Pulmonary Complications In Children Research Articles

Treatment and care received by children hospitalized with COVID-19 in a large hospital network in the United States, February 2020 to September 2021.

We described care received by hospitalized children with COVID-19 or multi-system inflammatory syndrome (MIS-C) prior to the 2021 COVID-19 Omicron variant surge in the US. We identified hospitalized children <18 years of age with a COVID-19 or MIS-C diagnosis (COVID-19 not required), separately, from February 2020-September 2021 (n = 126 hospitals). We described high-risk conditions, inpatient treatments, and complications among these groups. Among 383,083 pediatric hospitalizations, 2,186 had COVID-19 and 395 had MIS-C diagnosis. Less than 1% had both COVID-19 and MIS-C diagnosis (n = 154). Over half were >6 years old (54% COVID-19, 70% MIS-C). High-risk conditions included asthma (14% COVID-19, 11% MIS-C), and obesity (9% COVID-19, 10% MIS-C). Pulmonary complications in children with COVID-19 included viral pneumonia (24%) and acute respiratory failure (11%). In reference to children with COVID-19, those with MIS-C had more hematological disorders (62% vs 34%), sepsis (16% vs 6%), pericarditis (13% vs 2%), myocarditis (8% vs 1%). Few were ventilated or died, but some required oxygen support (38% COVID-19, 45% MIS-C) or intensive care (42% COVID-19, 69% MIS-C). Treatments included: methylprednisolone (34% COVID-19, 75% MIS-C), dexamethasone (25% COVID-19, 15% MIS-C), remdesivir (13% COVID-19, 5% MIS-C). Antibiotics (50% COVID-19, 68% MIS-C) and low-molecular weight heparin (17% COVID-19, 34% MIS-C) were frequently administered. Markers of illness severity among hospitalized children with COVID-19 prior to the 2021 Omicron surge are consistent with previous studies. We report important trends on treatments in hospitalized children with COVID-19 to improve the understanding of real-world treatment patterns in this population.

IL-6 and TGF-β as markers of air-blood barrier damage in children with acute lymphoblastic leukemia: сlinical and prognostic aspects

Background. Damage markers of blood-air barrier are important for studding pathological process in lungs in children with acute lymphoblastic leukemia (ALL).&#x0D; Purpose is to analyses pulmonary complications and to assess IL-6 and TGF-β levels in the exhaled breath condensate (EBC) in children with ALL and its prognostic value.&#x0D; Materials and Methods. 40 children with ALL aged 6–17 years were examined. 1st group included newly diagnosed ALL (n = 18). 2nd group involved ALL survivors who had completed course of ALL IC BFM 2009 protocols (n = 22). The control group consisted of 15 healthy children. The levels of IL-6 and TGF- β in the EBC were analyzed by ELISA.&#x0D; Results and discussion. Pulmonary complications presented in 82.5% of children with ALL during chemotherapy and in 15.8% of ALL survivors. IL-6 and TGF-β levels in EBC were significantly higher in both ALL groups than control: IL-6 p1-C = 0,000001; p2-C = 0,000000; TGF-β p1-C = 0.000014; p2-C = 0.009364. 1st group had higher levels of IL-6 and TGF-β in the EBC than 2nd group: IL-6 p1-2 = 0,000000; TGF-β p1-2 = 0.000141. There was a positive correlation between IL-6 and TGF-β levels (r = 0.681176, p = 0.000001). According to ROC analysis, IL-6 level in EBC collected during Protocol 1 &gt; 47.64 pg/ml can be prognostic for pulmonary complications during chemotherapy (AUC 0.875; Sensitivity 75.0%; Specificity 100,0%). Level of IL-6 &gt; 49.96 pg/ml can predict pneumonia during chemotherapy (AUC 0,883; Sensitivity 100.00%; Specificity 81.82%). IL-6 level after the total course of chemotherapy &gt; 23.64 pg/ml can predict pulmonary complications in ALL survivors (AUC 0.819; Sensitivity 75.00%; Specificity 81.82%). TGF-β level in EBC after the completion of chemotherapy &gt; 19.93 pg/ml can be prognostic for pulmonary complications in ALL survivors (AUC 0.896; Sensitivity 100.00%; Specificity 77.78%).&#x0D; Conclusions. IL-6 and TGF-β levels in EBC can be prognostic for pulmonary complications in children with ALL.

