, Christopher H. Goss, Dan Benscoter, John P. Clancy, Pradeep K. Singh

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Culture and sequencing have produced divergent hypotheses about cystic fibrosis (CF) lung infections. Culturing suggests that CF lungs are uninfected before colonization by a limited group of CF pathogens. Sequencing suggests diverse communities of mostly oral bacteria inhabit lungs early on and diversity decreases as disease progresses. We studied the lung microbiota of CF children using bronchoscopy and sequencing, with measures to reduce contamination. We found no evidence for oral bacterial communities in lung lavages that lacked CF pathogens. Lavage microbial diversity varied widely, but decreases in diversity appeared to be driven by increased CF pathogen abundance, which reduced the …

The Impact Of Pulmonary Hypertension In Preterm Infants With Severe Bronchopulmonary Dysplasia Through 1 Year., Joanne M. Lagatta, Erik B. Hysinger, Isabella Zaniletti, Erica M. Wymore, Shilpa Vyas-Read, Sushmita Yallapragada, Leif D. Nelin, William E. Truog, Michael A. Padula, Nicolas F M Porta, Rashmin C. Savani, Karin P. Potoka, Steven M. Kawut, Robert Digeronimo, Girija Natarajan, Huayan Zhang, Theresa R. Grover, William A. Engle, Karna Murthy, Children's Hospital Neonatal Consortium Severe Bpd Focus Group

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OBJECTIVES: To assess the effect of pulmonary hypertension on neonatal intensive care unit mortality and hospital readmission through 1 year of corrected age in a large multicenter cohort of infants with severe bronchopulmonary dysplasia.

STUDY DESIGN: This was a multicenter, retrospective cohort study of 1677 infants bornChildren's Hospital Neonatal Consortium with records linked to the Pediatric Health Information System.

RESULTS: Pulmonary hypertension occurred in 370 out of 1677 (22%) infants. During the neonatal admission, pulmonary hypertension was associated with mortality (OR 3.15, 95% CI 2.10-4.73, P < .001), ventilator support at 36 weeks of postmenstrual age (60% vs 40%, P < .001), duration of ventilation (72 IQR 30-124 vs 41 IQR 17-74 days, P < .001), and higher respiratory severity score (3.6 IQR 0.4-7.0 vs 0.8 IQR 0.3-3.3, P < .001). At discharge, pulmonary hypertension was associated with tracheostomy (27% vs 9%, P < .001), supplemental oxygen use (84% vs 61%, P < .001), and tube feeds (80% vs 46%, P < .001). Through 1 year of corrected age, pulmonary hypertension was associated with increased frequency of readmission (incidence rate ratio [IRR] = 1.38, 95% CI 1.18-1.63, P < .001).

CONCLUSIONS: Infants with severe bronchopulmonary dysplasia-associated pulmonary hypertension have increased morbidity and mortality through …

Evaluation Of The Illumigene Mycoplasma Direct Dna Amplification Assay, Neena Kanwar, Morgan A. Pence, Donna Mayne, Jeff Michael, Rangaraj Selvarangan

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Copyright © 2018 Kanwar et al. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. The illumigene Mycoplasma Direct (IMD) DNA amplification assay is a qualitative in vitro test utilizing loop-mediated isothermal amplification (LAMP) technology for the direct detection of M. Pneumoniae DNA in respiratory specimens. The IMD assay does not require the preextraction of nucleic acids from specimens, which is a prerequisite step for the previously approved illumigene Mycoplasma (iM) assay. The aim of this prospective multicenter study was to evaluate the performance characteristics of the newly developed IMD assay, compared with the iM assay. Subjects with symptoms of …

Protocol For A Randomised Trial Of Higher Versus Lower Intensity Patient-Provider Communication Interventions To Reduce Antibiotic Misuse In Two Paediatric Ambulatory Clinics In The Usa., Kathy Goggin, Andrea Bradley-Ewing, Angela Myers, Brian R. Lee, Emily A. Hurley, Kirsten B. Delay, Sarah Schlachter, Areli Ramphal, Kimberly Pina, David Yu, Kirsten Weltmer, Sebastian Linnemayr, Christopher C. Butler, Jason G. Newland

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INTRODUCTION: Children with acute respiratory tract infections (ARTIs) are prescribed up to 11.4 million unnecessary antibiotic prescriptions annually. Inadequate parent-provider communication is a chief contributor, yet efforts to reduce overprescribing have only indirectly targeted communication or been impractical. This paper describes our multisite, parallel group, cluster randomised trial comparing two feasible interventions for enhancing parent-provider communication on the rate of inappropriate antibiotic prescribing (primary outcome) and revisits, adverse drug reactions and parent-rated quality of shared decision-making, parent-provider communication and visit satisfaction (secondary outcomes).

