Asthma In Infants Research Articles

Prevalência e características clínicas da sibilância em crianças no primeiro ano de vida, residentes na cidade de Cuiabá, Mato Grosso, Brasil

ObjectiveTo evaluate the prevalence and the clinical characteristics of wheezing in 12‐15 months old infants in the city of Cuiabá, Mato Grosso State, Midwest Brazil. MethodsParents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the “Estudio Internacional de Sibilancia en Lactantes” (EISL) – phase 3 at primary health care clinics at the same day of children vaccination or at home, from August 2009 to November 2010. Results1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (<3 episodes of wheezing) was 15.0% and recurrent wheezing (≥ 3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2‐agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress and hospitalization due to severe episodes were significantly more frequent. Physician‐diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization, neverthless no differences between occasional and recurrent wheezing infants were found. ConclusionsThe prevalence of recurrent wheezing and physician‐diagnosed asthma in infants were lower compared with those found in other Brazilian studies Recurrent wheezing had early onset and high morbity.

Prevalence and clinical characteristics of wheezing in children in the first year of life, living in Cuiabá, Mato Grosso, Brazil

OBJECTIVE: To evaluate the prevalence and the clinical characteristics of wheezing in infants aged 12 to 15 months in the city of Cuiabá, Mato Grosso State, Midwest Brazil.METHODS: Parents and/or guardians of infants were interviewed and completed a written standardized questionnaire of the Estudio Internacional de Sibilancia en Lactantes (EISL) - phase 3 at primary healthcare clinics at the same day of children vaccination or at home, from August of 2009 to November of 2010.RESULTS: 1,060 parents and/or guardians completed the questionnaire, and 514 (48.5%) infants were male. Among the studied infants, 294 (27.7%) had at least one episode of wheezing during the first year of life, beggining at 5.8±3.0 months of age, with a predominance of male patients. The prevalence of occasional wheezing (&lt;3 episodes of wheezing) was 15.0% and recurrent wheezing (≥3 episodes) was 12.7%. Among the infants with recurrent wheezing, the use of inhaled β2-agonist, oral corticosteroid, leukotriene receptor antagonist, as well as night symptoms, respiratory distress, and hospitalization due to severe episodes were significantly more frequent. Physician-diagnosed asthma was observed in 28 (9.5%) of the wheezing infants. Among the wheezing infants, 80 (27.7%) were diagnosed with pneumonia, of whom 33 (11.2%) required hospitalization; neverthless, no differences between occasional and recurrent wheezing infants were found.CONCLUSIONS: The prevalence of recurrent wheezing and physician-diagnosed asthma in infants were lower compared with those observed in other Brazilian studies. Recurrent wheezing had early onset and high morbity.

High dose of maternal folic acid supplementation is associated to infant asthma

Maternal folic acid supplementation had a positive effect on preventing neural tube defects (NTDs), but its effects in infant asthma remained unclear. A hospital-based case–control study was conducted with outpatients between March 2010 and March 2011 including 150 onset infant asthma cases and 212 controls, together with a meta-analysis involving 14 438 participants, was performed. The association between maternal folic acid supplementation and the risk of infant asthma was not significant either in the meta-analysis (OR = 1.06, 95% CI = 0.99–1.14) or in the case–control study (OR = 0.72, 95% CI = 0.37–1.39). However, quantitative analysis of the supplementation dose demonstrated that the risk of infant asthma significantly increased for the infants whose mother were with high-dose supplementation (>72 000 µg•d; OR = 3.16, 95% CI = 1.15–8.71) after adjusting for confounding factors in the case–control study. Meanwhile, the risk of infant asthma significantly decreased for the infants whose mother were with low-dose supplementation (<36 000 µg•d; OR = 0.36, 95% CI = 0.17–0.77). A high dose of folic acid supplementation for mother during pregnancy was associated with an increased risk of infant asthma, whereas supplementation with a relatively low-dose was associated with a decreased risk of infant asthma. These findings should be further investigated in a large population.

