Function Testing In Children Research Articles

A study on thyroid function test in children with nephrotic syndrome

Background: This is a comparative study which was conducted to find out any impact of nephrotic syndrome on status of thyroid hormone level in children with nephrotic syndrome. Methods: Study was done from December 2014 to December 2015 at a tertiary care hospital in BBSR, Odisha. The study was carried out in total of 60 children of age between 1-8 years out of which 30 children(N group) were admitted for reason other than nephrotic syndrome(excluding known cases of thyroid disorder) and 30 children were suffering from nephrotic syndrome (NS group). Thyroid hormone level (T3, T4 and TSH) was tested in all children. Results: The T4 and T3 levels in nephrotic syndrome (NS group) patients were low. TSH level were high in NS group. T4 level was low in NS group in comparison to N group which was statistically significant. Hypothyroidism was found more in younger children 6 years which was statistically significant. Conclusions: This study concluded that incidence of hypothyroidism was more in children with nephrotic syndrome.

Clinical features and lung function in HIV-infected children with chronic lung disease

Background. Although chronic lung disease (CLD) is commonly seen in children with advanced HIV disease, it is poorly studied. Objectives. To report on the clinical manifestations and lung function tests in children with advanced HIV disease at a tertiary care centre, and determine clinical predictors of poor lung function. Methods. We undertook a cross-sectional study of children with advanced HIV disease in whom CLD was suspected. We undertook clinical evaluation and lung function tests, accompanied by a retrospective chart review. Results. In 56 children identified, the median age was 5 (interquartile range (IQR) 2 - 8) years with equal gender ratio. The majority (93%) had been previously treated for tuberculosis and/or pneumonia (71%). The most common CLD identified was lymphocytic interstitial pneumonitis (54%). The median nadir CD4 percentage was 13% (IQR 8.5 - 16%) and the median highest reported viral load was log5.8 (IQR log5.0 - log6.5). The median duration of antiretroviral therapy was 9.8 (IQR 1.1 - 19.5) months. Lung function tests were performed in 27 (48%) children. The median forced expiratory volume in 1 second (FEV 1 ) was 60% (IQR 45.3 - 86.3%) predicted. Previous hospitalisation, respiratory rate, digital clubbing, chest hyperinflation and hyperpigmented skin lesions were associated with a decreased FEV 1 in a univariate relationship. In a multiple linear regression analysis, hyperinflation, increased respiratory rate and hyperpigmented skin lesions were associated with poor lung function (percentage FEV 1 ). Conclusion. We identified useful clinical signs predictive of poor lung function in HIV-infected children with CLD, especially in resource-limited settings.

Pulmonary Function testing in Children

Spirometry is a simple and valuable tool in the evaluation of Pulmonary Function testing in children with respiratory symptoms. The maximum utilities in paediatric age group is 111 diagnosis and follow up of children with asthma and other wheezing problems, although it is useful for screening of children with restrictive lung diseases. This requires accurate and reproducible spirometrie measurements, which should comply with the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines. Training and refresher courses may produce and maintain good-quality testing, promote the use of spirometrie results in clinical practice and enhance the quality of interpretation. The use of correct ethnic reference equations is essential for comparative results.

The effect of obesity on asthma in children

Introduction: The prevalence of obesity and asthma is increasing in recent years. Obesity is a risk factor for asthma. The presence of obesity may affect the clinical course of the disease in patients with asthma. This study was conducted to determine the effect of obesity on clinical course of asthma and pulmonary function tests in children with asthma. Material and Method: One hundred and sixty children with asthma who were followed in Pediatric ImmunologyAllergy Clinic were included in this study. Patients were evaluated prospectively between January 2011-June 2011. The patients were interrogated with detailed history of allergic disease, age, kin marriage, familial atopy, exposure to tobacco smoke, number of asthma attacks within the previous year, and systemic steroid use. Asthma control test, pulmonary function tests, skin prick tests, eosinophilia and total immunoglobulin E measurements were performed. Patients with waist circumferences above the 90th percentile were considered obese. Results: Ninety-six (60%) patients were of normal weight and 64 (40%) of them were obese. There were no statistically significant difference between both groups in terms of age, gender, consanguinity, family history of atopy, smoking, and atopy. The number of attacks and need of systemic steroid within the previous one year were significantly higher in obese asthmatics compared to normalweight individuals (p<0.05). Asthma control in obese asthmatics was significantly worse (p<0.05). There were no statistically significant intergroup difference in terms of serum total IgE, eosinophilia and respiratory function parameters (p>0.05). Binary logistic regression analysis was used to investigate the variables that were effective on asthma control (age, family history of asthma, BMI, WC, number of attacks, systemic steroid use, FEV1, FVC, FEV1/FVC, PEF, and MEF 25-75). The effect of BMI was found to be greater (OR: 39 Cl: (0.36, 4435)). Discussion and Conclusion: Obesity worsens asthma control, increases systemic steroid use and the number of attacks in our patients with asthma. Weight loss together with appropriate treatment and avoidance from allergens may improve asthma control in these patients. 

