Early Childhood Pneumonia Research Articles

Immunological features of out-of-hospital pneumonia in children vaccinated with pneumococcal vaccine

Аim. To identify the immunological features of out-of-hospital pneumonia in vaccinated children, to assess their impact on the severity of the disease.Materials and methods. The study was conducted in 2017-2019. 85 children with various degrees of severity were hospitalized in Karaganda from 2 months to 3 years. They were divided into 2 groups: the first included vaccinated children (n=45), the second included children with impaired vaccination (n=40). The control group consisted of 20 children.The calculation and evaluation of the results obtained was carried out on an IBM compatible computer with the Windows XP operating system using the MS Excel 2017 (Microsoft), SPSS 12.0.2 and Statistica 20 software package. Statistical analysis was carried out using the STATISTICA package. Numerical data is represented by indicators such as Me (median), Q1 (L-quartile or lower quartile point) and Q3 (U-quartile or upper quartile point). Kruskall-Wallace criterion calculated [Kruskall W., Walles W. A.]. The differences were considered statistically significant at p < 0.05.Results and discussion. The quantitative indicator of anti-inflammatory MCP-1 cytokines in vaccinated children with severe nosocomial pneumonia in early childhood is 7.21 [5.25; 9.03] pg/ml Me [Q1; Q3], and in children with immunization disorders-15.18 [6.13; 50.11] pg/ml Me [Q1; Q3] (Kruskal criteria-Wallis p<0.05). In children aged 2 months to 3 years, the quantitative indicator of anti-inflammatory cytokines MCP-1 in vaccinated children with mild nosocomial pneumonia is 2.13 [0.01; 3.02] pg/ml Me [Q1; Q3], and in children with immunization disorders –3.46 [0.04; 6.74] pg/ml Me [Q1; Q3].

Effectiveness of transferring ultrasound deep learning models from adults to pediatrics for frame based pneumonia classification

Hand-held ultrasound devices are emerging as a promising intervention to aid in diagnosing deadly early childhood pneumonia in the developing world. Lung ultrasound (LUS) data, however, can be difficult to read and interpret accurately, and thus require trained professionals. A variety of deep learning (DL) models have been developed to aid professionals in this task, but the difficulty curating quality training datasets limits the generalization capabilities of these models. To combat this data scarcity, we utilized a variety of DL models trained on LUS data collected from adult COVID-19 patients in Italy and were able to apply transfer learning to increase pneumonia related imaging pattern classification in LUS data from children and infants in rural Zambia. In this regard, we found that transfer learning significantly increased frame classification F1 performance as compared to training models from scratch. These findings indicate the promising potential for developing generalizable AI for LUS classification in diverse contexts given limited data. This analysis demonstrates that DL models effectively transfer their capabilities when fine tuned on a new population demographics, allowing the possibility to clinically deploy these models without the need to acquire large amounts of new data.

Early Childhood Pneumonia Is Associated with Reduced Lung Function and Asthma in First Nations Australian Children and Young Adults.

Background: Some but not all previous studies report that pneumonia in children aged less than five years is associated with lower lung function and elevated risk of respiratory disease. To date, none have explored these associations in at-risk populations such as First Nations Australians, whose incidence of early childhood pneumonia is among the highest reported in the world. Methods: This cross-sectional study included 1276 First Nations Australian children/young adults aged 5–25 years recruited from regional/remote Queensland and Northern Territory communities and schools. Associations between pneumonia and both spirometry values and asthma were investigated using linear and logistic regression. Results: Early childhood pneumonia was associated with lower FEV1 and FVC Z-scores, but not FEV1/FVC% Z-scores, when occurring before age three (FEV1 β = −0.42, [95%CI −0.79, −0.04]; FVC β = −0.62, [95%CI −1.14, −0.09]), and between three and five years (β = −0.50, [95%CI −0.88, −0.12]; β = −0.63, [95%CI −1.17, −0.10]), compared to those who never had pneumonia. Similarly, pneumonia occurring when aged before age three years (OR = 3.68, 95%CI 1.96–6.93) and three to five years (OR = 4.81, 95%CI 1.46–15.8) was associated with increased risk of asthma in later childhood. Conclusions: Early childhood pneumonia is associated with lung function deficits and increased asthma risk in later childhood/early adulthood in First Nations Australians. The disproportionate impact of pneumonia on at-risk children must be addressed as a priority.