Exhaled phospholipids as a prognostic factor of pulmonary complications in children with acute lymphoblastic leukemia

Introduction. Pulmonary complications are common in children with acute lymphoblastic leukemia (ALL). The assessment of phospholipids (PL) in the exhaled breath condensate can provide more information about pathological processes in the lungs in children with ALL. Purpose - to assess the level of PL in the exhaled breath condensate (EBC) in children with ALL and its prognostic value. Materials and methods. 40 children with ALL aged 6-17 years were examined. 1st group included newly diagnosed children with ALL (n=18). 2nd group involved ALL survivors, who had completed the total course of chemotherapy (n=22). The control (С) group consisted of 15 healthy children. The levels of PL in the EBC were investigated by spectrophotometric thin-layer chromatography using an SPh 46 spectrophotometer. Results. The frequency of pulmonary complication was 82.5% during chemotherapy protocols and 18.4% in ALL survivals. The statistically significant increase in the level of phospholipids in 1st (150.75 (137.62; 158.45) mmol/l) and 2nd (130.12 (120.59; 138.34) mmol/l) ALL groups compared with the group C (54.80 (48.30; 60.80) mmol/l) has been detected (p1-C=0.0000; p2-C=0.0000). Children of the 1st group had significantly higher levels of PL in the EBC than children of the 2nd group (p1-2=0.002911). PL level in EBC collected during induction phase of chemotherapy &gt;132.15 mmol/l can be prognostic for the development of acute pulmonary complications (Sensitivity 93.75%; Specificity 100%). PL level in EBC collected after a complete course of chemotherapy &gt;133.28 mmol/l can be predictive for persistent pulmonary complications (Sensitivity 100.00%; Specificity 83.33%). Conclusions. PL level in EBC can be prognostic for the development of pulmonary complications, both during chemotherapy and in long-term remission after completed chemotherapy course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Non-infectious Pulmonary Complications in Children with Primary Immunodeficiency.

Primary immune deficiency (PID) is a large group of diseases characterized by defective immune function, leading to recurrent infections, and immune dysregulation. Clinical presentations, severity, and complications differ for each disease, based on the components of the immune system that are impacted. When patients with PID present with respiratory symptoms, infections should be initially suspected, investigated, and promptly managed. However, non-infectious complications of PID also frequently occur and can lead to significant morbidity and mortality. They can involve both the upper and lower respiratory systems, resulting in various presentations that mimic infectious diseases. Thus, clinicians should be able to detect these conditions and make an appropriate referral to an immunologist and a pulmonologist for further management. In this article, we use case-based scenarios to review the differential diagnosis, investigation, and multidisciplinary treatment of non-infectious pulmonary complications in patients with primary immune deficiencies.

Clinical Correlates of Acute and Chronic Pulmonary Complications in Children with Sickle Cell Disease from Madhya Pradesh, India: A Cross-sectional Study

Introduction: Sickle Cell Disease (SCD) is one of the most common hereditary haemoglobinopathies globally. Patients with SCD are at a high risk of pulmonary complications. However, there have been very few studies in literature regarding the spectrum of pulmonary involvement and its association with clinicotherapeutic parameters in Indian patients. Aim: To study the incidence of acute and chronic pulmonary complications in children with SCD and to estimate the association of various risk factors with pulmonary complications. Materials and Methods: The present observational crosssectional study was conducted in the Department of Paediatrics, Mahatma Gandhi Memorial Medical College (tertiary care hospital) and Maharaja Yeshwantrao (MY) Hospital, Indore, Madhya Pradesh, India, from June 2021 to July 2022. A total of 100 patients with SCD below the age of 18 years attending sickle-thalassaemia Outpatient Department (OPD) and Inpatient Department (IPD) with pulmonary symptoms admitted were enrolled in the study. Clinical history, physical examination and laboratory findings were noted as per the preconstructed proforma. Data were statistically analysed with unpaired t-test and Pearson’s Chi- square test. Results: A total of 100 patients with SCD were enrolled and the mean age of the study subjects was 9.27±3.39 years. Nearly equal distribution of males (n=52) and females (n=48) were seen with male to female ratio of 1:1.08. Incidence of complications was seen very high in homozygous sickle disease (63%) followed by only 40% in Haemoglobin S (HbS) beta thalassaemia. Most common complication noted in our patients was Acute Chest Syndrome (ACS) (57.7%), followed pneumonia (20%), sympneumonic effusion (15.6%) while only 6.7% had pulmonary hypertension. A statistically significant association (p-value&lt;0.05) was found between compliance to Hydroxyurea therapy and frequency of Vaso-occlusive Crisis (VOC) episodes with pulmonary complications status. Conclusion: In the present study, most frequent acute pulmonary complication noted was ACS followed by pneumonia and sympneumonic effusion. Frequency of VOCs episodes was significantly associated with increased risk of developing pulmonary complications.