Spirometry Findings Following Treatment with Oral and Inhalant Corticosteroids in Mild to Moderate Asthma Exacerbation in Children

Introduction: Asthma exacerbation is common in children. Treatment with oral corticosteroids (OCS) and inhaled corticosteroids are suggested for asthma exacerbation. It is shown that inhaled corticosteroids has similar outcome in reducing asthma symptoms compared to OCS. But few studies have evaluated the pulmonary function changes in these two treatments. In this study, we evaluated the changes in pulmonary function tests in children with mild-to-moderate asthma exacerbation receiving oral prednisolone and inhaled Budesonide. Methods and Materials: Forty-four children with mild-to-moderate asthma exacerbation were randomly assigned to receive oral prednisolone (2 mg/kg) or Budesonide spray (2 puffs every 12 hours, each puff contains 200 microgram Budesonide) using a spacer for one week. The first dose of the treatment was given in the emergency department. Children were followed for seven days and spirometry findings before and after treatment were evaluated. Results: There was no significant difference between pulmonary function tests before and after treatment between groups. Children receiving oral prednisolone had significantly more improvement in PEF (p=0.01). There was significant improvement in all respiratory parameters after treatment in both groups (p<0.05), but PEF had no significant change after treatment s in inhaled Budesonide group (p=0.63). Conclusion:Both inhaled Budesonide and oral prednisolone significantly improved respiratory function in children with mild-to-moderate asthma exacerbation. As there was no significant difference between groups in PFT findings and due to the low systemic effects of inhaled budesonide compared to oral prednisolone, this treatment seems to be more appropriate in mild to moderate exacerbations.

Ambient polycyclic aromatic hydrocarbons and pulmonary function in children.

Few studies have examined the relationship between ambient polycyclic aromatic hydrocarbons (PAHs) and pulmonary function in children. Major sources include vehicular emissions, home heating, wildland fires, agricultural burning, and power plants. PAHs are an important component of fine particulate matter that has been linked to respiratory health. This cross-sectional study examines the relationship between estimated individual exposures to the sum of PAHs with 4, 5, or 6 rings (PAH456) and pulmonary function tests (forced expiratory volume in one second (FEV1) and forced expiratory flow between 25% and 75% of vital capacity) in asthmatic and non-asthmatic children. We applied land-use regression to estimate individual exposures to ambient PAHs for averaging periods ranging from 1 week to 1 year. We used linear regression to estimate the relationship between exposure to PAH456 with pre- and postbronchodilator pulmonary function tests in children in Fresno, California (N=297). Among non-asthmatics, there was a statistically significant association between PAH456 during the previous 3 months, 6 months, and 1 year and postbronchodilator FEV1. The magnitude of the association increased with the length of the averaging period ranging from 60 to 110 ml decrease in FEV1 for each 1 ng/m(3) increase in PAH456. There were no associations with PAH456 observed among asthmatic children. We identified an association between annual PAHs and chronic pulmonary function in children without asthma. Additional studies are needed to further explore the association between exposure to PAHs and pulmonary function, especially with regard to differential effects between asthmatic and non-asthmatic children.