METHODS/ANALYSIS: We will attempt to recruit all eligible paediatricians and nurse practitioners (currently 47) at an academic …

Successful Reversal Of Furosemide-Induced Secondary Hyperparathyroidism With Cinacalcet., Tarak Srivastava, Shahryar Jafri, William E. Truog, Judith Sebestyen Vansickle, Winston M. Manimtim, Uri S. Alon

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Secondary hyperparathyroidism (SHPT) is a rare complication of furosemide therapy that can occur in patients treated with the loop diuretic for a long period of time. We report a 6-month-old 28-weeks premature infant treated chronically with furosemide for his bronchopulmonary dysplasia, who developed hypocalcemia and severe SHPT, adversely affecting his bones. Discontinuation of the loop diuretic and the addition of supplemental calcium and calcitriol only partially reversed the SHPT, bringing serum parathyroid hormone level down from 553 to 238 pg/mL. After introduction of the calcimimetic Cinacalcet, we observed a sustained normalization of parathyroid hormone concentration at 27 to 63 pg/mL …

A Novel Method Of Measuring Fractional Exhaled Nitric Oxide In Tracheostomized Ventilator-Dependent Children., Vydehi R. Murthy, Hugo Escobar, Michael Norberg, Charisse I. Lachica, Linda L. Gratny, Ashley K. Sherman, William E Truog, Winston M. Manimtim

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BACKGROUND: The lower airway concentration of fractional exhaled nitric oxide (FENO) is unknown in children with chronic lung disease of infancy who have tracheostomy for long-term mechanical ventilation. We aimed to evaluate an online method of measuring FENO in a cohort of ventilator-dependent children with a tracheostomy and to explore the relationship between the peak FENO concentration (FENO peak) and the degree of respiratory support using the respiratory severity score.

METHODS: We conducted a prospective cross-sectional study in 31 subjects who were receiving long-term respiratory support through a tracheostomy. We measured the FENO peak and FENO plateau concentration from the …

Mc-Ppea As A New And More Potent Inhibitor Of Clp-Induced Sepsis And Pulmonary Inflammation Than Fk866., Peixin Huang, Mark W Lee, Keivan Sadrerafi, Daniel P. Heruth, Li Q. Zhang, Dev Maulik, Shui Qing Ye

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Our previous study indicated that overexpression of nicotinamide phosphoribosyltransferase (NAMPT) aggravated acute lung injury, while knockdown of NAMPT expression attenuated ventilator-induced lung injury. Recently, we found that meta-carborane-butyl-3-(3-pyridinyl)-2E-propenamide (MC-PPEA, MC4), in which the benzoylpiperidine moiety of FK866 has been replaced by a carborane, displayed a 100-fold increase in NAMPT inhibition over FK866. Here, we determined the effects of MC4 and FK866 on cecal ligation and puncture (CLP) surgery-induced sepsis in C57BL/6J mice. MC4 showed stronger inhibitory effects than FK866 on CLP-induced mortality, serum tumor necrosis factor α (TNFα) levels, pulmonary myeloperoxidase activity, alveolar injury, and interleukin 6 and interleukin1β messenger …

