Prevalence Of Chronic Lung Disease Research Articles

Trends in the Incidence, Etiology, Treatment, and Outcomes of Pleural Infections in Adults Over a Decade in a Finnish University Hospital.

The aim of the study was to ascertain changes in the incidence, etiology, treatment, and outcomes of pleural infections over a decade in a Finnish University Hospital. All patients treated for pleural infections in Tampere University Hospital during 2000-2008 and 2012-2016 were included. The incidence rates and the epidemiologic data and medical history of patients, etiology of infection, and treatment trends and outcomes were compared between the cohorts. The incidence of pleural infections increased from 4.4 during 2000-2008 to 9.9 during 2012-2016 per 100.000 patient-years, p < 0.001. The patients in the latter group were older, 63 versus 57 years, p = 0.001, and the prevalence of chronic lung disease, hypertension, heart failure, dyslipidemia, and immunosuppressive medication were higher. The causes of infection remained similar and pneumonia accounted for 70% of all cases. The identification rate of the microbe pathogens increased from 49% to 64%, p = 0.002, while the distribution of identified pathogens was unchanged. More patients in the latter cohort were treated operatively, 88.3% versus 80.9%, p = 0.005, and, in these, the proportion of thoracoscopic surgery was higher, 57.4% versus 8.0%, p < 0.001, and the delay to surgery shorter, 5 versus 7 days, p < 0.001. Radiologic outcomes were similar. The 30-day mortality rate was 3.1% during 2000-2008 and 5.1% during 2012-2016, p = 0.293. The overall incidence of pleural infections has increased significantly while the causes of pleural infections and the distribution of pathogens remain unchanged. Contemporary patients are older with higher prevalence of comorbidities and more frequently undergo thoracoscopic surgery.

737. The Prevalence of Diagnosed Chronic Lung Disease in US Infants by Gestational Age: Implications for RSV Policy

BackgroundPerinatal chronic lung disease (CLD), previously referred to as bronchopulmonary dysplasia (BPD), is associated with preterm birth and occurs rarely among term infants. Children with CLD are at elevated risk for severe RSV disease in the first 2 years of life. Definitions of CLD/BPD identify infants who require supplemental oxygen at 28 days of life or 36 weeks postmenstrual age, with no restriction by gestational age (GA) at birth. However, the AAP Committee on Infectious Disease guidance does not recommend RSV immunoprophylaxis for infants with CLD born at ≥32 weeks gestational age (wGA), even though infants with CLD/BPD up to 41 wGA were included in pivotal efficacy studies. This study determined the prevalence of diagnosed CLD in US infants as a function of wGA at birth and the number of infants with CLD born at ≥32 wGA.MethodsThe Kids’ Inpatient Database (KID) is a nationally representative survey conducted every 3 years in the United States. Birth hospitalization data from KID were utilized to estimate the prevalence of CLD (ICD-9 = 770.7) among US infants in 2003–2012 overall and as a function of coincident codes for GA (ICD-9 = 765.21–765.29, reported in 2-week intervals). The prevalence of CLD among 32 wGA infants was imputed based on the distribution of CLD cases as a function of wGA. KID data from 2015 were not available due to the transition to ICD-10 coding.ResultsA total of 31,984 infants had a CLD diagnosis across the 4 years, representing 0.2% of US births. The prevalence of CLD declined from 20.8 to 19.5 per 10,000 between 2003 and 2012. Of those, 25,554 infants with CLD (80%) had GA coded in the database. The percentage of CLD infants born at <27 wGA increased from 44% in 2003 to 52% in 2012, whereas the percentage at ≥29 wGA decreased from 27% to 21% (figure). Overall, the percentages born at 31–32, 33–34, and >34 wGA were 5.7%, 2.2%, and 1.2%, respectively. An estimated 5.7% of infants with CLD were born at ≥32 wGA, representing 0.9 of every 10,000 US births or ~350 infants annually.ConclusionFewer than 400 infants are born at ≥32 wGA and diagnosed with CLD annually in the United States. The rationale for excluding this small but high-risk group of infants from the population recommended for RSV immunoprophylaxis is not clear.Funded by AstraZeneca :Disclosures. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. X. Jiang, EpiStat Institute: Employee, Consulting fee and Salary. AstraZeneca: Consultant, Consulting fee. K. Mavunda, AstraZeneca: Speaker’s Bureau, Speaker honorarium.