Approach to Liver Function Tests in Children

The liver is a multifactorial organ which is involved in a number of critical excretory, synthetic and metabolic functions. Although the term 'liver function test' is commonly used, it is imprecise since many of the tests, such as transaminase, do not measure liver function. Therefore, these tests should be referred to as 'liver enzyme tests', and 'liver function tests' should be the term used to measure hepatocyte synthetic functions, such as serum albumin and prothrombin time. Furthermore, commonly used biochemical tests may be normal in a patient with liver disease (compensated cirrhosis) or be abnormal in a case with a healthy liver. In this article different aspects of liver function tests and the approach to abnormal liver function tests are reviewed.

Study of some Pulmonary Function Tests in Children with Sickle Cell Anemia: Correlation with Iron Overload

Background: Sickle cell disease is hereditary hemoglobinopathy characterized by abnormal hemoglobin production, hemolytic anemia, and intermittent occlusion of small vessels, leading to acute and chronic tissue ischemia, and organ damage. Pulmonary function tests can differentiate between obstructive or restrictive lung diseases, assess the severity of the disease and evaluate the degree of efficacy of therapy in patients with sickle cell anemia. Objective: The aim of this study was to study pulmonary function tests in children with sickle cell anemia and its correlation with iron overload. Patients and methods: This study was carried out on 40 children with sickle cell anemia under follow up at Hematology unit, Pediatric Department, Tanta university hospital in the period between October 2012 and August 2014 including 24 males and 16 females with their age ranging from 9– 15 years and mean age value of 12.7+2.2 years and 40 healthy children as a control group including 22 males and 18 females with their age ranging from 7 – 15 years and mean age value of 10.3+2.36 years. All patients were subjected to the following investigations: Complete blood count, HB electrophoresis, serum ferritin, serum iron, total iron binding capacity and pulmonary function tests. Results: There were significantly higher serum ferritin, serum iron and lower TIBC in patients than controls, significantly lower Forced vital capacity (FVC), Forced expiratory volume in one second (FEV1), FEV1/FVC ratio, Peak expiratory flow rate, and Forced expiratory Flow in patients compared with controls, significant negative correlation between serum ferritin and both of FVC and FEV1 in studied patients. There were restrictive spirometric pattern in 30 patients with sickle cell anemia (75%) and mixed obstructive and restrictive pattern in 10 patients (25%) with highly significant differences between patients and controls regarding restrictive and mixed pattern of spirometry. Conclusion: Most SCD patients show abnormal pulmonary functions, predominantly of restrictive pattern. Recommendations: Patients with SCD should undergo pulmonary function tests to detect and confirm lung disease for early and proper therapeutic intervention.

Long-term respiratory impairment with the new BPD

In the presurfactant era, bronchopulmonary dysplasia (BPD) was common and was associated with significant long-term respiratory morbidity. Although survival after extreme preterm birth has been improving and the rate of severe BPD has declined over the past 20 years, a new pattern of lung injury with disruption of lung growth has emerged. This new pattern of BPD seems less severe but long-term data have been sparse. To investigate the long-term outcomes of former very low birth weight (VLBW) preterm infants born in the surfactant era, vom Hove et al from the University of Leipzig have completed a study of pulmonary function tests in children with a history of BPD and VLBW, compared with a matched preterm VLBW control group.

Paediatric spirometry guideline of the South African Thoracic Society: Part 1

Spirometry forms an important component in the diagnosis and management of pulmonary diseases in children. In the paediatric setting, there are different challenges in terms of performance and interpretation of good quality and reliable tests. An awareness of the physiological and developmental aspects that exist in children is necessary to improve the quality and reliability of spirometry. We reviewed the recommendations on the technical aspects of performing spirometry in children, from the available guidelines and clinical trials. The focus was on the indications, methods and the interpretation of lung function tests in children &lt;12 years of age. Reliable lung function testing can be performed in children, but an awareness of the limitations, the use of incentives and a dedicated lung function technologist are necessary.