Approach to Acute Respiratory Illness in Children with Hematological Malignancy: A Prospective Study Evaluating Utility of CT Scan

Abstract Introduction Various pulmonary complications can occur in children with hematological malignancies including both infection and malignant disease infiltration of pulmonary parenchyma. Objectives To assess the role of CT scan in determining the etiology of acute pulmonary complications in children with hematological malignancies. Materials and Methods All children &lt; 17 years with newly diagnosed hematological malignancy with respiratory symptoms (Group A) along with children who developed fever with persistent respiratory symptoms as well as worsening chest radiographs during treatment (Group B) and underwent CECT thorax, from February 2019 to July 2020 were enrolled. The final diagnosis was made on the basis of clinical history, laboratory as well as radiological investigations and treatment response. Results Thirty-seven children with mean age of 7.5 ± 3.5 years and male to female ratio of 1.3:1 who underwent CECT thorax were included in our study. For newly diagnosed cases, i.e., Group A (n = 8), the most common cause of respiratory symptoms as identified on CECT thorax was pulmonary tumoral infiltration (n = 5) followed by tuberculosis (n = 3). However, in Group B (n = 29) the cause of persistent respiratory symptoms was identified as infection (n = 17) followed by leukemic infiltration (n = 12). Thus, chest CT could accurately identify pulmonary tuberculosis, fungal pneumonia, bacterial infection, and pulmonary tumoral infiltrates. Conclusion CT scan can be used as an adjunctive tool for prompt diagnosis and management of pulmonary complications in children with persistent respiratory symptoms as they are often non-specific.

Pulmonary complications in children and adolescents after allogeneic hematopoietic stem cell transplantation

Relevance. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) makes it possible to treat severe malignant and non-malignant hematopoietic disorders system. Pulmonary complications (PC) occur in 40–60 % of patients after allo-HSCT. However to date, the effect of HSCT on functional and morphological pulmonary changes in recipients remains insufficiently studied.The objective of current study was to evaluate risk factors affecting long-term survival in children and adolescents after allo-HSCT.Methods and materials. The current study was both retrospective and prospective. The analysis included 362 patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), aged 5 months to 18 years, who received allo-HSCT at Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation in 2000–2018. All the patients underwent chest computed tomography (CT). When detecting CT changes, we performed fibrobronchoscopy (FBS) with microbiological examination of bronchoalveolar lavage (BAL).Results. PC were diagnosed in 124 patients (64 %) who received allo-HSCT in 2014–2018. Decrease of overall survival (OS) is associated with PC development during the first year after allo-HSCT(р&lt;0,001).The development of early PC in remission of the underlying disease significantly affected OS (p=0.001).The probability of PC development is 2.26 times higher in patients older than 9 years (p=0.006). When comparing the intensity of conditioning regimens (MACvsRIC) in remission of the underlying disease, we did not get significant differences in the incidence of PC (p&gt;0.05). Graft source, donor type, HLA-compatibility, recipient gender did not affect the incidence of PC (p&gt;0.05). When using graft-versus-host disease (GVHD) prophylaxis (ptCYvsATG), the 5-year OS in patients without PC was 78.8 % and 62.8 %respectively. The 5-year OS in patients with PC was 51.8 % and 42.4 % respectively (р=0.007). Decrease of OS in patients with PC is associated with chGVHD(58.3 %,) (р=0.03).Conclusion. Pulmonary complications (infectious and non-infectious) in allo-HSCT recipients are more likely to occur in the first year after transplantation. Among bacterial pathogens, the predominance of Gr(-) flora remains. The incidence of pulmonary complications was significantly lower when using ptCY as a prevention of GVHD.