Діагностичне значення імунологічних маркерів запальної відповіді організму у верифікації бактеріальної природи фебрильних нападів бронхіальної астми в дітей раннього та дошкільного віку

Мета дослідження полягала у вивченні діагностичної цінності деяких клінічних та імунологічних тестів у верифікації бактеріальної та/або вірусної інфекції при фебрильних епізодах загострень бронхіальної астми у дітей раннього віку. На базі алергологічного відділення Чернівецької обласної дитячої лікарні методом простої випадкової вибірки було проаналізовано дані 104 дітей з бронхіальною астмою, які надійшли в лікарню з приводу загострення астми, пов’язаного з лихоманкою, і з яких були сформовані дві групи клінічного спостереження. При проведенні аналізу клінічних та лабораторних даних у дітей з фебрильними нападами бронхіальної астми бактеріальної або вірусної природи висловлено припущення, що у таких пацієнтів вірогідно частіше імунологічні показники запальних реакцій були підвищеними — рівень сироваткового інтерлейкіну-8 перевищував 50,0 пг/мл (52,9 %), а концентрація С-реактивного білка в сироватці крові становила понад 50,0 мг/л (43,1 %).

ABSTRACT 387

Background and aims: Asthma is very common in pediatric admissions and its confusing with acute bronchiolitis in infants because of the similarity of signs and symptoms. Treatment of acute bronchiolitis may include the use of nasal CPAP. Aims: To describe the occurance of neck and upper chedt emphysema post nasal cpap use in an infant. Methods: Case report of subcutaneous emphysema post nCPAP in asthmatic infant and resolution aftrr discontinue CPAP and starting intravenous and continuous salbutamol nebulization. Results: The use of nCPAP in asthmatic infants may lead to air leak syndrome such as subcutaneous emphysema. Proper history taking revealed the history of recurrent wheezy chest responding to asthma therapy and when asthma treatment optimized the clinical condition improved and emphysema resolved. Conclusions: The use of nasal CPAP in asthmatic infant may lead to subcutaneous emphysema.

Increased risk of autism spectrum disorder among early life asthma patients: An 8-year nationwide population-based prospective study

Previous research has suggested an association between autism spectrum disorder (ASD) and allergic disorders, but epidemiological evidence regarding asthma remains limited. We conducted a nationwide population-based prospective cohort study (1:4 case:control patients, age- and gender-matched), hypothesizing that asthma in infancy or toddlerhood increased the risk of ASD. The participants comprised 2134 asthmatic infants and children and 8536 controls aged 0–3 years in 2002. We identified cases of ASD that occurred near the end of the follow-up period (December 31, 2010), determining that asthmatic infants and children exhibited a higher accumulative incidence rate of ASD than did the controls (1.3% vs 0.7%, P=.007). After adjusting for age at enrollment, gender, level of urbanization, and comorbid allergic diseases (i.e., allergic rhinitis and atopic dermatitis), asthmatic infants and children exhibited an elevated risk of developing ASD (hazard ratio: 2.01, 95% confidence interval: 1.19–3.40). This prospective study indicated a temporal relation between asthma and subsequent ASD diagnosis, supporting the immune hypothesis of ASD pathogenesis. Further studies are required to clarify the probable interactional effects between these disorders and define a homogenous ASD subgroup.

Curcumin Prevents Replication of Respiratory Syncytial Virus and the Epithelial Responses to It in Human Nasal Epithelial Cells

The human nasal epithelium is the first line of defense during respiratory virus infection. Respiratory syncytial virus (RSV) is the major cause of bronchitis, asthma and severe lower respiratory tract disease in infants and young children. We previously reported in human nasal epithelial cells (HNECs), the replication and budding of RSV and the epithelial responses, including release of proinflammatory cytokines and enhancement of the tight junctions, are in part regulated via an NF-κB pathway. In this study, we investigated the effects of the NF-κB in HNECs infected with RSV. Curcumin prevented the replication and budding of RSV and the epithelial responses to it without cytotoxicity. Furthermore, the upregulation of the epithelial barrier function caused by infection with RSV was enhanced by curcumin. Curcumin also has wide pharmacokinetic effects as an inhibitor of NF-κB, eIF-2α dephosphorylation, proteasome and COX2. RSV-infected HNECs were treated with the eIF-2α dephosphorylation blocker salubrinal and the proteasome inhibitor MG132, and inhibitors of COX1 and COX2. Treatment with salubrinal, MG132 and COX2 inhibitor, like curcumin, prevented the replication of RSV and the epithelial responses, and treatment with salubrinal and MG132 enhanced the upregulation of tight junction molecules induced by infection with RSV. These results suggest that curcumin can prevent the replication of RSV and the epithelial responses to it without cytotoxicity and may act as therapy for severe lower respiratory tract disease in infants and young children caused by RSV infection.