Prenatal and Postnatal Household Air Pollution Exposures and Pneumonia Risk: Evidence From the Ghana Randomized Air Pollution and Health Study

Nearly 40%of the world's population is exposed daily to household air pollution. The relative impact of prenatal and postnatal household air pollution exposure on early childhood pneumonia, a leading cause of mortality, is unknown. Are prenatal or postnatal household air pollution, or both, associated with pneumonia risk in the first year of life? The Ghana Randomized Air Pollution and Health Study enrolled 1,414 nonsmoking, pregnant women before 24weeks' gestation with prospective follow-up to the child's age of 1 year. We measured 72-h personal household air pollution exposures, indexed by carbon monoxide (CO), four times prenatally and three times postnatally. Weekly fieldworker surveillance identified ill-appearing children for physician pneumonia assessment. We used quasi-Poisson models to examine associations between prenatal and postnatal CO and physician-diagnosed pneumonia and severe pneumonia. Sex-specific effects were examined. Of the 1,306 live births, 1,141 infants were followed up with 55,605 child-weeks of fieldworker surveillance. The estimated risk for pneumonia and severe pneumonia in the first year of life increased by 10%(relative risk [RR], 1.10; 95%CI, 1.04-1.16) and 15%(RR, 1.15; 95%CI, 1.03-1.28), respectively, per 1-part per million (ppm) increase in average prenatal CO exposure and by 6%(RR, 1.06; 95%CI, 0.99-1.13) per 1-ppm increase in average postnatal CO exposure. Sex-stratified analyses suggest that in girls, higher prenatal CO exposure was associated with pneumonia risk, while no association was seen in boys. Prenatal household air pollution exposure increased risk of pneumonia and severe pneumonia in the first year of life. Clean-burning interventions may be most effective when begun prenatally. ClinicalTrials.gov; No.: NCT01335490; URL: www.clinicaltrials.gov.

A review of the etiology and clinical presentation of non-cystic fibrosis bronchiectasis: A tertiary care experience.

Non-cystic fibrosis(CF) bronchiectasis has been recognized in children for the past 200 years. Early childhood pneumonia and underlying conditions such as immunodeficiency, primary ciliary dyskinesia(PCD), and congenital lung pathology should be considered in the etiology. The aim of our study was to describe the clinical characteristics, laboratory, and radiological findings of a large population of patients with non-CF bronchiectasis at a tertiary center. We analyzed the clinical findings of 187 patients diagnosed with non-CF bronchiectasis over a period of 10 years (January 2005-December 2015) at the Hacettepe University Faculty of Medicine Department of Pediatric Pulmonology. The median age at the time of diagnosis of non-CF bronchiectasis was 8 years (1-18 years). Consanguinity was positive in 59.4% (n = 111) of patients and 19.8% (n = 37) of patients had a positive family history for non-CF bronchiectasis. Common causes were PCD in 51.3% (n = 96), immunodeficiency in 15% (n = 28), history of tuberculosis in 5.9% (n = 11), post-infectious complication in 3.2% (n = 6) and other anomalies in 2.1% (n = 4) of patients. The frequency of pulmonary lobe involvement was as follows: 71.1% left-lower lobe, 59.4% right lower lobe, 54% right-middle lobe, 26.8% left lingula, 13.9% right upper lobe, and 9.6% left upper lobe. Diagnosis of non-CF bronchiectasis is often delayed because of a failure to recognize the significance of symptoms. Through clinical investigation, including a HRCT scan of the chest, sweat test, studies of immune function, and ciliary function in a child with a prolonged suppurative cough, remains important. In Turkey, the most common causes of non-CF bronchiectasis are PCD and immunodeficiency, related to a high frequency of consanguinity.