Aspergillus spp. in Patients with Chronic Lung Disease in Colombia : Prevalence of Increased Serum IgE, Aspergillus Sensitization and Colonization Chronic Obstructive Lung Disease COPD

Aspergillus spp. in Patients with Chronic Lung Disease in Colombia : Prevalence of Increased Serum IgE, Aspergillus Sensitization and Colonization Chronic Obstructive Lung Disease COPD

Noncommunicable Lung Disease in Sub-Saharan Africa. A Community-based Cross-Sectional Study of Adults in Urban Malawi.

Noncommunicable diseases are major causes of morbidity and mortality in sub-Saharan Africa (sSA). Valid burden of disease estimates are lacking for noncommunicable lung disease in sSA. We performed a community-based survey to determine the prevalence of chronic lung disease among adults 18 years or older in Malawi, using American Thoracic Society standard spirometry, internationally validated respiratory symptom and exposure questionnaires, and an assessment of HIV status. An age- and sex-stratified random sample of 2,000 adults was taken from the population of the Chilomoni district of Blantyre, Malawi. Fieldworkers collected questionnaire data, conducted HIV testing, and performed pre- and post-bronchodilator spirometry on eligible participants. Survey-weighted population prevalence estimates of respiratory symptoms and spirometric abnormalities were computed, and bivariate and multivariable regression were used to identify associated variables. Questionnaire data, HIV status, and standard spirometry were obtained from 1,059, 933, and 749 participants, respectively. Current respiratory symptoms, exposure to biomass, and ever-smoking were reported by 11.8, 85.2, and 10.4% of participants, respectively. HIV prevalence was 24.2%. Moderate to severe airway obstruction was seen in 3.6%. The prevalence of spirometric restriction was 38.6% using National Health and Nutrition Examination Survey III reference ranges and 9.0% using local reference ranges. Age was positively associated with obstruction, whereas low body mass index was associated with restriction. More than 40% of the Malawian adults in our urban population sample had abnormal lung function (mostly restrictive) in the context of widespread exposure to biomass smoke and a high prevalence of HIV. These findings potentially have major public health implications for Malawi and the broader sSA region.

Age, Sexual Dimorphism, and Disease Associations in the Developing Human Fetal Lung Transcriptome.

The fetal origins of disease hypothesis suggests that variations in the course of prenatal lung development may affect life-long pulmonary function growth, decline, and pathobiology. Many studies support the existence of differences in the developing lung trajectory in males and females, and sex-specific differences in the prevalence of chronic lung diseases, such as asthma and bronchopulmonary dysplasia. The objectives of this study were to investigate the early developing fetal lung for transcriptomic correlates of postconception age (maturity) and sex, and their associations with chronic lung diseases. We analyzed whole-lung transcriptome profiles of 61 females and 78 males at 54-127 days postconception (dpc) from nonsmoking mothers using unsupervised principal component analysis and supervised linear regression models. We identified dominant transcriptomic correlates for postconception age and sex with corresponding gene sets that were enriched for developing lung structural and functional ontologies. We observed that the transcriptomic sex difference was not a uniform global time shift/lag, rather, lungs of males appear to be more mature than those of females before 96 dpc, and females appear to be more mature than males after 96 dpc. The age correlate gene set was consistently enriched for asthma and bronchopulmonary dysplasia genes, but the sex correlate gene sets were not. Despite sex differences in the developing fetal lung transcriptome, postconception age appears to be more dominant than sex in the effect of early fetal lung developments on disease risk during this early pseudoglandular phase of development.

