Interstitial lung disease in infancy

Abstract

To describe the clinical profile of interstitial lung disease in infancy. A retrospective analysis of cases diagnosed to have ILD was carried out in Kanchi Kamakoti CHILDS Trust hospital over a period of 2 yr. Infants aged 1 month to 1 yr of age were included if they had (1) respiratory symptoms (Cough, tachypnea or crepitations) for at least 1 month (2) diffuse infiltrates on chest radiography (3) Hypoxemia as defined by oxygen saturation less than 90% by pulse oximetry and (4) High Resolution Computed Tomography (HRCT) of the chest revealing findings of interstitial infiltrates or ground glass pattern. Their case records were analyzed for clinical data, treatment and follow up details. Of the 9 children, who were diagnosed to have ILD, 5 were boys and 4 were girls. The male: female ratio was 1.25: 1. The median age of onset of symptoms was 5 month. The common clinical features observed were tachypnea associated with chest indrawing (100%), cough (100%), hypoxia (100%), failure to thrive and fever (55%) each. The following radiographic patterns were observed in the chest skiagrams: reticulo-nodular pattern in 6(67%) and ground glass pattern in 3(33%). HRCT showed interstitial infiltrates in 6 (67%) and ground glass pattern in 3(33%). Evidence for cyto megalo virus (CMV) infection was detected in 5(56%), Adenovirus in 1 (11%) and Pneumocystis carinii (PCP) in 1(11%) infant. Open lung biopsy was performed in 2 infants, which detected CMV in 1 and PCP in the other. All children received oxygen therapy and systemic corticosteroids (oral/IV) in addition to specific therapy for infection and 3 of these infants succumbed to respiratory failure. CMV Infection was the commonest cause of ILD in infancy in our study. However, the consequences on long term follow up in these infants need to be ascertained.