Maternal exposure to ambient air temperature during pregnancy and early childhood pneumonia

BackgroundPneumonia has been widely recognized as the leading cause of death in children worldwide, but its etiology still remains unclear. ObjectiveWe examined the association between maternal exposure to ambient air temperature during pregnancy and lifetime pneumonia in the offspring. MethodsWe conducted a cohort study of 2598 preschool children aged 3–6 years in Changsha, China. The lifetime prevalence of pneumonia was assessed using questionnaire. We backwards estimated each child's exposure to air temperature during prenatal and postnatal periods. Multiple regression model was used to examine the association between childhood pneumonia and exposure to air temperature in terms of odd ratios (OR) and 95% confidence interval (CI). ResultsPrevalence of childhood pneumonia in Changsha was high up to 38.6%. We found that childhood pneumonia was significantly associated with prenatal exposure to air temperature, with adjusted OR (95% CI) = 1.77 (1.23–2.54) for an interquartile range (IQR) increase in temperature, particularly during the second trimester with adjusted OR (95% CI) = 2.26 (1.32–3.89). Boys are more susceptible to the risk of pneumonia due to air temperature than girls. We further observed that maternal exposure to extreme heat days during pregnancy increased the risk of pneumonia in the offspring. ConclusionsMaternal exposure to air temperature during pregnancy, particularly the second trimester, was associated with pneumonia in the children, providing the evidence for fetal origins of pneumonia.

Prenatal exposure to diurnal temperature variation and early childhood pneumonia

BackgroundChildhood pneumonia is one of the leading single causes of mortality and morbidity in children worldwide, but its etiology still remains unclear. ObjectiveWe investigate the association between childhood pneumonia and exposure to diurnal temperature variation (DTV) in different timing windows. MethodsWe conducted a prospective cohort study of 2,598 children aged 3–6 years in Changsha, China. The lifetime prevalence of pneumonia was assessed by a questionnaire administered by the parents. Individual exposure to DTV during both prenatal and postnatal periods was estimated. Logic regression models was used to examine the association between childhood pneumonia and DTV exposure in terms of odds ratios (OR) and 95% confidence interval (CI). ResultsLifetime prevalence of childhood pneumonia in preschool children in Changsha was high up to 38.6%. We found that childhood pneumonia was significantly associated with prenatal DTV exposure, with adjusted OR (95%CI) =1.19 (1.02–1.38), particularly during the second trimester. However, childhood pneumonia not associated with postnatal DTV exposure. Sensitivity analysis indicated that boys are more susceptible to the pneumonia risk of diurnal temperature variation than girls. We further observed that the prevalence of childhood pneumonia was decreased in recent years as DTV shrinked. ConclusionsEarly childhood pneumonia was associated with prenatal exposure to the diurnal temperature variation (DTV) during pregnancy, particularly in the second trimester, which suggests fetal origin of childhood pneumonia.

Early Childhood Pneumonia and Impaired Adult Lung Function

Early Childhood Pneumonia and Impaired Adult Lung Function

Novel Risk Factors for Allergic Rhinitis in Korean Elementary School Children: ARCO-kids Phase II in a Community.

PurposeAllergic rhinitis (AR) is a multifactorial disease whose genetic and environmental risk factors have been studied for decades. Many pediatric studies have pointed out the familial history of allergy, hygiene hypothesis, breast-feeding, pet ownership, and diets as risk factors of AR. However, most of factors are still up for debate. This preliminary report aimed to confirm the known risk factors and find the novel risk factors for AR in the Korean pediatric population.MethodsA bi-seasonal, winter and summer, study in 2 elementary schools included all students whose parents completed the questionnaire of medical and social histories, quality of life, infant and early-childhood history, and the living styles. Skin prick tests and endoscopic examinations were conducted on all participants.ResultsAmong total 1,020 children, 338 participants had AR. The multivariate logistic regression analysis highlighted 6 factors: male gender (OR, 2.10; 95% CI, 1.32-3.33), older age (1.65; 1.03-2.65), previous history of allergic conjunctivitis (14.25; 4.99-40.74), asthma (2.73; 0.96-7.76) and pneumonia (0.39; 0.19-0.82), and an hour increase in daily playing time (0.90; 0.80-1.00).ConclusionsLack of pneumonia in early childhood and short playing time are newly found risk factors for Korean pediatric AR in this study confirming male gender, older age and previous history of allergic conjunctivitis and asthma as the risk factors.

What can rotavirus vaccines teach us about rotavirus?