Erratum To: Scaling Up Strategies Of The Chronic Respiratory Disease Programme Of The European Innovation Partnership On Active And Healthy Ageing (Action Plan B3: Area 5)., J Bousquet, J Farrell, G Crooks, P Hellings, E H. Bel, M Bewick, N H. Chavannes, J Correia De Sousa, A A. Cruz, T Haahtela, G Joos, N Khaltaev, J Malva, A Muraro, M Nogues, S Palkonen, S Pedersen, C Robalo-Cordeiro, B Samolinski, T Strandberg, A Valiulis, A Yorgancioglu, T Zuberbier, A Bedbrook, W Aberer, M Adachi, A Agusti, C A Akdis, M Akdis, J Ankri, A Alonso, I Annesi-Maesano, I J. Ansotegui, J M. Anto, S Arnavielhe, H Arshad, C Bai, I Baiardini, C Bachert, A K. Baigenzhin, C Barbara, E D. Bateman, B Beghé, A Ben Kheder, K S. Bennoor, M Benson, K C. Bergmann, T Bieber, C Bindslev-Jensen, L Bjermer, H Blain, F Blasi, A L. Boner, M Bonini, S Bonini, S Bosnic-Anticevitch, L P. Boulet, R Bourret, P J. Bousquet, F Braido, A H. Briggs, C E. Brightling, J Brozek, R Buhl, P G. Burney, A Bush, F Caballero-Fonseca, D Caimmi, M A. Calderon, P M. Calverley, P A M Camargos, G W. Canonica, T Camuzat, K H. Carlsen, W Carr, A Carriazo, T Casale, A M. Cepeda Sarabia, L Chatzi, Y Z. Chen, R Chiron, E Chkhartishvili, A G. Chuchalin, K F. Chung, G Ciprandi, I Cirule, L Cox, D J. Costa, A Custovic, R Dahl, S E. Dahlen, U Darsow, G De Carlo, F De Blay, T Dedeu, D Deleanu, E De Manuel Keenoy, P Demoly, J A. Denburg, P Devillier, A Didier, A T. Dinh-Xuan, R Djukanovic, D Dokic, H Douagui, G Dray, R Dubakiene, S R. Durham, M S. Dykewicz, Y El-Gamal, R Emuzyte, L M. Fabbri, M Fletcher, A Fiocchi, A Fink Wagner, J Fonseca, W J. Fokkens, F Forastiere, P Frith, M Gaga, A Gamkrelidze, J Garces, J Garcia-Aymerich, B Gemicioğlu, J E. Gereda, S González Diaz, M Gotua, I Grisle, L Grouse, Z Gutter, M A. Guzmán, L G. Heaney, B Hellquist-Dahl, D Henderson, A Hendry, J Heinrich, D Heve, F Horak, J O' B Hourihane, P Howarth, M Humbert, M E. Hyland, M Illario, J C. Ivancevich, J R. Jardim, E J. Jares, C Jeandel, C Jenkins, S L. Johnston, O Jonquet, K Julge, K S. Jung, J Just, I Kaidashev, M R. Khaitov, O Kalayci, A F. Kalyoncu, T Keil, P K. Keith, L Klimek, B Koffi N'Goran, V Kolek, G H. Koppelman, M L. Kowalski, I Kull, P Kuna, V Kvedariene, B Lambrecht, S Lau, D Larenas-Linnemann, D Laune, L T T Le, P Lieberman, B Lipworth, J Li, K Lodrup Carlsen, R Louis, W Macnee, Y Magard, A Magnan, B Mahboub, A Mair, I Majer, M J. Makela, P Manning, S Mara, G D. Marshall, M R. Masjedi, P Matignon, M Maurer, S Mavale-Manuel, E Melén, E Melo-Gomes, E O. Meltzer, A Menzies-Gow, H Merk, J P. Michel, N Miculinic, F Mihaltan, B Milenkovic, G M Y Mohammad, M Molimard, I Momas, A Montilla-Santana, M Morais-Almeida, M Morgan, R Mösges, J Mullol, S Nafti, L Namazova-Baranova, R Naclerio, A Neou, H Neffen, K Nekam, B Niggemann, G Ninot, T D. Nyembue, R E. O'Hehir, K Ohta, Y Okamoto, K Okubo, S Ouedraogo, P Paggiaro, I Pali-Schöll, P Panzner, N Papadopoulos, A Papi, H S. Park, G Passalacqua, I Pavord, R Pawankar, R Pengelly, O Pfaar, R Picard, B Pigearias, I Pin, D Plavec, D Poethig, W Pohl, T A. Popov, F Portejoie, P Potter, D Postma, D Price, K F. Rabe, F Raciborski, F Radier Pontal, S Repka-Ramirez, S Reitamo, S Rennard, F Rodenas, J Roberts, J Roca, L Rodriguez Mañas, C Rolland, M Roman Rodriguez, A Romano, J Rosado-Pinto, N Rosario, L Rosenwasser, M Rottem, D Ryan, M Sanchez-Borges, G K. Scadding, H J. Schunemann, E Serrano, P Schmid-Grendelmeier, H Schulz, A Sheikh, M Shields, N Siafakas, Y Sibille, T Similowski, F E R Simons, J C. Sisul, I Skrindo, H A. Smit, D Solé, T Sooronbaev, O Spranger, R Stelmach, P J. Sterk, J Sunyer, C Thijs, T To, A Todo-Bom, M Triggiani, R Valenta, A L. Valero, E Valia, E Valovirta, E Van Ganse, M Van Hage, O Vandenplas, T Vasankari, B Vellas, J Vestbo, G Vezzani, P Vichyanond, G Viegi, C Vogelmeier, T Vontetsianos, M Wagenmann, B Wallaert, S Walker, D Y. Wang, U Wahn, M Wickman, D M. Williams, S Williams, J Wright, B P. Yawn, P K. Yiallouros, O M. Yusuf, A Zaidi, H J. Zar, M E. Zernotti, L Zhang, N Zhong, M Zidarn, J Mercier