Chronic lung disease and multiple sclerosis: Incidence, prevalence, and temporal trends

ObjectivesWe aimed to estimate the incidence and prevalence of chronic lung disease (CLD), including asthma and chronic obstructive pulmonary disease, in the MS population versus a matched cohort from the general population. MethodsWe used population-based administrative data from four Canadian provinces to identify 44,452 persons with MS and 220,849 age-, sex- and geographically-matched controls aged 20 years and older. We employed a validated case definition to estimate the incidence and prevalence of CLD over the period 1995–2005, and used Poisson regression to assess temporal trends. ResultsIn 2005, the crude incidence of CLD per 100,000 persons was 806 (95%CI: 701–911) in the MS population, and 757 in the matched population (95%CI: 712–803). In 2005, the crude prevalence of CLD was 13.5% (95%CI: 13.1–14.0%) in the MS population, and 12.4% (95%CI: 12.3–12.6%) in the matched population. Among persons aged 20–44 years, the average annual incidence of CLD was higher in the MS population than in the matched population (RR 1.15; 95%CI: 1.02–1.30), but did not differ between populations for those aged ≥45 years. The incidence of CLD was stable, but the prevalence of CLD increased 60% over the study period. ConclusionCLD is relatively common in the MS population. The incidence of CLD has been stable over time, but the prevalence of CLD has increased. Among persons aged 20–44 years, CLD is more common in the MS population than in a matched population. Given the prevalence of CLD in the MS population, further attention to the effects of CLD on outcomes in MS and approaches to mitigating those effects are warranted.

Increasing Prevalence of Chronic Lung Disease in Veterans of the Wars in Iraq and Afghanistan.

Research from the wars in Afghanistan and Iraq have focused on traumatic brain injury (TBI) and mental health conditions; however, it is becoming clear that other health concerns, such as respiratory illnesses, warrant further scientific inquiry. Early reports from theater and postdeployment health assessments suggested an association with deployment-related exposures (e.g., sand, burn pits, chemical, etc.) and new-onset respiratory symptoms. We used data from Veterans Affairs medical encounters between fiscal years 2003 and 2011 to identify trends in chronic obstructive pulmonary disease, asthma, and interstitial lung disease in veterans. We used data from Veterans Affairs and Department of Defense sources to identify sociodemographic (age, sex, race), military (e.g., service branch, multiple deployments) and clinical characteristics (TBI, smoking) of individuals with and without chronic lung diseases. Generalized estimating equations found significant increases over time for chronic obstructive pulmonary disease and asthma in both unadjusted and adjusted analyses. Trends for interstitial lung disease were significant only in adjusted analyses. Age, smoking, and TBI were also significantly associated with chronic lung diseases; however, multiple deployments were not associated. Research is needed to identify which characteristics of deployment-related exposures are linked with chronic lung disease.

Respiratory syncytial virus immunoprophylaxis in high-risk infants and development of childhood asthma

Respiratory syncytial virus (RSV) lower respiratory tract infection is implicated in asthma development. RSV immunoprophylaxis during infancy is efficacious in preventing RSV-related hospitalizations and has been associated with decreased wheezing in the first years of life. We investigated whether greater adherence to immunoprophylaxis in infants at high risk for severe RSV would be associated with decreased childhood asthma. We conducted a retrospective cohort investigation including children born from 1996-2003 who were enrolled in Kaiser Permanente Northern California or Tennessee Medicaid and eligible to receive RSV immunoprophylaxis. Asthma was defined at 4.5 to 6years of age by using asthma-specific health care visits and medication fills. We classified children into immunoprophylaxis eligibility groups and calculated adherence (percentage receipt of recommended doses). We used a set of statistical strategies (multivariable logistic regression and propensity score [PS]-adjusted and PS-matched analyses) to overcome confounding by medical complexity because infants with higher adherence (≥70%) have higher prevalence of chronic lung disease, lower birth weight, and longer nursery stays. By using multivariable logistic regression and PS-adjusted models in the combined group, higher adherence to RSV immunoprophylaxis was not associated with decreased asthma. However, in PS-matched analysis, treated children with 70% or greater adherence had decreased odds of asthma compared with those with 20% or less adherence (odds ratio, 0.62; 95% CI, 0.50-0.78). This investigation of RSV immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups. Our findings highlight the need for larger studies and prospective cohorts and provide estimates of potential preventive effect sizesin high-risk children.