Acute and Late Pulmonary Effects After Radiation Therapy in Childhood Cancer Survivors: A PENTEC Comprehensive Review

The Pediatric Normal Tissue Effects in the Clinic (PENTEC) pulmonary task force reviewed dosimetric and clinical factors associated with radiation therapy (RT)-associated pulmonary toxicity in children. Comprehensive search of PubMed (1965-2020) was conducted to assess available evidence and predictive models of RT-induced lung injury in pediatric cancer patients (<21 years old). Lung dose for radiation pneumonitis (RP) was obtained from dose-volume histogram (DVH) data. RP grade was obtained from standard criteria. Clinical pulmonary outcomes were evaluated using pulmonary function tests (PFTs), clinical assessment, and questionnaires. More than 2,400 abstracts were identified; 460 articles had detailed treatment and toxicity data; and 11 articles with both detailed DVH and toxicity data were formally reviewed. Pooled cohorts treated during 1999 to 2016 included 277 and 507 patients age 0.04 to 22.7 years who were evaluable for acute and late RP analysis, respectively. After partial lung RT, there were 0.4% acute and 2.8% late grade 2, 0.4% acute and 0.8% late grade 3, and no grade 4 to 5 RP. RP risk after partial thoracic RT with mean lung dose (MLD) <14 Gy and total lung V20Gy <30% is low. Clinical and self-reported pulmonary outcomes data included 8,628 patients treated during 1970 to 2013, age 0 to 21.9 years. At a median 2.9- to 21.9-year follow-up, patients were often asymptomatic; abnormal PFTs were common and severity correlated with lung dose. At ≥10-year follow-up, multi-institutional studies suggested associations between total or ipsilateral lung doses >10 Gy and pulmonary complications and deaths. After whole lung irradiation (WLI), pulmonary toxicity is higher; no dose response relationship was identified. Bleomycin and other chemotherapeutics at current dose regimens do not contribute substantially to adverse pulmonary outcomes after partial lung irradiation but increase risk with WLI. After partial lung RT, acute pulmonary toxicity is uncommon; grade 2 to 3 RP incidences are <1%. Late toxicities, including subclinical/asymptomatic impaired pulmonary function, are more common (<4%). Incidence and severity appear to increase over time. Upon review of available literature, there appears to be low risk of pulmonary complications in children with MLD < 14 Gy and V20Gy <30% using standard fractionated RT to partial lung volumes. A lack of robust data limit guidance on lung dose/volume constraints, highlighting the need for additional work to define factors associated with RT-induced lung injury.

Association of Sugammadex or Neostigmine With Major Postoperative Pulmonary Complications in Children.

Recent data in adult patients indicate that the use of sugammadex compared to neostigmine for reversal of neuromuscular block (NMB) was associated with a significant reduction in the risk of composite postoperative pulmonary complications. Despite the clinical significance of pulmonary complications in children, studies exploring the role of NMB reversal in the risk of these complications are currently unavailable. We performed a propensity score-matched retrospective study using the Pediatric Health Information System (PHIS) dataset spanning the years 2016 and 2020. We studied children <18 years who underwent elective, inpatient, noncardiac surgical procedures and received either neostigmine or sugammadex for reversal of NMB. Our primary outcome was major postoperative pulmonary complication, which we defined as the occurrence of either postoperative pneumonia or respiratory failure. Our study included a study population of 33,819 children, of whom 23,312 (68.9%) received neostigmine and 10,507 (31.1%) received sugammadex. After propensity score matching (10,361 matched from each group), we found no evidence of a statistically significant association between the NMB reversal agent and the incidence of pulmonary complications (3.1% vs 3.1%; odds ratio [OR], 0.90; 95% confidence interval [CI], 0.78-1.05; P = .19). The components of pulmonary complications, including respiratory failure and pneumonia, were not statistically associated with the choice of NMB reversal agent. Choice of NMB reversal agent does not appear to impact the incidence of major postoperative pulmonary complications. Further research is needed to determine whether our results carry forth across subpopulations defined by surgical specialty, the presence of complex chronic conditions, and anesthesia technique.