Marked induction of matrix metalloproteinase‐10 by respiratory syncytial virus infection in human nasal epithelial cells

Respiratory syncytial virus (RSV) is an important pathogen of bronchiolitis, asthma, and severe lower respiratory tract disease in infants and young children. Matrix metalloproteinases (MMPs) play key roles in viral infection, inflammation and remodeling of the airway. However, the roles and regulation of MMPs in human nasal epithelial cells (HNECs) after RSV infection remain unclear. To investigate the regulation of MMP induced after RSV infection in HNECs, an RSV-infected model of HNECs in vitro was used. It was found that mRNA of MMP-10 was markedly increased in HNECs after RSV infection, together with induction of mRNAs of MMP-1, -7, -9, and -19. The amount of MMP-10 released from HNECs was also increased in a time-dependent manner after RSV infection as was that of chemokine RANTES. The upregulation of MMP-10 in HNECs after RSV infection was prevented by inhibitors of NF-κB and pan-PKC with inhibition of RSV replication, whereas it was prevented by inhibitors of JAK/STAT, MAPK, and EGF receptors without inhibition of RSV replication. In lung tissue of an infant with severe RSV infection in which a few RSV antibody-positive macrophages were observed, MMP-10 was expressed at the apical side of the bronchial epithelial cells and alveolar epithelial cells. In conclusion, MMP-10 induced by RSV infection in HNECs is regulated via distinct signal transduction pathways with or without relation to RSV replication. MMP-10 may play an important role in the pathogenesis of RSV diseases and it has the potential to be a novel marker and therapeutic target for RSV infection.

INFANT ASTHMA: KEY PRINCIPLES OF CONTROL ATTAINMENT IN THE MODERN STAGE

The article is dedicated to the issue of bronchial asthma in children. Immaturity of respiratory and immune systems, peculiarities of the disease course, difficulty in establishing diagnosis and selecting delivery devices for drugs and a limited amount of evidence-based recommendations determine the current situation: only few guides touch upon the subject of infant asthma management. Although asthma is the most widespread disease of lower respiratory tract in children, a significant number of patients do not receive adequate treatment, which is why they cannot control asthma. The authors of this article analyzed the most up-to-date documents (ICON, GINA, PRACTALL, NAEPP, SIGN) that touch upon this subject and briefly stated the key principles of attaining control over this nosology in order to increase availability, spread and introduction of standard therapy of infant asthma.

Wheeze phenotypes in young children have different courses during the preschool period

BackgroundRules for predicting the course of asthma in wheezy infants have low specificity. ObjectiveTo determine if the novel phenotypes—mild early viral wheeze (EVW), atopic multiple-trigger wheeze (MTW), and nonatopic uncontrolled wheeze (NAUW)—have different courses during the preschool period. MethodsPart of the prospectively followed Trousseau Asthma Program cohort was phenotyped using cluster analysis with 12 parameters (sex, asthma severity and control with inhaled corticosteroid [ICS], parental asthma, allergic rhinitis, eczema, food allergy, EVW or MTW, and allergen exposure trigger). Wheezing trajectories were assessed by crossing the original phenotypes with the phenotypes obtained at 5 years. ResultsFour clusters were identified at 5 years of age: asymptomatic children (n = 47) with no wheezing (98%), children with mild EVW (n = 40, 87% with EVW, 50% with EVW controlled with low-dose ICS), those with atopic MTW (n = 30, 100% with MTW, only 17% with MTW controlled with low-dose ICS, more significant for pollen asthmatic trigger), and those with atopic severe UW (n = 33, 63% with UW uncontrolled despite high doses of ICS, more significant for allergic rhinitis and dust as asthmatic trigger). Those with mild EVW became asymptomatic or remained with mild EVW. Those with atopic MTW remained with atopic MTW and those with NAUW developed severe UW in most cases. ConclusionThese results show that remission is most frequently observed in mild EVW and that no remission is observed in atopic MTW.