Constitutively high-level expression of TGFβ isoforms in cord blood and its relationship to perinatal findings

BackgroundThe clinical significance of TGFβ isoforms in cord blood is not well understood. MethodsWe obtained cord blood samples from 37 term infants and 85 preterm infants who were born in several clinical settings. The serum levels of 3 TGFβ isoforms and of the other 17 cytokines in cord blood were investigated using cytometric bead array technology. ResultsVery high levels of TGFβ1 and TGFβ2 isoforms compared to the level of other cytokines were found; mean levels were 44,180 and 1871pg/mL, respectively. The levels of all 3 isoforms of TGFβ were significantly correlated with birth weight, and the levels of TGFβ1 and TGFβ3 were correlated with gestational age. The levels of TGFβ1 and β2 isoforms were strongly correlated with each other, but not with levels of other cytokines. The levels of TGFβ1 and TGFβ2 were significantly higher in male infants and significantly lower in infants with fetal growth restriction. The prevalence of chronic lung disease was related to a low level of TGFβ1, and that of patent ductus arteriosus was related to a high level of TGFβ1 in preterm infants. ConclusionsTGFβ1 and TGFβ2 appeared to play a significant role in physiological and pathological conditions in the fetus. TGFβ isoform levels appear to be regulated independently of those of other cytokines and do not appear to be influenced by inflammation in the fetal period. The role of TGFβ3 in cord blood and the postnatal chronological changes of the TGFβ isoforms should be investigated in the future.

Combined neonatal therapies for cardiac function in adulthood – live together, die alone?

The healthy development of a fetus and the continued health of a newborn child are of primary interest to all beings. Unfortunately, pregnancy does not always progress favourably and can result in premature birth. Preterm infants are at high risk of complications in the neonatal period, such as chronic lung disease, and may develop cardiorespiratory problems in later life. As a consequence, different therapeutic strategies have been developed to improve the cardiorespiratory health of neonates. One popular choice is the use of glucocorticoid therapy, such as dexamethasone, because it reduces the relatively high prevalence of chronic lung disease in prematurely born offspring. However, negative side-effects of neonatal dexamethasone therapies are also known. For instance, the beneficial short-term effects of glucocorticoid therapy are accompanied by a variety of severe long-term cardiovascular complications, including pathological cardiac and vascular remodelling, hypertension, renal damage and insulin resistance (for specific references see Niu et al. 2013). These negative cardiovascular outcomes highlight the need for alternative therapies that achieve improved maturation of the respiratory system and alleviation of acute inflammatory symptoms associated with neonatal chronic lung disease, as well as maintained survival of the offspring into adulthood. To date, little is known about neonatal therapies that achieve these ambitious aims.

Pulmonary Ossification Syndrome in a Patient with Chronic Thromboembolic Pulmonary Hypertension

Pulmonary ossification syndrome is a rare disease characterized by bone tissue formation in the lung parenchyma with or without bone marrow elements. This disorder, often under-recognized, can be idiopathic or secondary to an underlying chronic disorder such as chronic thromboembolic pulmonary hypertension. The pathogenesis involves tissue injury and an alkaline environment in which the precipitation of calcium salts enables alkaline phosphatase activity. This activates profibrogenic cytokines that convert fibroblasts into osteoblasts. Diagnosis can prove challenging and is based on clinical, radiographic and functional tests, and by tissue biopsy. Achieving an accurate and timely diagnosis is essential to avoid erroneous treatments due to misdiagnosis and to expand knowledge of its progression, prognosis and treatment. As the population and prevalence of chronic lung disease increases, it is likely that physicians will encounter more cases of pulmonary ossification.

CD14 C-159T polymorphism and its association with chronic lung diseases: A pilot study on isocyanate exposed population of Central India.