Pulmonary Complications in Children with Sickle Cell Disease Followed at the Pediatric Department of Gabriel Toure University Hospital

Objective: To study the pulmonary complications of major sickle cell syndromes in children aged 6 months to 15 years followed at the Department of Pediatrics of Gabriel Toure University Hospital. Materials and methods: This was a retrospective study from January 1st, 2017 to February 28, 2018 and a prospective study from March 1, 2018 to December 31, 2019, concerning sickle cell disease children followed at the Gabriel Touré University Hospital. All children with sickle cell disease confirmed by hemoglobin electrophoresis, aged 6 months to 15 years with a pulmonary complication and admitted to pediatrics were included. Were not included: 1) Infants and children with sickle cell disease not presenting a pulmonary complication coming only to their routine follow-up. 2) Sickle cell patients over 16 years of age and those whose parents do not consent. 3) Those who have not done electrophoresis. Results: During the study period, we were able to include 45 sickle cell children with a pulmonary complication. The frequency of pulmonary complications was 13.76%, involving homozygotes in 91.11% of cases. The age group 6 - 10 years predominated with 46.66% and the sex ratio was 0.45. Vaso-occlusive crisis was the most frequent reason for consultation with 35.56%. Respiratory distress (80%), fever (66.67%), crepitus rales (64.44%) and chest pain (60%) were the most frequent clinical signs. The main pulmonary complication was acute chest syndrome with 86.67%. Treatment was based on hydration (91.91%), analgesics (91.91%) and antibiotics (73.33%). Lethality was 4.44%. Conclusion: Pulmonary complications of sickle cell disease are serious and constitute the main cause of mortality in our context.

Role of ct scan in diagnosis of pulmonary complications in children with hematological malignancy

Role of ct scan in diagnosis of pulmonary complications in children with hematological malignancy

Pulmonary Complications in Children Following Hematopoietic Cell Transplantation: A Case Report and Review of the Diagnostic Approach.

Pulmonary complications are common in children following hematopoietic cell transplantation (HCT) and contribute to their morbidity and mortality. Early diagnosis is essential for management and prevention of progression of lung injury and damage. In many cases, diagnosis can be challenging and may require diagnostic imaging and more invasive testing such as bronchoscopy and lung biopsy. We report the case of a 12-year-old girl who developed recurrent episodes of acute respiratory failure requiring intensive care unit admission in the post-HCT phase and describe the diagnostic and multidisciplinary approach for her management. In addition, we review the diagnostic approach of pulmonary complications post-HCT and highlight the utility and risks of bronchoscopy and lung biopsy in these children.

Determining optimal positive end-expiratory pressure and tidal volume in children by intratidal compliance: a prospective observational study

BackgroundLimited data exist regarding optimal intraoperative ventilation strategies for the paediatric population. This study aimed to determine the optimal combination of PEEP and tidal volume (VT) based on intratidal compliance profiles in healthy young children undergoing general anaesthesia. MethodsDuring anaesthesia, infants (1 month–1 yr), toddlers (1–3 yr), and children (3–6 yr) were assigned serially to four ventilator settings: PEEP 8 cm H2O/VT 8 ml kg−1 (PEEP8/VT8), PEEP 10 cm H2O/VT 5 ml kg−1 (PEEP10/VT5), PEEP 10 cm H2O/VT 8 ml kg−1 (PEEP10/VT8), and PEEP 12 cm H2O/VT 5 ml kg−1 (PEEP12/VT5). The primary outcome was intratidal compliance profile, classified at each ventilator setting as horizontal (indicative of optimal alveolar ventilatory conditions), increasing, decreasing, or combinations of increasing/decreasing/horizontal compliance. Secondary outcomes were peak inspiratory, plateau, and driving pressures. ResultsIntratidal compliance was measured in 15 infants, 13 toddlers, and 15 children (15/43 [35%] females). A horizontal compliance profile was most frequently observed with PEEP10/VT5 (60.5%), compared with PEEP10/VT8, PEEP8/VT8, and PEEP12/VT5 (23.3–34.9%; P<0.001). Decreasing compliance profiles were most frequent when VT increased to 8 ml kg−1, PEEP increased to 12 cm H2O, or both. Plateau airway pressures were lower at PEEP8/VT8 (16.9 cm H2O [2.2]) and PEEP10/VT5 (16.7 cm H2O [1.7]), compared with PEEP10/VT8 (19.5 cm H2O [2.1]) and PEEP12/VT5 (19.0 cm H2O [2.0]; P<0.001). Driving pressure was lowest with PEEP10/VT5 (4.6 cm H2O), compared with other combinations (7.0 cm H2O [2.0]–9.5 cm H2O [2.1]; P<0.001). ConclusionsVT 5 ml kg−1 combined with 10 cm H2O PEEP may reduce atelectasis and overdistension, and minimise driving pressure in the majority of mechanically ventilated children <6 yr. The effect of these PEEP and VT settings on postoperative pulmonary complications in children undergoing surgery requires further study. Clinical trial registrationNCT04633720.

