Showing posts with label pulmonology. Show all posts
Showing posts with label pulmonology. Show all posts

Friday, September 11, 2015

Very Low Birth Weight Infants As Adults: How Are Their Lungs Doing?


By: Lewis First, MD, MS; Editor-in-Chief   
David Quitoriano

     We, along with other journals, are finding ourselves publishing more and more studies on long-term outcomes of former preterm infants as they grow and develop.  Recently, thanks to the neonatal inroads made at the start of life, even the highest risk infants are not only surviving, but many are thriving into adulthood.  While we are certainly interested in developmental outcomes of these infants as seen in the myriad of articles published in this area, there is less available about the medical complications of prematurity that may still exist in terms of adult health and wellbeing. 
      Yet this week, Saarenpaa et al. (doi: 10.1542/peds.2014-2651) share with us the results of a longitudinal population of 160 very low birth weight (VLBW) infants and a matched control group in Norway in terms of their pulmonary function when restudied at 18 to 27 years of age.  Infants with and without bronchopulmonary dysplasia (BPD) were separated into their own groups, and yet even without BPD, former VLBW infants who are now adults are showing reduced airflow, increasing their risk for obstructive airway disease as they age.   
      If you have former VLBW infants now growing up in your practice, this is a study to know about and share with the families of those patients, so appropriate attention can be paid for monitoring respiratory status in these patients as they get older and leave your practice.   You and your VLBW patients may breathe more easily learning what this study has to say about the respiratory status of this special population of patients.

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Monday, July 6, 2015

A National Look at Trends in Pediatric Pulmonary Hypertension


By: Lewis First, MD, MS; Editor-in-Chief  

Engineering for Change
          Admittedly, pulmonary hypertension is not common in anyone’s individual practice—but the problem does exist and the more we can learn from patients with this disorder, the more we can help them.  Fortunately Maxwell et al. (doi:10.1542/peds.2014-3834) used a national database of pediatric hospital discharges to find all cases of pulmonary hypertension logged into the 43 million hospitalizations contained in that database. Over the 16 years studied (1997-2012), 0.13% of discharges or 5,590 of them involved a child with pulmonary hypertension with numbers increasing over time.   
     This is the largest compilation of pulmonary hypertension cases that we are aware of and there is lots to learn from this population in aggregate ranging from how many were or were not associated with congenital heart disease to costs of care for these patients and the changes in mortality rate over time, just to name a few.   
     To help elucidate the lessons learned from this study in regard to our future care of these patients, Drs. Abman and Dunbar offer their expertise in an accompanying commentary. (doi: 10.1542/peds.2015-1697If you need a refresher on pulmonary hypertension and its natural history in children, this study and commentary will allow you to breathe more easily when it comes to knowing more about this serious physiologic disorder.

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Friday, June 5, 2015

Isoniazid-resistant Tuberculosis: A Problem More Common than You Might Have Thought


By: Lewis First, MD, MS; Editor-in-Chief

          Tuberculosis (TB) in children remains a global health problem and yet for decades we have relied on the use of isoniazid to help treat this devastating illness.  Sadly however, we have become more and more aware of isoniazid resistance in cases of TB in children.  But how prevalent is this resistance?  Yuen et al. (doi: 10.1542/peds.2015-0172) studied this question and estimated on the basis of their data that globally more than 120,000 children or 12.1% of all children with TB have isoniazid-resistant TB. Just where these cases are is well described in this study so please take a few minutes and read and learn more. 
      It appears, based on what the authors share in this study, that adults with resistance to isoniazid are transferring this resistance to children and raises new concerns as to whether we should continue to use this drug as first line in children with active or even latent disease.   
     The good news is that the AAP’s Committee on Infectious Diseases is also following this story and will keep us well informed of changes in treatment regimens as data like that shared in this important study continue to accumulate.  

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