CONTEXT:CD14 functions as a multifunctional receptor for bacterial cell wall components including endotoxin and lipopolysaccharide and is likely to influence the cytokine profile and subsequent immunoglobulin E production in response to antigen/allergen contact in allergic phenotypes.AIMS:The present study was to investigate genetic polymorphism in CD14 gene - 159C/T, which may be one of the risk factor for increased prevalence of Chronic Lung Diseases in the Central India.SETTINGS AND DESIGN:Survivors of Methyl isocyanates toxicity in Bhopal still suffering from various respiratory ailments were examined.MATERIALS AND METHODS:Polymerase chain reaction-restriction fragment length polymorphism was performed to determine the polymorphism of C-159T.RESULTS:The genotype and allelic frequencies were in Hardy-Weinberg’s equilibrium. Prevalence of CC, CT, and TT were 5.5%, 22.2% and 9.25% respectively in asthmatics; 16.6%, 20.3% and 5.5% respectively in chronic obstructive pulmonary disease (COPD) patients and 5.5%, 14.8% and 1.85 respectively among interstitial lung disorder (ILD) patients; whereas the control cohort with no methyl isocyanate exposure displayed (CC, CT, and TT) cytosine, thymine as 2%, 1.6% and 2% respectively. Increased risk of Asthma among those carrying TT genotype and T allele (odds ratio [OR] =2.61 and 2.02 respectively).CONCLUSION:COPD risk significantly found among those with CC genotype and C allele (OR = 2.81 and 1.50 respectively), whereas ILD risk found significantly among CT genotype and C allele (OR = 1.75 and 1.40 respectively). Therefore, single nucleotide polymorphism (SNP) C-159T polymorphism in CD14 gene might be a risk factor for development of CLD in this population.

795 Arterial Blood Pressure Variation in Critically ill Newborns. Can We Predict the Volume Status?

Volume expansion is one of the most frequent used interventions in critically ill newborns, despite lack of hard evidence. In a case of a truly hypovolaemic patient, for example after...

End-stage kidney disease due to scleroderma--outcomes in 127 consecutive ANZDATA registry cases

Scleroderma is an uncommon cause of end-stage kidney disease (ESKD) which carries significant morbidity and mortality risks. The aim of this study was to determine the prevalence, treatment and outcomes of scleroderma patients with ESKD. A study was conducted of all ESKD patients enrolled in the ANZDATA registry, who commenced dialysis between 15 May 1963 and 31 December 2005, and remained on dialysis for at least 90 days. Of the 40 238 patients who commenced dialysis during the study period, 127 (0.3%) patients had ESKD secondary to scleroderma. Scleroderma ESKD patients were more likely than other ESKD patients to be female (72% versus 43%, P < 0.001), Caucasian (98% versus 79%, P < 0.001) and of lower BMI (22.7 ± 4.7 versus 26.0 ± 5.9, P < 0.001) with a higher prevalence of chronic lung disease (36 versus 14%, P < 0.001) and lower prevalence of diabetes mellitus (10% versus 32%, P < 0.001) and coronary artery disease (23% versus 35%, P = 0.01). Median survival was significantly shorter in scleroderma ESKD (2.43 years, 95% confidence interval (CI) 1.75-3.11 years) than other ESKD (6.02 years, 95% CI 5.89-6.14 years, log-rank score 55.7, P < 0.001). Renal recovery was more likely in scleroderma patients (10% versus 1%, P < 0.001) with a shorter time to recovery. Scleroderma was found to be an independent predictor for mortality (HR 2.47, 95% CI 1.99-3.05) and renal recovery (HR 11.1, 95% CI 6.37-19.4). Five year deceased donor and live donor renal allograft survival rates of recipients with scleroderma were 53 and 100%, respectively. Scleroderma is an uncommon cause of ESKD, which is associated with increased risks of both spontaneous renal recovery and mortality.

Estratégias de suporte ventilatório no recém-nascido pré-termo – Inquérito nacional (2008)

Background: Respiratory support strategies for the preterm newborn have been the subject of intense research.Aim: To survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials.Methods: Questionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators, modes of ventilation, lung function monitoring, use of exogenous surfactant, oxygen saturation levels used and the prevalence of chronic lung disease in the preterm newborn.Results: There was a 94% response rate. Draeger babylog was the most frequently used ventilator in neonates. Twelve (41%) units prefer to use early nasal continuous positive airway pressure (NCPAP) whenever possible. Triggered ventilation is the choice of invasive ventilation in 24 (83%) units (SIMV, SIPPV, PSV); four (14%) units have high frequency oscillation ventilation. SIMV is the most frequent (n=13, 45%) weaning mode. Exogenous surfactant is used as prophylactic in 12 (41%) units. All units use lung function measurements to aid choice of ventilator settings and five (17%) units monitor PaCO2 (transcutaneous=3; capnometry=2). Seventeen (59%) units allow oxygen saturation levels from 90% to 95% in infants with respiratory distress syndrome and 15 (52%) levels from 85% to 90% in infants with chronic lung disease. Prevalence of chronic lung disease of prematurity ranged from 0% to 75% (median: 10).Conclusions: Many respiratory strategies for extremely low birth weight infants reflect the result of large randomised trials. More effective methods may be required to encourage the use of early NCPAP preferably with binasal prongs, the use of SIPPV as the main weaning mode, the use of volume targeted ventilation and a more judicious use of exogenous surfactant in order to ensure evidence–based practice.Rev Port Pneumol 2009; XV (6): 1043-1071