MULTIMODAL APPROACH TO DIAGNOSTIC RADIOLOGY OF PULMONARY COMPLICATIONS OF PNEUMONIA IN CHILDREN

Introduction. Pneumonia and its complications are one of the leading causes of death in children worldwide. According to the WHO in 2017, 808,694 children under the age of 5 died of pneumonia, accounting for 15% of all deaths of children under the age of 5 worldwide. Materials and methods. The object of the study was 154 children with pulmonary and pleural complications of pneumonia in the age aspect from 3 months to 18 years, who were examined and treated at the clinic of the Tashkent Pediatric Medical Institute for the period from 2014 to 2019. A comprehensive examination of children was carried out at the TashPMI clinic. Digital radiography was the main and primary radiation method of investigation for suspected pulmonary complications of pneumonia in children. In case of destructive pneumonia, the zones of infiltration of the lung tissue (“darkening”) with a decrease in its airiness were determined on X-ray images. It was obligatory to perform radiographs in two projections – direct and lateral. Results and Discussion. We have identified radiation signs of pulmonary complications in children. Pulmonary complications accounted for 92 children, of whom 75 (57.0%) were diagnosed with pulmonary destruction and 17 (43.0%) with lung abscess. Destructive changes in lung tissue were found in young children, mainly up to 3 years of age. Conclusion. Thus, the results of our study showed that the use of high-tech methods of radiation examination significantly increases the accuracy of diagnosing lung lesions with complications of pneumonia at different stages of examination and treatment of patients.

FACTORS ASSOCIATED WITH THE OCCURRENCE OF POST-OPERATIVE PULMONARY COMPLICATIONS IN CHILDREN SIX YEARS OLD AND ABOVE WHO UNDERWENT CARDIO THORACIC SURGERY

SESSION TITLE: Cardiothoracic Surgery Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Postoperative pulmonary complications are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. The high incidence of post -operative pulmonary complication after cardiothoracic surgery led to the initiation of this study. Despite pre-operative evaluation and pulmonary risk stratification of patients prior to surgery, it is unfortunate that a lot of them still acquire pulmonary complications hence receive further intervention and stay in the hospital for a longer time. This study aims to identify the the significant preoperative risk factors in the development of post -operative pulmonary complications in children six-year-old and above who underwent cardio thoracic surgery. In addition, this study wants to determine the incidence of post-operative pulmonary complications. METHODS: The study is prospective cohort study that examines the factors associated in predicting post-operative pulmonary complications in children undergoing cardio thoracic surgery. It was implemented in year 2019 and was conducted for a period of 1 year. The study involved patients who are 6-year-old to 18year old who underwent cardio thoracic surgery in the Philippine Heart Center. RESULTS: One hundred fifty patients, were enrolled in the study and a total of 78 patient were noted with complications. The following are the post-operative pulmonary complications: Lobar atelectasis (20.67%); Persistent pleural effusion (18.00%); Pneumonia (17.33%) Pneumothorax not related to chest tube manipulation (12.00 %) and Pulmonary congestion in cardiac conditions of which congestion is not an expected outcome after correction (10.00 %). The pre-operative risk factors found to be significantly associated with post- operative pulmonary complication are 1.) Reduced FVC (P - value 0.016), 2.) Reduced FEF 25-75 (P-value 0.003), 3.) Presence of URTI (P-value 0.001), 4.) Presence of Pulmonary Artery Hypertension on 2D-echo (P-value 0.010). The other variables that were found not to be a significant risk factor in the development of post operative pulmonary complication include patient's age, sex, nutritional status based on WHO and SGNA, medical history of asthma and tuberculosis, ASA physical status, Acid Base Status, Complete Blood count, and chest radiograph prior to procedure. CONCLUSIONS: In this study, the incidence of post -operative pulmonary complication is 52%, with atelectasis as being the most common complication. The four significant pre- operative risk factors are reduced FVC, reduced FEF 25-75, presence of upper respiratory tract infection, and presence of pulmonary arterial hypertension on echocardiography. CLINICAL IMPLICATIONS: Knowledge of the risk factors associated with the development of post- operative pulmonary complication is important in the prevention pulmonary morbidity. DISCLOSURES: No relevant relationships by JENNEYFER REZZA RUCKENBROD, source=Web Response