Suspected and unexpected clinical features of pathogens might only become apparent during clinical trials to test vaccines or after implementation of vaccination programmes. For example, the role of Haemophilus influenzae type b (Hib) in early childhood pneumonia was not evident until findings of a clinical vaccine trial in The Gambia showed that—after 3 years of follow-up—Hib caused more than 20% of radiologically defined pneumonia in infants.1,2 Moreover, the ability of different pneumococcal serotypes, but not meningococcal serogroups, to replace competing strains in nasopharyngeal carriage and invasive disease was only noted after implementation of pneumococcal and group C meningococcal glycoconjugate vaccines.

Air Pollution and Respiratory Infections during Early Childhood: An Analysis of 10 European Birth Cohorts within the ESCAPE Project

Background: Few studies have investigated traffic-related air pollution as a risk factor for respiratory infections during early childhood.Objectives: We aimed to investigate the association between air pollution and pneumonia, croup, and otitis media in 10 European birth cohorts—BAMSE (Sweden), GASPII (Italy), GINIplus and LISAplus (Germany), MAAS (United Kingdom), PIAMA (the Netherlands), and four INMA cohorts (Spain)—and to derive combined effect estimates using meta-analysis.Methods: Parent report of physician-diagnosed pneumonia, otitis media, and croup during early childhood were assessed in relation to annual average pollutant levels [nitrogen dioxide (NO2), nitrogen oxide (NOx), particulate matter ≤ 2.5 μm (PM2.5), PM2.5 absorbance, PM10, PM2.5–10 (coarse PM)], which were estimated using land use regression models and assigned to children based on their residential address at birth. Identical protocols were used to develop regression models for each study area as part of the ESCAPE project. Logistic regression was used to calculate adjusted effect estimates for each study, and random-effects meta-analysis was used to calculate combined estimates.Results: For pneumonia, combined adjusted odds ratios (ORs) were elevated and statistically significant for all pollutants except PM2.5 (e.g., OR = 1.30; 95% CI: 1.02, 1.65 per 10-μg/m3 increase in NO2 and OR = 1.76; 95% CI: 1.00, 3.09 per 10-μg/m3 PM10). For otitis media and croup, results were generally null across all analyses except for NO2 and otitis media (OR = 1.09; 95% CI: 1.02, 1.16 per 10-μg/m3).Conclusion: Our meta-analysis of 10 European birth cohorts within the ESCAPE project found consistent evidence for an association between air pollution and pneumonia in early childhood, and some evidence for an association with otitis media.Citation: MacIntyre EA, Gehring U, Mölter A, Fuertes E, Klümper C, Krämer U, Quass U, Hoffmann B, Gascon M, Brunekreef B, Koppelman GH, Beelen R, Hoek G, Birk M, de Jongste JC, Smit HA, Cyrys J, Gruzieva O, Korek M, Bergström A, Agius RM, de Vocht F, Simpson A, Porta D, Forastiere F, Badaloni C, Cesaroni G, Esplugues A, Fernández-Somoano A, Lerxundi A, Sunyer J, Cirach M, Nieuwenhuijsen MJ, Pershagen G, Heinrich J. 2014. Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect 122:107–113; http://dx.doi.org/10.1289/ehp.1306755

Traffic-related air pollution and respiratory infections during early childhood: an analysis of seven European birth cohorts within the ESCAPE project

Background: Few studies have investigated traffic-related air pollution as a risk factor for respiratory infections during early childhood. Aim: To examine the association between air pollution and respiratory infection in 7 European birth cohorts - BAMSE (Sweden), GASPII (Italy), GINI/LISA (Germany), INMA (Spain), MAAS (UK) and PIAMA (The Netherlands) - and to calculate combined effect estimates using meta-analyses. Method: Parent report of physician diagnosed respiratory infection during early childhood were assessed in relation to annual average pollutant levels (NO2, NOx, PM2.5, PM2.5 absorbance, PM10, Coarse PM) estimated using land use regression models and assigned to children based on their birth address. Identical protocols were used to assess exposure for each study as part of ESCAPE. Logistic regression was used to calculate adjusted effect estimates for each study and random-effects meta-analysis was used to calculate combined estimates. Results: For pneumonia, combined estimates were consistently elevated and statistically significant (aOR:1.31(95%CI:1.06-1.63) per 10µg/m³ increase in NO2;1.76(1.00-3.09) per 10µg/m³ increase in PM10). For otitis media and croup, results were null across all analyses except for NO2 and otitis media (1.09(1.02-1.16) per 10µg/m³ increase). Air pollution effects were generally greater during the first year of life compared to the second (1.19(1.07-1.33) versus 1.07(0.96-1.20) per 10µg/m³ increase in NO2 for otitis media; 1.77(1.18-2.67) versus 1.42(0.99-2.03) per 10µg/m³ increase in PM10 for pneumonia). Sensitivity analyses using back-extrapolated data were consistent with overall findings. Conclusion: Our meta-analysis of 7 European birth cohorts within the ESCAPE project found strong evidence for an association between traffic-related air pollution and pneumonia in early childhood and inconsistent evidence for an association with otitis media. Policies that reduce traffic-related air pollution may also reduce the burden of pneumonia in early childhood.