Comparative study of respiratory function tests in children from a rural and an urban community in Mexico

Comparative study of respiratory function tests in children from a rural and an urban community in Mexico

Classroom in the Clinic

Classroom in the Clinic

Comparison of Deflazacort and Prednisone in Duchenne Muscular Dystrophy

How to Cite this Article: Karimzadeh P, Ghazavi A. Comparison of Deflazacort and Prednisone in Duchenne Muscular Dystrophy. IranianJournal of Child Neurology 2012;6(1):5-12. Objective Duchenne muscular dystrophy (DMD) is a degenerative disease that usually becomes clinically detectable in childhood as progressive proximal weakness. No cure is yet available for DMD, but the use of steroids improves muscle strength and function. This study has been carried out to select the best steroid for the management of DMD. Materials & Methods This study is a single-blind, randomized clinical trial with a sample volume of 34 DMD patients. Half of these patients were treated with deflazacort (0.9 mg/kg daily) and the other half with prednisone (0.75 mg/kg daily) for a period of 18 months. The motor function score and excess body weight were registered one year after the start and also at the end of the study and compared between the two groups. Results Deflazacort was more effective in the improvement of motor function after one year, but there was no significant difference between the two drugs at the end of the study (18 months after start). Weight gain after one year and at the end of the study was higher in prednisone group and steroid treatment with deflazacort appears to cause fewer side effects than prednisone regarding weight gain. Conclusion Deflazacort seems to be more effective than prednisone in the improvement of motor function causing fewer side effects, particularly weight gain. This medication may be important for the improvement of motor function and could be used as the best steroidal treatment for Duchenne muscular dystrophy. References Lankester BJA, Whitehouse MR, Gargan MF. Duchenne muscular dystrophy. Current Orthopedics 2007;21:298- 300. Wenger DR, Rang M. The art and practice of children’s orthopedics. Philadelphia, PA: Lippincott; Baltimore: Williams and Wilkins; 1993. Sussman M. Duchenne muscular dystrophy. J Am Acad Orthop Surg 2002 Mar-Apr;10(2):138-51. Escolar DM, Leshner RT. Muscular dystrophies. In: Swaiman KF, Ashwal S, Ferriero DM. Pediatric Neurology. 4th ed. Philadelphia: Mosby; 2006. p. 1967-86. Sarnat HB, Menkes JH. Disease of the motor unit. In: Menkes JH, Sarnat HB, editors. Child Neurology. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 984-9. Biggar WD, Politano L, Harris VA, Passamano L, Vajsar J, Alman B, et al. Deflazacort in duchenne muscular dystrophy: a comparison of two different protocols. Neuromuscul disord 2004 Sep;14(8-9):476-82. Radley HG, De Luca A, Lynch GS, Grounds MD. Duchenne muscular dystrophy: focus on pharmaceutical and nutritional interventions. Int J Biochem Cell Biol 2007;39(3):469-77. Biggar WD, Klamut HJ, Demacio PC, Stevens DJ. Duchenne muscular dystrophy: current knowledge, treatment and future prospects. Clin Orthop Relat Res 2002 Aug;401:88-106. Sohn RL, Gussoni E. Stem cell therapy for muscular dystrophy. Expert Opin Biol Ther 2004 Jan;4(1):1-9. Houde S, Filiatrault M, Fournier A, Dube J, D’Arcy S, Berube D et al. Deflazacort use in duchenne muscular dystrophy: an 8-year follow-up. Pediatr Neurol 2008 Mar;38(3):200-6. Bonifati MD, Ruzza G, Bonometto P, Berardinelli A, Gorni K, Orcesi K et al. A multicenter double-bind randomized trial of deflazacort versus prednisone in Duchenne muscular dystrophy: analysis after 2 years. Basic Appl Myol 2000;10:171-5. Reitter B. Deflazacort vs. prednisone in Duchenne muscular dystrophy: trends of an ongoing study. Brain Dev 1995;17 Suppl:39-43. Polgar G, Promadhat V. Standard values. In: pulmonary function testing in children: techniques and standards. Philadelphia: W.B. Saunders, 1971:102-3. Biggar WD, Gingras M, Febling DL, Harris VA, Steele CA. Deflazacort treatment of Duchenne muscular dystrophy. J Pediatr 2001 Jan;138(1):45-50.