Asthma Heredity, Cord Blood IgE and Asthma-Related Symptoms and Medication in Adulthood: A Long-Term Follow-Up in a Swedish Birth Cohort

Cord blood IgE has previously been studied as a possible predictor of asthma and allergic diseases. Results from different studies have been contradictory, and most have focused on high-risk infants and early infancy. Few studies have followed their study population into adulthood. This study assessed whether cord blood IgE levels and a family history of asthma were associated with, and could predict, asthma medication and allergy-related respiratory symptoms in adults. A follow-up was carried out in a Swedish birth cohort comprising 1,701 consecutively born children. In all, 1,661 individuals could be linked to the Swedish Prescribed Drug Register and the Medical Birth Register, and 1,227 responded to a postal questionnaire. Cord blood IgE and family history of asthma were correlated with reported respiratory symptoms and dispensed asthma medication at 32–34 years. Elevated cord blood IgE was associated with a two- to threefold increased risk of pollen-induced respiratory symptoms and dispensed anti-inflammatory asthma medication. Similarly, a family history of asthma was associated with an increased risk of pollen-induced respiratory symptoms and anti-inflammatory medication. However, only 8% of the individuals with elevated cord blood IgE or a family history of asthma in infancy could be linked to current dispensation of anti-inflammatory asthma medication at follow-up. In all, 49 out of 60 individuals with dispensed anti-inflammatory asthma medication at 32–34 years of age had not been reported having asthma at previous check-ups of the cohort during childhood. Among those, only 5% with elevated cord blood IgE and 6% with a family history of asthma in infancy could be linked to current dispensation of anti-inflammatory asthma medication as adults. Elevated cord blood IgE and a positive family history of asthma were associated with reported respiratory symptoms and dispensed asthma medication in adulthood, but their predictive power was poor in this long-time follow-up.

Up-regulation of Slc39A2(Zip2) mRNA in peripheral blood mononuclear cells from patients with pulmonary tuberculosis

Zinc is the most common trace mineral after iron in the human body. In organisms, zinc transporters help zinc influx and efflux from cells. A previous study has reported that Zip2 was up-regulated over 27-fold in human monocytic THP-1 cells, when intracellular zinc was depleted by TPEN. Our study found Zip2 was over-expressed in leukocytes of asthmatic infants, especially those in which the serum zinc level was lower than those in healthy infants. Pulmonary tuberculosis (PTB) patients have significantly low serum zinc levels. Here we investigated whether Zip2 level was changed in the patients with PTB. Zip2 mRNA and protein levels in peripheral blood mononuclear cells (PBMC) from PTB (n1=23) and healthy controls (n2=42) were detected by quantitative real-time PCR and western blot, respectively. mRNA expression levels of another four zinc transporters, Zip1, Zip6, Zip8 and ZnT1, were detected by quantitative real-time PCR. Zip2 mRNA level was significantly up-regulated in PTB patients (P=0.001), and Zip8 mRNA level was significantly down-regulated compared with control individuals (P<0.001). In contrast, there were no significant changes in mRNA levels of Zip1, Zip6 and ZnT1 in either group (P>0.05). Zip2 protein expression levels increased in PTB patients compared with control individuals. Our study found that knockdown of ZIP2 with siRNA caused a decrease in Zip2 levels in PBMC of PTB patients, while reducing the expression of INF-γ (P<0.01) and increasing the expression of IL-6(P<0.01). These data provide evidence that increased expression of Zip2 gene is closely associated with immunity of PTB patients, suggesting that the Zip2 gene may play a key role in the initial infection control of the human body, by promoting and maintaining the immune response of adaptive T cells.

Pediatric allergy and immunology in Brazil

The subspecialty of pediatric allergy and immunology in Brazil is in its early years and progressing steadily. This review highlights the research developed in the past years aiming to show the characteristics of allergic and immunologic diseases in this vast country. Epidemiologic studies demonstrated the high prevalence of asthma in infants, children, and adolescents. Mortality rates and average annual variation of asthma hospitalization have reduced in all pediatric age groups. Indoor aeroallergen exposure is excessively high and contributes to the high rates of allergy sensitization. Prevalence of food allergy has increased to epidemic levels. Foods (35%), insect stings (30%), and drugs (23%) are the main etiological agents of anaphylaxis in children and adolescents. Molecular diagnosis of primary immunodeficiencies (PID) showed a high incidence of fungal infections including paracoccidioidomycosis in X-linked hyper-IgM syndrome, and the occurrence of BCG adverse reactions or other mycobacterial infections in patients with chronic granulomatous disease. Education in pediatric allergy and immunology is deficient for medical students, but residency programs are effective in training internists and pediatricians for the practice of allergy. The field of PID requires further training. Last, this review is a tribute to Prof. Dr. Charles Naspitz, one of the pioneers of our specialty in Brazil.