Respiratory support strategies for the preterm newborn – National survey 2008

BackgroundRespiratory support strategies for the preterm newborn have been the subject of intense research. AimTo survey neonatal respiratory support practices in Portugal and to determine whether they reflect evidence from randomised trials. MethodsQuestionnaires were given out to 31 Portuguese neonatal units to determine the types of ventilators, modes of ventilation, lung function monitoring, use of exogenous surfactant, oxygen saturation levels used and the prevalence of chronic lung disease in the preterm newborn. ResultsThere was a 94% response rate. Draeger babylog was the most frequently used ventilator in neonates. Twelve (41%) units prefer to use early nasal continuous positive airway pressure (NCPAP) whenever possible. Triggered ventilation is the choice of invasive ventilation in 24 (83%) units (SIMV, SIPPV, PSV); four (14%) units have high frequency oscillation ventilation. SIMV is the most frequent (n=13, 45%) weaning mode. Exogenous surfactant is used as prophylactic in 12 (41%) units. All units use lung function measurements to aid choice of ventilator settings and five (17%) units monitor PaCO2 (transcutaneous = 3; capnometry = 2). Seventeen (59%) units allow oxygen saturation levels from 90% to 95% in infants with respiratory distress syndrome and 15 (52%) levels from 85% to 90% in infants with chronic lung disease. Prevalence of chronic lung disease of prematurity ranged from 0% to 75% (median: 10). ConclusionsMany respiratory strategies for extremely low birth weight infants reflect the result of large randomised trials. More effective methods may be required to encourage the use of early NCPAP preferably with binasal prongs, the use of SIPPV as the main weaning mode, the use of volume targeted ventilation and a more judicious use of exogenous surfactant in order to ensure evidence–based practice.

Amnionitis with Ureaplasma urealyticum or other microbes leads to increased morbidity and prolonged hospitalization in very low birth weight infants

Objective To investigate the influence of culture proven intrauterine infection on preterm morbidity and to test the effect of antimicrobial treatment. Methods Retrospective cohort study conducted between October 1997 and February 2001 in patients with preterm premature rupture of membranes or preterm labor. Vaginal swabs were sampled and amniocentesis for microbiologic culture of the amniotic fluid was performed. Patients with Ureaplasma urealyticum in the amniotic fluid were treated with josamycin. Infants were followed post partum according to birth weight, gestational age, APGAR score and infant morbidity. Results In 49 eligible patients, 40% of cultures were positive, 22% for Ureaplasma urealyticum, 12% for other bacteria and 6% for candida. Children of mothers with positive amniotic fluid cultures had significantly lower gestational ages (26 + 4 weeks for Ureaplasma urealyticum [ p = 0.04] and 25 + 5 weeks for other microorganisms [ p = 0.0017] versus 28 + 6 weeks for mothers with negative amniotic fluid cultures) and lower birth weights (975 g [n.s.] and 828 g [ p = 0.0072] versus 1041 g) but were appropriate for their gestational ages. 33.3% and 66.7% versus 24% of the children were mechanically ventilated [n.s.], duration of mechanical ventilation was 5.3 [ p = 0.02] and 10.1 days [ p = 0.04] versus 1.4 days, and prevalence of chronic lung disease was 38% and 33% versus 11% [n.s.]. Prevalence of severe intraventricular hemorrhage (12.5% [n.s.] and 33% [ p = 0.04] versus 3.4%) and nosocomial infections (50% for both groups of positive cultures versus 10.3% for negative cultures, p = 0.02 and 0.03, respectively) was higher and median length of stay was significantly longer (121 [ p = 0.02] and 107 days [ p = 0.03] versus 60 days) in these patients. Maternal positive vaginal swab cultures were not associated with any of the above-mentioned factors. In none of the patients treated with macrolids for proven Ureaplasma urealyticum amnionitis could the microbes be eradicated. Conclusion Maternal positive amniotic fluid cultures have been associated with lower gestational age and lower birth weight. Rate of infant morbidity was higher and length of stay was significantly longer in this group. Positive vaginal swabs were not predictive for infant morbidity. Treatment of mothers showing positive amniotic fluid cultures with macrolids was not effective.