Comparison of Fecal Elastase‐1 and Pancreatic Function Testing in Children

The fecal pancreatic elastase-1 (FE-1) test is considered a simple, noninvasive, indirect measure of pancreatic function. We aimed to evaluate the performance of the FE-1 test compared with the direct pancreatic function test (PFT) with secretin stimulation in children. Data of 70 children (6 months-17 years of age) who had both FE-1 test and PFT were analyzed. The average FE-1 concentration was 403 ± 142 μg/g. Eleven children had concentrations below 200 μg/g, 23 between 201 to 500 μg/g, and 36 were above 500 μg/g. The average pancreatic elastase activity measured on direct stimulation was 49.1 ± 38.6 μmol · min (-1)· ml(-1) and 11 children had activity below the established cutoff (10.5 μmol · min(-1) · ml(-1)). Among the 11 children with pathologic PFT, 7 had normal FE-1, 4 were in the intermediate range (201-500 μg/g), and none were in the low range (<200 μg/g). Among the 59 children with normal direct PFT 11 (19%) had pathologic (<200 μg/g) and 19 (32%) had intermediate FE-1 tests. Twenty-nine children had both normal FE-1 concentration and normal PFT, giving a negative predictive value of 80%. The correlation between pancreatic elastase activity and FE-1 concentration was poor (r = 0.190). The sensitivity of the FE-1 test was found to be 41.7%, whereas the specificity was 49.2%. The positive predictive value of the FE-1 test was only 14%. The FE-1 test is a simple, noninvasive, indirect method; however, ordering physicians should be aware of its limitations. It can give false-positive results and has low sensitivity in children with mild pancreatic insufficiency without cystic fibrosis and in those with isolated pancreatic enzyme deficiencies.

Children Should Not Be Treated Like Little Adults in the PFT Lab

Over the years a great deal of effort has been made to standardize all pulmonary function tests on adults. Many of the "rules" concerning the interpretation of the spirogram have been based entirely on adult observations. In the age of increasing conformity, and attempts to relate "adult" literature to the pediatric population, the latter was given much less emphasis than the former. This review will attempt to show what areas in pulmonary function testing are similar in adults and children, but more specifically will show the areas that are different. The latest standards published by the American Thoracic Society/European Respiratory Society in 2005 have attempted to incorporate some differences for the pediatric population for spirometry, but more work needs to be done in this area. While it is recognized that spirometry is the primary pulmonary function test for children, there are a number of circumstances where the addition of plethysmography and lung diffusion measurements are necessary. The review will state some of the limitations of these tests when performed by children. Lung function testing, particularly spirometry, has much to offer in the diagnosis of lung disease in children and the monitoring of response to therapy. With better standardization of pulmonary function testing in children, and more trained technologists, the age limits for testing can be extended to below 6 years of age and sometimes below 5. Also with better standardization the results obtained are meaningful and when interpreted in context of age offer excellent diagnostic information to better treat the child with lung disease.

Abnormal thyroid function tests in children on ethionamide treatment [Short communication

Ethionamide (ETH) treatment may cause hypothyroidism. Clinical data, serum thyroid stimulating hormone (TSH) and free thyroxine (fT4) levels were retrospectively assessed in 137 children receiving anti-tuberculosis treatment including ETH. Abnormal thyroid function tests (TFTs) were recorded in 79 (58%) children: elevated serum TSH and suppressed fT4 (n = 30), isolated elevated serum TSH (n = 20), isolated low serum fT4 (n = 28) and isolated low TSH (n = 1). The risk for biochemical hypothyroidism was higher for children on regimens including para-aminosalicylic acid and in human immunodeficiency virus infected children. TFT abnormalities are frequent in children on ETH and are mainly due to primary hypothyroidism or euthyroid sick syndrome.

Liver function tests in children and adolescents receiving risperidone treatment for a year: A longitudinal, observational study from Turkeya

Objective. To determine the changes in liver function tests after long-term risperidone treatment in a child and adolescent population. Methods. Weight, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transpeptidase, alkaline phosphatase and serum bilirubin of the patients were assessed in pre-treatment period, and at the sixth and 12th months of treatment. One hundred children and adolescents (aged between 3 and 18 years) were enrolled to the study. Results. Liver enzyme and bilirubin levels are higher than normal in 21.0% of the patients without clinical symptoms. No cases of hepatic failure or jaundice were seen. Only in an 8-year-old boy were there ALT level increases up to three-fold and AST level increases up to two-fold. After discontinuation of the risperidone treatment, enzyme levels were normalized in this patient. Alkaline phosphatase, alanine and aspartate aminotransferases were the most frequently increased enzymes. Conclusion. In this study, after long-term risperidone treatment of children and adolescents there was no evidence of clinically significant increases of liver enzymes and bilirubin levels. These results indicate that risperidone treatment may rarely cause serious liver enzyme increases, and may commonly cause clinically insignificant changes in liver function tests.