Associations Between Particulate Matter Constituents And Early-Life Pneumonia In Seven Birth Cohorts: Results From The TRANSPHORM Project

Background: Evidence for an association between traffic-related particulate matter (PM) and pneumonia in early childhood was found by the ESCAPE project. Which, if any, specific particle matter (PM) constituent(s) are primarily responsible for this adverse health outcome is unknown. Aim: Using a standardized approach, we aimed to assess the association between PM constituents and pneumonia during the first years of life in seven birth cohort studies: BAMSE (Sweden), GASPII (Italy), GINI and LISA (Germany), INMA (Spain), MAAS (The United Kingdom) and PIAMA (The Netherlands). Methods: Concentrations of eight PM constituents (copper, iron, potassium, nickel, sulfur, silicon, vanadium, and zinc), each respectively derived from particles with aerodynamic diameters less than 10µg/m³(PM10) and 2.5µg/m³ (PM2.5), were calculated using land-use regression models developed from a common protocol as part of the TRANSPHORM project. Constituent concentrations were individually assigned to each child's birth address (Ntotal=15,775). Logistic regression models assessed cohort-specific associations between parental report of physician-diagnosed pneumonia during the first two years of life (three for MAAS) and each constituent. Models were adjusted for relevant host and environmental covariates and for total PM10 or PM2.5, depending on the origin of the constituent. Random-effects meta-analysis was used to obtain combined estimates. Results: Pneumonia was associated with zinc derived from PM10 (1.53 [1.04, 2.25] per 20ng/m³ increase) and potassium derived from PM2.5 (1.78 [1.07, 2.97] per 50ng/m³ increase) in the fully adjusted models.. Estimates for zinc derived from PM2.5 were elevated but non-significant (1.31 [0.98, 1.75] per 10ng/m³ increase). Conclusions: Results from a multi-center analysis of seven European birth cohorts indicate that zinc and potassium derived from traffic-related PM increase the risk of pneumonia in the first years of life. Zinc has been associated with tire wear.