Respiratory outcome in late childhood after neonatal continuous negative pressure ventilation

Background: The outcome in late childhood for children entered into a randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard respiratory management for the treatment of neonatal respiratory distress...

Placental and other perinatal risk factors for chronic lung disease in very low birth weight infants.

To clarify the relationship between chorioamnionitis and chronic lung disease (CLD) in very low birth weight (VLBW) infants, we performed a retrospective cohort study of all inborn patients between 1995-1997 with gestational age (GA) less than 32 wk, birth weight less than 1.5 kg, survival to 36 wk adjusted GA, and placentas submitted to pathology (n = 371). Racial distribution as defined by the mother was 40% white/60% nonwhite. Prevalence of CLD, defined as O(2) dependence at 36 wk adjusted GA, was 30%. In a preliminary analysis GA and birth weight for GA (standard deviations from the mean, Z-score), considered together, were inversely related to CLD. After adjustment for GA and Z-score, other risk factors for CLD were white race, acute respiratory distress, pulmonary air leak, patent ductus arteriosus, and septicemia. Two placental lesions were inversely related to CLD: histologic chorioamnionitis and acute atherosis (a placental indicator of preeclampsia). Following multivariate analysis, independent risk factors for CLD were GA (OR, 0.6; 95% CI = 0.5, 0.7), birthweight for GA (OR, 0.4; 95% CI = 0.3, 0.6), white race (OR, 1.9; 95% CI = 1.0, 3.3), patent ductus arteriosus (OR, 2.0; 95% CI = 1.0, 3.5), and pulmonary air leak (OR, 3.0; 95% CI = 1.3, 7.1). Acute atherosis was inversely related to CLD (OR, 0.2; 95% CI = 0.1, 0.8). Chorioamnionitis was stratified by subtype and again no association with CLD was seen in the population as a whole. Finally, chorioamnionitis of all subtypes tended to be increased in white infants and decreased in black infants with CLD. This dichotomy was not explained by differences in death rates, acute respiratory distress, intubation on d 2 of life, or total duration of assisted ventilation. We conclude that while chorioamnionitis was not a risk factor for CLD in our total population, racial differences in its relationship to CLD are worthy of further study.

Multiple respiratory symptoms predict quality of life in chronic lung disease: a population-based study of Australian adults.

Previous studies have shown that it is possible to improve the health-related quality of life (HRQoL) of chronic lung disease (CLD) patients without a concurrent change in morbidity. A valid CLD index that discriminates between different levels of CLD severity and is associated with HRQoL status is an important tool for primary care settings. In this study a symptom-based CLD index was assessed for its validity and relationship with HRQoL in a representative Australian population sample. The study also measured the prevalence of self-reported CLD. Representative population survey of adults aged 18 years and over using a multistage, systematic, clustered area sample. Metropolitan Adelaide and country centres in South Australia with a population of over 1000 persons. Three hundred twenty-nine adults with CLD identified through a representative population survey of 3010 South Australians. The CLD index and the SF-36 were administered to participants to assess the association between each subscale of the CLD index with each HRQoL scale. The CLD index was also used to assess the prevalence of CLD and the distribution of severity in self-reported CLD in the South Australian population. Each symptom sub-scale of the CLD index was significantly correlated with all scales of the SF-36. The prevalence of CLD as measured by the CLD index was 7.7% (mild), 2.2% (moderate) and 1.0% (severe). In the Australian context the CLD index is a reliable patient interview instrument that can be used to assess the effects of CLD on general HRQoL, improve assessment, and lead to interventions for physicians and their patients.