Prebiotics in infants for prevention of allergy

Prebiotics (commonly oligosaccharides) added to infant feeds have the potential to prevent sensitisation of infants to dietary allergens. To determine the effect of prebiotic given to infants for the prevention of allergy. We performed an updated search in August 2012 of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 8), MEDLINE, EMBASE, conference proceedings, citations, expert informants and clinical trials registries. Randomised and quasi-randomised controlled trials that compared the use of a prebiotic to no prebiotic, or a specific prebiotic compared to a different prebiotic in infants for prevention of allergy. Assessment of trial quality, data extraction and synthesis of data were performed using the standard methods of The Cochrane Collaboration. The 2012 update identified 13 studies classified as ongoing or awaiting classification (yet to report allergy outcomes). Forty-three studies were excluded, primarily as no allergy data were reported, although none of these enrolled infants were at high risk of allergy. Four studies enrolling 1428 infants were eligible for inclusion. All studies were at high risk of attrition bias. Allergy outcomes were reported from four months to two years of age.Meta-analysis of two studies (226 infants) found no significant difference in infant asthma although significant heterogeneity was found between studies. Meta-analysis of four studies found a significant reduction in eczema (1218 infants, typical risk ratio 0.68, 95% CI 0.48 to 0.97; typical risk difference -0.04, 95% CI -0.07 to -0.00; number needed to treat to benefit (NNTB) 25, 95% CI 14 to > 100; P = 0.03). No statistically significant heterogeneity was found between studies. One study reported no significant difference in urticaria.No statistically significant subgroup differences were found according to infant risk of allergy or type of infant feed. However, individual studies reported a significant reduction in asthma and eczema from supplementation with a mixture of galacto- and fructo-oligosaccharide (GOS/FOS 9:1 ratio) (8 g/L) in infants at high risk of allergy; and in eczema from supplementation with GOS/FOS (9:1) (6.8 g/L) and acidic oligosacccharide (1.2 g/L) in infants not selected for allergy risk. Further research is needed before routine use of prebiotics can be recommended for prevention of allergy in formula fed infants. There is some evidence that a prebiotic supplement added to infant feeds may prevent eczema. It is unclear whether the use of prebiotic should be restricted to infants at high risk of allergy or may have an effect in low risk populations; or whether it may have an effect on other allergic diseases including asthma.

The role of inhaled corticosteroids in management of asthma in infants and preschoolers

This review analyses published data on the treatment of wheezing in infants and preschoolers with inhaled corticosteroids (ICS), including the effect in subgroups of patients such as 'multiple trigger wheeze' and 'episodic viral wheeze'. Therapy with ICS at daily doses of 100-200 μg results in significant clinical improvements in several outcomes in preschoolers and infants suspected of having asthma (multiple trigger wheeze). Such treatment is normally considered well tolerated. Although not well studied, higher daily doses may be associated with measurable effects on growth, which are not cumulative with continued treatment. In children who only wheeze in association with viral infections (episodic viral wheeze), preemptive treatment with high doses of ICS has demonstrated significant clinical effects on several outcomes, whereas lower doses seem to have little effect. Intermittent use of high doses of ICS has been associated with significant reductions in height and weight gain over 1 year. The review illustrates the complexity of treating wheezing in infants and preschoolers and interpreting the study results. It emphasizes the need for more studies in clinical subgroups, more long-term studies and dose-response studies to assess the optimal doses and safety of intermittent as well as regular ICS treatment.

Changes of Histamine Receptors and CC Chemokines in Nasal Epithelial Cells and Fibroblasts after Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) is reported as the most influential factor that triggers hyperreactivity of the airway and causes asthma in infants and children. However, the mechanisms remain to be elucidated. The study evaluated the changes in the levels of four types of histamine receptor (HR) and CC chemokines, such as eotaxin and regulated on activation, normal T cell expressed and presumably secreted (RANTES), in nasal epithelial cells and fibroblasts after RSV infection. Nasal cavity mucosa attained from 20 patients who had undergone inferior turbinoplasty were cleaned by normal saline mixed with gentamicin. Each sample was divided in half. One-half was used for incubation of epithelial cells, and the other half was used for culturing fibroblasts. The levels of HR 1 (H1R), 2 (H2R), 3 (H3R), 4 (H4R), eotaxin, and RANTES were measured by real-time polymerase chain reaction 0, 12, and 36 hours after infection with RSV. H1R was significantly increased at 12 and 36 hours compared with 0 hours in both cell types. The level of H2R was significantly increased in epithelial cells from 0 to 36 and 12 to 36 hours and in fibroblasts from 0 to 12 and 0 to 36 hours. There were significant increases of H3R level in fibroblasts from 0 to 12 and 0 to 36 hours, and of H4R in epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. Eotaxin and RANTES were also significantly increased in both epithelial cells and fibroblasts from 0 to 12 and 0 to 36 hours. RSV infection increases the levels of all four HRs, especially H1R and H2R, as well as the levels of eotaxin and RANTES in nasal epithelial cells and fibroblasts. These findings suggest that RSV infection might cause respiratory tract hyperreactivity by increasing the content of HRs and CC chemokines.