Sleep-disordered Breathing and Pneumonia

Research Article| September 01 2012 Sleep-disordered Breathing and Pneumonia AAP Grand Rounds (2012) 28 (3): 33. https://doi.org/10.1542/gr.28-3-33 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Sleep-disordered Breathing and Pneumonia. AAP Grand Rounds September 2012; 28 (3): 33. https://doi.org/10.1542/gr.28-3-33 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: pneumonia, sleep apnea syndromes Source: Goldbart AD, Asher T, Givon-Lavi N, et al. Sleep-disordered breathing is a risk factor for community-acquired alveolar pneumonia in early childhood. Chest. 2012; 141(5): 1210– 1215; doi: https://doi.org/10.1378/chest.11-1998Google Scholar To determine if sleep-disordered breathing (SDB) is more frequent among children with community-acquired alveolar pneumonia (CAAP), investigators from the Soroka and Ben-Gurion Universities in Israel conducted a case-control study in 2006 to 2008 of children <5 years old. Children who met World Health Organization (WHO) radiologic criteria for alveolar pneumonia1 were enrolled from the pediatric emergency department (ED) or after hospital admission. Age-matched controls were enrolled from well child clinic visits or admissions for elective surgery. Using a previously developed questionnaire,2 the authors interviewed parents of case and control children regarding symptoms of SDB in the preceding 12 months (including snoring >3 times a week, nighttime breathing problems, restless sleep, chronic rhinorrhea, and daytime tiredness or irritability), history of previous polysomnography (PSG) and/or adenoidectomy, and demographics. Of 2,645 children radiographically diagnosed with CAAP, 1,546 were enrolled. Compared to 441 controls, children with CAAP were significantly older (mean age of 22 months vs 11 months), more likely to have been born premature (12.9% vs 6.1%; P < .001), and less likely to have been breastfed (85.5% vs 95%). Symptoms of SDB were significantly more common among children with CAAP compared to control children, including snoring (18.6% vs 2.9%), restless sleep (16.8% vs 5.3%), rhinorrhea (12.5% vs 1.8%), and daytime tiredness or irritability (6.3% vs 0.2%). History of an adenoidectomy was also significantly more common among children with CAAP. Obstructive sleep apnea (OSA) had been confirmed by PSG before enrollment in 5% of the children with CAAP as compared to only 1.3% of controls (OR=3.7; 95% CI, 1.6–10.0). The authors conclude that SDB is an independent risk factor for CAAP and recommend that SDB be considered among young children with CAAP. Drs Dubik and Geskey have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The association between SDB and lower respiratory airway diseases has been reported in adults and has been suspected among young children.1 Aspiration to some degree may be the underlying mechanism.2 However, there are a number of limitations in the current study that pediatricians should consider before screening every child who is diagnosed with pneumonia for SDB, especially if it would automatically lead to PSG. First, because of the design of the study, the investigators could not control for several potential confounders. There were significant differences between the case and control groups on several demographic characteristics; for instance, children with CAAP had higher rates of daycare attendance, were less likely to have been breastfed, and had higher rates of asthma and pneumonia than the control group. Second, laboratory and clinical data were collected but were not extensively reported. This is important because even though the authors used a... You do not currently have access to this content.

Sleep-Disordered Breathing Is a Risk Factor for Community-Acquired Alveolar Pneumonia in Early Childhood

Data are scarce with regard to risk factors for acute community-acquired alveolar pneumonia (CAAP) in children, but it is known that children with sleep-disordered breathing (SDB) experience more respiratory infections. We aimed to assess whether SDB is a risk factor for CAAP in early childhood. We conducted a prospective, nested, case-control study assessing children < 5 years old who had been given a diagnosis of CAAP based on World Health Organization radiographic criteria. Demographic and clinical data were collected. SDB symptoms were documented using a structured questionnaire. CAAP study and retrospective sleep laboratory databases were compared. SDB presence and severity were determined by questionnaire and polysomnography (PSG). A total of 14,913 children underwent chest radiography during the study period; 1,546 children with radiographically proven CAAP (58% boys) and 441 control subjects (54% boys) were prospectively enrolled. Frequent snoring was reported in 18.6% vs 2.9% subjects with CAAP and control subjects, respectively (P < .001). The respective figures for subjects with CAAP and control subjects for restless sleep, nocturnal breathing problems, abnormal behavior, and chronic rhinorrhea were 21.6% vs 5.3%, 5% vs 1.4%, 6.4% vs 0.2%, and 12.9% vs 1.8%, (P < .001 for each). Fifty children (3.3%) with CAAP vs three control subjects (0.7%) underwent adenoidectomy (P < .001). PSG diagnosis of obstructive sleep apnea had been established previously in 79 patients (5%) with CAAP vs six (1.3%) of the control subjects (OR, 3.7 [95% CI, 1.6-10.0]; P < .001), with higher severity in patients with CAAP than in control subjects. SDB is common in children with CAAP and is possibly a predisposing risk factor for CAAP in children < 5 years old. We recommend considering SDB in young children who are given a diagnosis of CAAP.

Airway microbiology and host defences in paediatric non-CF bronchiectasis

Bronchiectasis in children without cystic fibrosis is most common in socioeconomically disadvantaged communities. Recurrent pneumonia in early childhood and defective pulmonary defences are important risk factors. These help establish a 'vicious cycle' of impaired mucociliary clearance, infection, airway inflammation and progressive lung injury. Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Pseudomonas aeruginosa are the main infecting pathogens. H. influenzae predominates across all ages, while P. aeruginosa is found in older children with advanced disease. It is uncertain whether viruses and upper airway commensal bacteria play an important aetiological role. Overall, the microbiological data are limited however and there are difficulties obtaining reliable respiratory specimens from young children. Bronchiectasis is a complex disorder resulting from susceptibility to pulmonary infection and poorly regulated respiratory innate and adaptive immunity. Airway inflammatory responses are excessive and persist, even once infection is cleared. Improved specimen collection, molecular techniques and biomarkers are needed to enhance management.