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[This corrects the article DOI: 10.1186/s13601-016-0116-9.].

Intravenous Versus Oral Antibiotics For Postdischarge Treatment Of Complicated Pneumonia., Samir S. Shah, Rajendu Srivastava, Susan Wu, Jeffrey D. Colvin, Derek J. Williams, Shawn J. Rangel, Waheeda Samady, Suchitra Rao, Christopher Miller, Cynthia Cross, Caitlin Clohessy, Matthew Hall, Russell Localio, Matthew Bryan, Gong Wu, Ron Keren, Pediatric Research In Inpatient Settings Network

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BACKGROUND AND OBJECTIVES: Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatment-related complications of postdischarge antibiotics delivered by these 2 routes.

METHODS: This multicenter retrospective cohort study included children ≥2 months andadministration, classified as PICC or oral. The primary outcome was treatment failure. Secondary outcomes included PICC complications, adverse drug reactions, other related revisits, and a composite of all 4 outcomes, termed "all related revisits."

RESULTS: Among 2123 children, 281 (13.2%) received antibiotics …

Indoor Tobacco Legislation Is Associated With Fewer Emergency Department Visits For Asthma Exacerbation In Children., Christina E. Ciaccio, Tami Gurley-Calvez, Theresa I. Shireman

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BACKGROUND: During the past 3 decades, numerous cities and states have adopted laws that ban smoking in public indoor spaces. The rationale for these policies has been to protect nonsmokers from the adverse health effects of secondhand smoke.

OBJECTIVE: To determine whether the implementation of indoor smoking legislation is associated with a decrease in emergency department visits for asthma in children.

METHODS: This retrospective analysis used a natural experiment to estimate the impact of clean indoor air legislation on the rate of emergency department admissions for asthma exacerbation in children. Data were obtained from the Pediatric Health Information System. A …

Genetic Variation In The Histamine Production, Response, And Degradation Pathway Is Associated With Histamine Pharmacodynamic Response In Children With Asthma., Bridgette Jones, Catherine M T Sherwin, Xiaoxi Liu, Hongying Dai, Carrie A. Vyhlidal

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Introduction: There is growing knowledge of the wide ranging effects of histamine throughout the body therefore it is important to better understand the effects of this amine in patients with asthma. We aimed to explore the association between histamine pharmacodynamic (PD) response and genetic variation in the histamine pathway in children with asthma. Methods: Histamine Iontophoresis with Laser Doppler Monitoring (HILD) was performed in children with asthma and estimates for area under the effect curve (AUEC), maximal response over baseline (Emax), and time of Emax (Tmax) were calculated using non-compartmental analysis and non-linear mixed-effects model with a linked effect PK/PD …

Executive Summary: The Management Of Community-Acquired Pneumonia In Infants And Children Older Than 3 Months Of Age: Clinical Practice Guidelines By The Pediatric Infectious Diseases Society And The Infectious Diseases Society Of America., John S. Bradley, Carrie L. Byington, Samir S. Shah, Brian Alverson, Edward R. Carter, Christopher Harrison, Sheldon L. Kaplan, Sharon E. Mace, George H. Mccracken, Matthew R. Moore, Shawn D. St Peter, Jana A. Stockwell, Jack T. Swanson, Pediatric Infectious Diseases Society And The Infectious Diseases Society Of America

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Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.