Investigating the effectiveness of the Mediterranean diet in pregnant women for the primary prevention of asthma and allergy in high-risk infants: protocol for a pilot randomised controlled trial

BackgroundOver recent decades there has been a substantial increase in asthma and allergic disease especially in children. Given the high prevalence, and the associated high disease burden and costs, there is a need to identify effective strategies for the primary prevention of asthma and allergy. A recent systematic review of the literature found strong supportive epidemiological evidence for a protective role of the Mediterranean diet, which now needs to be confirmed through formal experimental studies. This pilot trial in pregnant women aims to establish recruitment, retention and acceptability of a dietary intervention, and to assess the likely impact of the intervention on adherence to a Mediterranean diet during pregnancy.Methods/DesignThis study was a pilot, two-arm, randomised controlled trial in a sample population of pregnant women at high risk of having a child who will develop asthma or allergic disease.DiscussionThe work ultimately aims to contribute to improving health outcomes through seeking to reduce the incidence of asthma and allergic problems. This pilot trial will prove invaluable in informing the subsequent planned large-scale, parallel group, randomised controlled trial.Trial registrationClinicalTrials.gov: NCT01634516

Salivary cortisol monitoring: Determination of reference values in healthy children and application in asthmatic children

Venipuncture testing of adrenocortical function in asthmatic infants and young children receiving inhaled corticosteroids can raise cortisol levels and mask physiological responses. This study aimed to establish reference ranges for salivary cortisol levels and evaluate the safety and effects of jet-nebulized budesonide inhalation suspension (BIS) on salivary cortisol levels and patient outcomes in infants and young children with mild or persistent asthma. Reference salivary cortisol levels were determined in healthy children aged 6 months to 4 years old. A 12-week multicenter, randomized, parallel-group, open-label study was performed involving 53 age-matched asthmatic children who received either 0.5 mg/day of BIS or 40-60 mg/day of cromolyn sodium inhalation suspension (CIS) via compressor nebulizer. The effective measuring range of salivary cortisol concentration in asthmatic children was 0.12-3.00 micrograms/dL. The upper and lower limits of the reference range were 0.827 and 0.076 micrograms/dL, respectively. No significant difference was seen from baseline through week 12 in the CIS and BIS groups. BIS was safe in these patients, with no inhibitory effects on adrenocortical function. Salivary cortisol measurement offers a useful and accurate tool for testing adrenocortical function in infants and young children. Longer-term studies that incorporate testing of the hypothalamic-pituitary-adrenal axis are warranted to confirm our findings.

A pilot trial on the treatment of gastroesophageal reflux-related cough in infants.

Diagnosing asthma in infancy is largely made on the basis of the symptoms of cough and wheeze. A similar presentation can be seen in neurologically normal infants with excessive gastroesophageal reflux (GER). There are no randomized placebo controlled studies in infants using proton pump inhibitors (PPI) alone or in addition to prokinetic agents. The primary objective was to confirm the presence of excessive GER in a population of infants that also had respiratory symptoms suggestive of asthma. Second, in a randomized placebo-controlled fashion, we determined whether treatment of GER with bethanacol and omeprazole could improve these respiratory symptoms. Infants (n=22) with a history of chronic cough and wheeze were enrolled, if they had evidence of GER by history and an abnormal pH probe or gastric emptying scan. Infants were randomly allocated to four treatment groups: placebo/placebo (PP), omeprazole plus bethanacol (OB), omeprazole/placebo (OP), bethanacol/placebo (BP). Evaluations by clinic questionnaire and exam, home diary, and pH probe data were done before, after study-medication and after open label of OB. Nineteen children were studied. PP did not affect GER or respiratory symptoms, and did not decrease GER measured by pH probe. In contrast, OB decreased GER as measured by pH probe indices and parental assessment. In association, OB significantly decreased daytime coughing and improved respiratory scores. No adverse effects were reported. In infants with a clinical presentation suggestive of chronic GER-related cough, the use of omeprazole and bethanacol appears to be viable therapeutic option.