Impact of Endoscopic Sinus Surgery on Pulmonary Function in Children with Cystic Fibrosis

Objective: Determine the impact of endoscopic sinus surgery on pulmonary function in children with cystic fibrosis. Method: Retrospective chart review of cystic fibrosis patients at a tertiary children’s hospital who underwent endoscopic sinus surgery between 1995 and 2010. Main outcome measures include presurgical and 1- and 6-month postsurgical pulmonary function tests (PFTs). Results: Sixty-two children underwent 110 endoscopic sinus surgeries. Pre- and post-PFT data (FEVI and FVC) were available for 66 surgeries. Postoperative, only 10 out of 66 children (15%) at 1 month and 11 out of 66 (16%) at 6 months showed improvement following surgery. A total of 41 out of 66 children (62%) at 1 month and 42 out of 66 (64%) at 6 months showed no difference, while 15 out of 66 (23%) at 1 month and 13 out of 66 (20%) at 6 months were worse following surgery. There was no difference in pulmonary function following primary (28/66 [42%]) or revision (38/66 [58%]) surgeries. Conclusion: Improvement of sinonasal symptoms achieved with endoscopic sinus surgery does not correlate with improvement in pulmonary function as measured by pre- and postoperative pulmonary function testing in children with cystic fibrosis.

Pulmonary Function Testing in Children with Restrictive Chest Wall Disorders.

Disorders of the chest wall, spine, and respiratory muscles lead to lung function abnormalities consistent with restrictive lung disease. Common disorders of the thorax include diseases with respiratory muscle weakness, growth abnormalities of the thorax and spine, such as scoliosis. Spirometry alone is not sufficient to diagnose these abnormalities but may be useful to serially monitor changes over time or in response to treatments. In contrast, obesity does not produce restrictive respiratory disease in most children and produces obstructive lung disease more often. Test of respiratory muscle function, breathing during sleep, and during exercise have led to additional insights about the pathophysiology of these conditions that may provide new avenues for future therapies.

Correlation of Spine Deformity, Lung Function, and Seat Pressure in Spina Bifida

Spinal deformity, a common problem in children with myelodysplasia, is associated with alterations in pulmonary function and sitting balance. Sitting imbalance causes areas of high pressure in patients already at high risk for developing pressure ulcers due to insensate skin. We asked: Does spinal deformity affect pulmonary function tests in children with myelodysplasia? Does the magnitude of spinal curvatures and pelvic obliquity affect seating pressures? Does spinal deformity and seated pressures correlate with a history of pressure ulcers? We retrospectively reviewed 32 patients with myelodysplasia and scoliosis (mean age, 14 years). The mean thoracic scoliosis was 64° with a mean pelvic obliquity of 15°. The mean forced vital capacity was 59% of predicted. The mean of the average and peak seated pressures were 24 and 137 mm Hg, respectively. We examined spinal radiographs, pulmonary function tests, and seated pressure maps and evaluated correlations of spinal deformity measures, pulmonary function, and seated pressures. The thoracic scoliosis inversely correlated with lung volume and weakly related with only the forced midexpiratory volume parameter (R(2) = 31%). The curve magnitude was associated with % seated area with pressures of 38 to 70 mm Hg while lesser degrees of pelvic obliquity were associated with % seating area with pressures of less than 38 mm Hg (R(2) = 25% and 24%, respectively). A history of pressure ulcers did not correlate with any spinal deformity or seated pressure measures. All patients displayed a reduced forced vital capacity, but this reduction was not related to increasing scoliosis. The smaller scoliosis curves and lesser degrees of pelvic obliquity were associated with larger areas of low seated pressures.