Risk factors for postoperative pulmonary complications in children with severely compromised pulmonary function secondary to severe scoliosis.

After corrective surgery for scoliosis, postoperative pulmonary complications lead to increases in morbidity, length of hospital stay (LOS) and mortality. This study aimed to identify associations with such respiratory complications, and to assess the utility of noninvasive ventilation (NIV) in children with severe scoliosis METHODS: This retrospective cohort study included all children aged ≤17 years who underwent spinal surgery for scoliosis between January 2009 and January 2012 at a quaternary pediatric hospital. Data were collated regarding polysomnography (PSG) and NIV use, before and after corrective surgery. Factors associated with severely compromised pulmonary function (SCPF) were established and correlations with the occurrence of postoperative pulmonary complications and LOS were identified. Altogether, 133 children had corrective surgery for scoliosis, aged 12.7 (range: 2-17) years at operation. Scoliosis causes were identified as: idiopathic (39.8%), neuromuscular disease (32.2%), syndrome (15.7%), and congenital (12%). Correlates with SCPF (forced vital capacity [FVC] <40% predicted, n = 10) included markers of sleep hypoventilation, including serum bicarbonate ≥29 mmol/L, morning pCO2 > 50mm Hg (P = .003), and overnight, episodic CO2 retention of >7 mm Hg. Using these parameters an additional eight children with SCPF were identified making a total of 18 out of 133 (13.5%) of the patients. Postoperative pulmonary complications were seen in 24 children (18%) and their occurrence correlated with higher Cobb angle (>90°), lower pulmonary function (FVC), higher serum bicarbonate and underlying neuromuscular disease. Amongst the 18 children with SCPF, regular use of NIV preoperatively was associated with reduced rate of postoperative pulmonary complications (P = .02) and reduced LOS by 6.4 days (P = .01). Nocturnal hypoventilation on PSG identifies children with SCPF. Use of NIV in children with SCPF was linked to fewer postoperative pulmonary complications and reduced duration of hospital stay.

Effects of sugammadex on postoperative respiratory management in children with congenital heart disease: a randomized controlled study

BackgroundEarly extubation can reduce pulmonary complications in children undergoing cardiac surgery. The aim of this study is to evaluate the effects of sugammadex for postoperative respiratory management in children with congenital heart disease. MethodsSixty children with congenital heart disease undergoing elective cardiac surgery were divided into group S and group C (30 children in each group). When post tetanic twitches count (PTC) = 1-2 and train-of-four (TOF) = 0, the children in group S received sugammadex4 mg/kg for reversal of neuromuscular block at the end of surgery, and the children in group C received the same volume of normal saline. The recovery time to TOF of 0.9, the mechanical ventilation and extubation times were recorded. On the other side, the hemodynamic parameters before and 5 min after administration, and side effects were also recorded. The levels of C-reactive protein (CRP) and procalcitonin (PCT) before and 24 h after surgery were measured. ResultsThe recovery time to TOF of 0.9 and extubation time were significantly shorter in the group S than in the group C (4.2 ± 1.4 vs 108.2 ± 26.7 min, 66.3 ± 6.5 vs 171.6 ± 23.1 min, respectively, P < 0.01). The CRP and PCT levels were found to be increased in both groups at postoperative 24 h than before surgery. Further, the levels of PCT and CRP at postoperative 24 h were lower in group S when compared to group C (median, 7 vs 17.5 mg/ml, 1.76 vs 5.22 ng/ml, respectively, P < 0.05). There were no statistical differences observed between the two groups (P> 0.05) with respect to side effects. ConclusionSugammadex is rapid and effective in reversing rocuronium-induced neuromuscular block, and significantly reduces the extubation time and the release of postoperative CRP and PCT in children with congenital heart diseases.