The Risk of Asthma in Late Preterm Infants

RationalePreterm infants have been reported to have a higher risk of asthma compared to term infants. However, little is known about the risk of asthma among late preterm (LPT) infants (34 0/7 to 36 6/7 weeks of gestation).MethodsThis study used a retrospective birth cohort born in Olmsted County, Minnesota from 2002 through 2006 that was identified using the Rochester Epidemiology Project. Appropriate for gestational age (AGA) weight LPT infants and AGA term infants (37 0/7 to 40 6/7 weeks of gestation) were randomly sampled with regard to gender, birth year, and institution using frequency matching. Asthma status was ascertained by applying predetermined criteria for asthma. Study subjects were followed until 12/31/2010 by censoring event, last follow up date, and end of study period. Cumulative incidence of asthma during the first 8 years of life was compared using log-rank test and Kaplan-Meier curves.ResultsThere were 654 LPT infants and 7447 term infants born during the study period. We enrolled 200 eligible AGA LPT infants and 200 frequency matched term infants. In this preliminary report, 119 LPT infants (50% male, 67% Caucasian) and 116 term infants (54% male, 72% Caucasian) were available. The cumulative incidence of asthma among LPT infants during the study period was 24.5% while in term infants it was 14.5% (p=0.041).ConclusionsBased on this preliminary data, the risk of asthma is higher in former LPT infants. The results warrant completion of this ongoing study given the significant finding. The nature of this association needs to be further examined. RationalePreterm infants have been reported to have a higher risk of asthma compared to term infants. However, little is known about the risk of asthma among late preterm (LPT) infants (34 0/7 to 36 6/7 weeks of gestation). Preterm infants have been reported to have a higher risk of asthma compared to term infants. However, little is known about the risk of asthma among late preterm (LPT) infants (34 0/7 to 36 6/7 weeks of gestation). MethodsThis study used a retrospective birth cohort born in Olmsted County, Minnesota from 2002 through 2006 that was identified using the Rochester Epidemiology Project. Appropriate for gestational age (AGA) weight LPT infants and AGA term infants (37 0/7 to 40 6/7 weeks of gestation) were randomly sampled with regard to gender, birth year, and institution using frequency matching. Asthma status was ascertained by applying predetermined criteria for asthma. Study subjects were followed until 12/31/2010 by censoring event, last follow up date, and end of study period. Cumulative incidence of asthma during the first 8 years of life was compared using log-rank test and Kaplan-Meier curves. This study used a retrospective birth cohort born in Olmsted County, Minnesota from 2002 through 2006 that was identified using the Rochester Epidemiology Project. Appropriate for gestational age (AGA) weight LPT infants and AGA term infants (37 0/7 to 40 6/7 weeks of gestation) were randomly sampled with regard to gender, birth year, and institution using frequency matching. Asthma status was ascertained by applying predetermined criteria for asthma. Study subjects were followed until 12/31/2010 by censoring event, last follow up date, and end of study period. Cumulative incidence of asthma during the first 8 years of life was compared using log-rank test and Kaplan-Meier curves. ResultsThere were 654 LPT infants and 7447 term infants born during the study period. We enrolled 200 eligible AGA LPT infants and 200 frequency matched term infants. In this preliminary report, 119 LPT infants (50% male, 67% Caucasian) and 116 term infants (54% male, 72% Caucasian) were available. The cumulative incidence of asthma among LPT infants during the study period was 24.5% while in term infants it was 14.5% (p=0.041). There were 654 LPT infants and 7447 term infants born during the study period. We enrolled 200 eligible AGA LPT infants and 200 frequency matched term infants. In this preliminary report, 119 LPT infants (50% male, 67% Caucasian) and 116 term infants (54% male, 72% Caucasian) were available. The cumulative incidence of asthma among LPT infants during the study period was 24.5% while in term infants it was 14.5% (p=0.041). ConclusionsBased on this preliminary data, the risk of asthma is higher in former LPT infants. The results warrant completion of this ongoing study given the significant finding. The nature of this association needs to be further examined. Based on this preliminary data, the risk of asthma is higher in former LPT infants. The results warrant completion of this ongoing study given the significant finding. The nature of this association needs to be further examined.