Non‐cystic fibrosis bronchiectasis

Non-cystic fibrosis (CF) bronchiectasis is said to be a declining problem in developed countries, although its prevalence in indigenous communities in Australia and New Zealand is among the highest reported in the world. Early childhood pneumonia and underlying conditions such as immunodeficiency and primary ciliary dyskinesia need to be considered in the aetiology. A high-resolution computerised tomography scan is the key investigation in children with a chronic wet cough in whom bronchiectasis is suspected. Regardless of the cause, the treatment of bronchiectasis is centred upon facilitating the clearance of airway secretions and the treatment of pulmonary exacerbations. This review aims to provide general paediatricians with an update on the presenting features, investigation and management of non-cystic fibrosis bronchiectasis.

Influenza is a Major Contributor to Childhood Pneumonia in a Tropical Developing Country

Pneumonia is the leading cause of child mortality worldwide. The role of influenza in childhood pneumonia in tropical developing countries is poorly understood. We undertook population-based surveillance among low-income urban preschool children to determine its role in childhood pneumonia. Longitudinal prospective active surveillance was conducted among randomly selected households in a poor urban area of Dhaka. Nasopharyngeal washes were collected from 1 in 5 children for influenza culture isolation. Clinical data were collected at clinical presentation and through the illness course. From April 1, 2004 through December 31, 2007, 12,062 children presented in clinic with eligible febrile and respiratory illnesses, from whom 321 influenza isolates were obtained from 2370 nasopharyngeal washes (13.5%), representing 16,043 child-years of observation (adjusted influenza incidence 102 episodes/1000 child-years). There were 8198 pneumonia episodes during the period (pneumonia incidence 511 episodes/1000 child-years). Ninety influenza-positive children (28%) developed pneumonia during their illness. Among influenza culture-positive children, those with pneumonia were younger than those without (23.4 vs. 29.7 months, ANOVA: P < 0.001). Pneumonia was more commonly associated with Influenza A (H3N2) than either A (H1N1) or B infections (age-adjusted relative odds (RO) 2.98, [95% CI: 1.56, 5.71] and 2.75, [95% CI: 1.52, 4.98], respectively). Influenza was associated with 10% all childhood pneumonia. Influenza is a major contributor to childhood pneumonia both through high influenza infection incidence and high pneumonia prevalence among infected children. Its contribution to early childhood pneumonia appears under-appreciated in high pneumonia-endemic tropical settings. Influenza vaccine trials against childhood pneumonia are warranted.

Swyer-James syndrome with pulmonary vein hypoplasia detected by multislice CT

Swyer James syndrome is a rare and complex disease characterized by hyperlucency of one lung, lobe, or part of a lobe, due the diminished pulmonary vascular supply and alveolar overdistension. This syndrome seems to be an acquired disease that develops after viral bronchiolitis and/or viral pneumonia in early childhood. Pulmonary artery hypoplasia and bronchiectasis are well known associations of the syndrome. We report a 49-year-old patient with Swyer-James syndrome with pulmonary artery and vein hypoplasia, which were demonstrated by multislice computed tomography.

Consideraciones diagnósticas sobre el llamado síndrome del pulmón hiperclaro unilateral (síndrome de Swyer-James o de Mc-Leod)

Swyer-James-Mac-Leod Syndrome (SJMS) is considered to be a relatively uncommon and complex disease characterized by roentgenographic hyperlucency of one lung, lobe, or part of a lobe, due the pulmonary vascular structure and alveolar overdistension. It is sometimes associated with bronchiectasis. This syndrome seems to be an acquired disease that develops after viral bronchiolitis and/or viral pneumonia in early childhood. Microscopically, there is evidence of patchy bronchitis and bronchiolitisSJMS is usually asymptomatic and discovered accidentally by chest radiography in a child with respiratory symptoms and should be differentiated from other causes of unilateral hyperlucency on chest radiography, such as those related to congenital of this syndrome in children have been published. We describe the case of a 12-year-old boy with unilateral hyperlucency of the lung and respiratory symptoms of acute pneumonia and discuss the main diagnostic features of this syndrome