Long-term Follow-up Study of Pulmonary Function Test in Children with History of Hydrocarbon Aspiration

Background Aspiration of hydrocarbons causes several acute and chronic pulmonary complications; it may even lead to death. The aim of this study was to investigate the types of long-term pulmonary complications in children with a history of hydrocarbon aspiration. Materials and Methods In this case-control study, 21 children with history of hydrocarbon aspiration in the past 1-10 years were considered as case group, and 63 children without history of toxicity were regarded as the control group. The two groups were matched in terms of age and gender. Both groups underwent physical examination (such as height, weight and body mass index), and pulmonary function tests by spirometry. Pulmonary function was categorized based on three spirometric patterns, normal, obstructive, and restrictive. In addition, the baseline characteristics of children and information obtained from clinical and paraclinical examinations during poisoning were recorded in a researcher-made checklist. The obtained data were analyzed using SPSS software (version 16.0). Results The percentage of normal, obstructive and restrictive spirometric patterns were 61.89%, 28.58%, and 9.52% in the case group, and 88.88%, 11.11% and 0% in the control group, respectively (P 0.05). The results of the pulmonary function test were not related to the time elapsed from poisoning (P> 0.05). Conclusion Based on the results, long-term hydrocarbon poisoning caused pulmonary dysfunction in terms of spirometric patterns in children.

The thoracic air-leak syndrome (TALS): the frequency of occurrence and radiological signs in the structure of late non-infectious lung lesions in children after the allogeneic HSСT

The thoracic air-leak syndrome (TALS) can be a presentation of late-onset noninfectious pulmonary complications in children with a chronic pulmonary graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation. We determined the frequency of occurrence of TALS in patients of the Center after HSСT in the period from January 2012 to December 2017. We have described the main X-ray signs of the Thoracic air-leak syndrome and manifestations of late onset noninfectious pulmonary complications in children. The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. Parents patients agreed to use personal data in research and publications.

Pulmonary Complications in Pediatric and Adolescent Patients Following Allogeneic Hematopoietic Cell Transplantation.

Pulmonary complications after hematopoietic cell transplantation (HCT) can lead to significant morbidity and mortality. Limited evaluation of the true incidence of these complications in children and subsequent outcomes of these complications have not been evaluated recently. In April 2018, the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; and the National Cancer Institute cosponsored a meeting of experts to describe the status of pulmonary complications in children after HCT, identify critical gaps in knowledge, and explore avenues for research to advance care and optimize outcomes. The Center for International Blood and Marrow Transplant Research was used to evaluate the cumulative incidence of pulmonary complications in children and their respective survival. Of the 5022 children included in this analysis who received allogeneic HCT from 2010 to 2016, 606 developed pulmonary complications within the first year after HCT. Pneumonitis occurred in 388 patients, 125 patients developed pulmonary hemorrhage, and 200 patients had lung graft-versus-host disease (GVHD). For those developing pulmonary complications within 1 year, overall survival 100 days after diagnosis of pulmonary complications was 49% (95% confidence interval [CI], 43% to 54%) for patients with pneumonitis, 23% (95% CI, 16% to 31%) in patients with pulmonary hemorrhage, and 87% (95% CI, 81% to 91%) in patients with pulmonary GVHD. This study demonstrates the approximate incidence of these complications, as well as their significant effects on survival, and can serve as a baseline for future research.